News & Analysis as of

Medical Reimbursement

Epstein Becker & Green

Third Circuit Holds that the Public Disclosure Bar Precludes Qui Tam Actions Based on Information Available on Publicly Accessible...

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In its recent unpublished decision, United States ex rel. Stebbins v. Maraposa Surgical Inc., 2024 WL 4947274 (3d Cir. Dec. 3, 2024), the Third Circuit clarified that the public disclosure bar prevents whistleblower False...more

Whiteford

Navigating New Medicare Overpayment Rules and Practical Tips to Comply

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On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) finalized the Medicare regulations interpreting the federal 60-day overpayment refund requirement (the Overpayment Statute) for Medicare Parts A and B as...more

Baker Donelson

2025 Medicare Physician Fee Schedule: Payment and Overpayment Policies

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On December 9, 2024, the Centers for Medicare & Medicaid Services' (CMS's) Calendar Year 2025 Physician Fee Schedule Final Rule (the Final Rule) was published in the Federal Register. The Final Rule includes noteworthy...more

Fennemore

California Department of Public Health (CDPH) ‘All Facilities Letter’ and Survey Activities Impacting Nurse Anesthesiology Scope...

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The California Department of Public Health’s (CDPH) September 6, 2024, All Facilities Letter (AFL) reaffirms the independent practice authority of Certified Registered Nurse Anesthetists (CRNAs). Despite this reaffirmation,...more

Arnall Golden Gregory LLP

Pandemic-Era Telehealth Flexibilities Currently on Life Support

Medicare coverage of telehealth services is reaching a critical point as many pandemic-era flexibilities are set to expire on December 31, 2024. As it stands, after the close of the year, Medicare coverage for telehealth...more

Nelson Mullins Riley & Scarborough LLP

Federal Regulatory Update: CMS Medicare Payment Changes & Congressional Next Steps

The Centers for Medicare & Medicaid Services (CMS) have released significant updates affecting Medicare payments for 2025. The changes, outlined in two final rules, will impact both physicians and hospitals, eliciting strong...more

Goldberg Segalla

Defending HIMP-1 Claims: Top Things to Know

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In New York State, the Health Insurance Matching Program – widely known as HIMP – provides means for a claimant’s private health insurer to seek reimbursement for treatment they believe a workers’ compensation carrier or...more

Marshall Dennehey

Understanding Reimbursements for CPT Code 97039

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CPT code 97039 has been in a state of constant flux in Florida and recent rulings have created greater change. First, one must understand what 97039 is and its history. According to the American Medical Association (AMA), CPT...more

Troutman Pepper

California Governor Signs Legislation Impacting Health Care Claim Reimbursement and DMHC Requests for Records

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On September 27, California Governor Gavin Newsom signed into law two bills that will impact health care service plans and insurers in the state....more

Arnall Golden Gregory LLP

Healthcare Authority Newsletter - September 2024 #2

News Briefs - Licensure Compact Aims to Allow PAs to Practice in Other States - By 2028, the nation as a whole will be short some 100,000 critical health care workers, according to a new report....more

Goodwin

Reliance on Third-Party “Pricing” Facilitators Under Increasing Antitrust Scrutiny

Goodwin on

In the past year, healthcare systems and providers across the country have filed a series of antitrust lawsuits against MultiPlan Inc. and major US health insurers, alleging a hub-and-spoke conspiracy to fix and reduce...more

Troutman Pepper

D.C. Circuit Dismisses Appeal of Class Certification Denial Due to Lack of Standing

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The U.S. Court of Appeals for the District of Columbia Circuit recently dismissed an appeal in the case of Lewis v. Becerra, Secretary of the United States Department of Health and Human Services (HHS). The appellants sought...more

Baker Donelson

CMS Proposes Significant Changes to the Medicare Shared Savings Program and 60-Day Rule

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Under the CY 2025 Medicare Physician Fee Schedule (PFS) proposed rule, CMS proposes several modifications to the Medicare Shared Savings Program (MSSP) that would become effective in performance year 2025. CMS also proposed...more

Marshall Dennehey

Florida Tort Reform: The Impact of House Bill 837 on Health Care Litigation

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On March 24, 2023, Florida Governor Ron DeSantis signed House Bill 837 into law. Also known as the “Civil Remedies” or “Tort Reform” law, HB 837 has changed civil litigation in Florida, including providing a uniform standard...more

Holland & Knight LLP

Fiscal Intermediaries Sue NYDOH Over CDPAP Reimbursement Changes

Holland & Knight LLP on

A group of fiscal intermediaries (FIs) on July 22, 2024, filed a lawsuit against the New York State Department of Health (DOH) and its commissioner, Dr. James McDonald, alleging that the defendants disregarded established...more

Saul Ewing LLP

Pennsylvania Expands Use and Reimbursement of Telemedicine and Bans Noncompete Agreements for Certain Health Care Practitioners

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In July 2024, Pennsylvania enacted two significant pieces of legislation relating to telemedicine and physician noncompetition agreements that will have a meaningful impact within the healthcare delivery system with the...more

Schwabe, Williamson & Wyatt PC

Recent Decision Allows Tribes to Recover Healthcare Expenses ‎

In its recent decision, Becerra v. San Carlos Apache, No. 23-250, the U.S. Supreme Court ruled the Indian Self Determination and Education Assistance Act (ISDEAA), 25 U.S.C. § 5301 et seq., requires the Indian Health Service...more

McDermott Will & Emery

Trending in Telehealth: July 2 – 8, 2024

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Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate...more

Polsinelli

Provider Reimbursement Disputes Go Back to 1984 Following Supreme Court’s Regulatory Reset

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One could forgive the healthcare industry for thinking someone drove Doc Brown’s DeLorean time machine through One First Street when it awoke on Friday, June 28, to a blast from the past....more

Benesch

Dental/DSO Intelligence Monthly Report: May/June 2024

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ADA, and other organizations move to boost workforce development, training for dental hygienists - In addition to several legislative moves aimed at boosting the training and development of dental hygienists, dental...more

Dorsey & Whitney LLP

Tribes Win Healthcare Contract Support Costs at Supreme Court

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On June 6, 2024, the Supreme Court issued its decision in the consolidated cases of Becerra v. San Carlos Apache Tribe (No. 23-250) and Becerra v. Northern Arapaho Tribe (No. 23-253)....more

Snell & Wilmer

Supreme Court Ruling Supports Tribal Healthcare Funding and Self-Determination

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By Heidi McNeil Staudenmaier and Kelsey Haake  In a momentous decision on June 6, 2024, the U.S. Supreme Court delivered a resounding victory for Native American tribes. The Court ruled that the Indian Health Service (IHS)...more

Fox Rothschild LLP

Who’s a Party in Interest? The Supreme Court’s Ruling in Truck Insurance Exchange v. Kaiser Gypsum Co. Inc. Opens the Door for...

Fox Rothschild LLP on

Kaiser Gypsum Company Inc. and Hanson Permanente Cement, Inc. (collectively, the “Debtors”), manufacturers of asbestos-containing cement products, filed for chapter 11 bankruptcy on September 30, 2016 (“Petition Date”) in the...more

WilmerHale

In Narrow Victory for Tribal Nations, US Supreme Court Requires Federal Government to Reimburse Tribal Nations for Healthcare...

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On June 6, 2024, the US Supreme Court decided Becerra v. San Carlos Apache Tribe and Becerra v. Northern Arapaho Tribe (Nos. 23-250 and 23-253), holding that the Indian Health Service (IHS) must reimburse Native nations,...more

Epstein Becker & Green

A Day for Specialists - SCOTUS Today

Another Three-for Thursday at the Supreme Court, with none of the decisions a landmark but each of utmost relevance to legal specialists and technicians in the fields of bankruptcy, estate taxation, and Indian affairs....more

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