Private Insurers

Rivkin Radler’s Michael Sirignano wrote an article, “An Insurance Fraud Year in Review,” that was published in the January 6 issue of the New York Law Journal. Among the many cases and settlements discussed were False Claims Act cases involving federal healthcare programs, healthcare fraud related to COVID-19 testing and telehealth services,

The federal No Surprises Act, effective January 1, 2022, established new requirements for healthcare providers, facilities, and providers of air ambulance services to protect consumers from “surprise” medical bills. These requirements are in addition to applicable state laws regulating balance billing and surprise bills.

If a consumer receives care from an out-of-network provider, the patient’s

Many of the changes to telehealth requirements during the COVID-19 pandemic on both the federal and state levels were intended to be temporary, as previously discussed here. Recently, a bipartisan group of lawmakers in Congress introduced the Telehealth Extension Act, which would, among other things, eliminate the requirement that patients live in a

The New Jersey Attorney General’s Office and Division of Consumer Affairs recently announced that two New Jersey-based printing companies, Command Marketing Innovations, LLC (CMI) and Strategic Content Imaging, LLC (SCI), agreed, pursuant to a Consent Order, to pay $130,000 in fines and penalties to settle allegations that they violated the state’s Consumer Fraud Act

The U.S. Supreme Court has agreed to review the scope of the Medicare Secondary Payer Act (MSPA) as it relates to the treatment of patients with end-stage renal disease (ESRD). The case to be heard by the high court, Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita, Inc.[1], originated from a suit

On Thursday, November 18, in the next installment of Rivkin Radler’s Healthcare Compliance Lunch & Learn series, Rivkin Radler Partner Eric D. Fader will present an overview of changes in the provision of telehealth services, and federal and state regulation of them, since the beginning of the COVID-19 pandemic.  New rules and waivers that are

The federal government will delay for six months its enforcement of key portions of the Transparency in Coverage (TiC) final rule that goes into effect on January 1, 2022. The change was announced in guidance issued jointly by the U.S. Departments of Labor, Health and Human Services, and the Treasury on August 20.

The TiC

On August 16, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) issued a favorable Advisory Opinion regarding an arrangement between a Medicare Supplemental Health Insurance (“Medigap”) plan and a preferred hospital organization (PHO). The arrangement in question incentivized Medigap policyholders to seek inpatient care from hospitals that participated in the

In an April 15 notice on its COVID-19 portal, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) reminded healthcare providers that COVID-19 vaccines must be administered at no out-of-pocket cost to patients. OIG has received complaints from patients that their providers charged them for COVID-19 vaccines.

Under the Centers for