News & Analysis as of

Medicare Denial of Insurance Coverage

Oberheiden P.C.

What Does it Take to Win Medicare Appeals in 2024?

Oberheiden P.C. on

Lots of health care service providers find themselves in the position of needing to file a Medicare appeal. Despite the systematic nature of modern Medicare billing, wrongful denials remain common, and errors during Medicare...more

Whiteford

New CMS Guidance on Use of Algorithms and AI in Prior Authorizations and Utilization Management

Whiteford on

Use of algorithms and artificial intelligence (AI) in prior authorization and utilization management is facing growing criticism and litigation. Notable lawsuits include alleged automatic authorization denials for tests that...more

Arnall Golden Gregory LLP

Preemption and Exhaustion Requirements Thwart Medicare Advantage Plan Members’ Ability to Hold Health Insurers Accountable

Most states have statutes or common law that allow an insurance policyholder to bring a civil action and seek more than just compensatory damages (e.g., punitive damages) when her insurance company denies coverage in bad...more

Carlton Fields

7th Cir. Holds Insurance Coverage Applies to Settlement Payments for Alleged Anti-Kickback and False Claims Act Violations

Carlton Fields on

On May 3, 2023, the Seventh Circuit Court of Appeals, in Astellas US Holding Inc. v. Federal Insurance Co., held that a liability insurer was required to contribute its limits toward its insured’s payment to settle potential...more

Manatt, Phelps & Phillips, LLP

[Webinar] Access to Coverage and Care: Policy Trends in Medicaid, Medicare and the Commercial Market - October 6th, 1:00 pm - 2:00...

Join Manatt for the First of Our Imperatives Deep-Dive Sessions on the Topics You Voted Most Important to You. To benefit fully from America’s health care system, people need both timely access to health care services and...more

King & Spalding

Federal Court Affirms Denial of Medicare Payment for Inpatient On-Call Services to Critical Access Hospital

King & Spalding on

On March 31, 2021, Judge Carl Nichols of the United Stated District Court for the District of Columbia issued a decision upholding CMS’s denial of reimbursement to a California Critical Access Hospital (CAH) for compensation...more

Health Care Compliance Association (HCCA)

Telehealth Risks Come into Focus; Some Payers Don't Cover Audio-Only

Report on Medicare Compliance 30, no. 8 (March 1, 2021) - After the 2021 Medicare Physician Fee Schedule extended coverage of many telehealth services until the end of the public health emergency (PHE), including...more

Bradley Arant Boult Cummings LLP

$25.5 Million Oklahoma Verdict: Jackpot Justice or Case Study on Bad Faith Litigation?

We all know how prevalent bad faith claims are. It seems like almost every case involving disputed policy benefits includes one. Many have no merit and should be disposed of on summary judgment. The rest, however, arguably...more

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