A Managed Care Organization (MCO) contracts with providers to create provider networks that deliver health care services at discounted rates. The plan accessing the provider network may offer a Coverage Agreement issued by the MCO. In the alternative, the plan
Continue Reading New Cost Containment Strategies Allow Payors to Reduce In-Network Reimbursements
The national opioid crisis has triggered an avalanche of lawsuits around the country. Pharmaceutical manufacturers and distributors are often among the named defendants, but other entities are also at risk. The wide variety of claims that figure in these lawsuits
Continue Reading Health Care Providers and Pharmaceutical Distributors Should Heed These Warnings to Reduce the Risk of an Opioid-Related Lawsuit
Wellness programs have quickly found favor with many employers: studies indicate that nearly half of employers who sponsor a health plan offer a wellness program. However, wellness programs have been operating under cloud ever since a federal court decision invalidated
Continue Reading Employer Wellness Programs Operating Under a Cloud of Uncertainty
Cybersecurity is a significant and growing compliance risk for health care organizations. If your organization fails to protect patients from cybersecurity risks, the result could be serious fines and penalties for non-compliance with federal and state cybersecurity and data breach
Continue Reading Health Care Organizations Should Take Heed of New HHS Cybersecurity Guidance
On January 14, 2019, the U.S. Department of Health and Human Services Office of the Inspector General (the “OIG”) issued Advisory Opinion 19-01, which was favorable to a federally qualified health center’s (“FQHC’s”) proposal to routinely waive co-payments and/or
Continue Reading OIG Issues Advisory Opinion Allowing a Federally Qualified Health Center to Routinely Waive Co-Payments and/or Deductibles for Medicare and TRICARE Patients
Years before the rise of the “#MeToo” movement, the Illinois Gender Violence Act (IGVA) was enacted to give victims of criminal “gender violence” a civil remedy. The IGVA creates a civil cause of action for persons who have been subjected
Continue Reading What Health Care Providers Need to Know About the Illinois Gender Violence Act
Years before the rise of the “#MeToo” movement, the Illinois Gender Violence Act (IGVA) was enacted to give victims of criminal “gender violence” a civil remedy. The IGVA creates a civil cause of action for persons who have been subjected
Continue Reading What Health Care Providers Need to Know About the Illinois Gender Violence Act
The U.S. healthcare industry needs to be aware of recent federal legislation that was signed into law on October 24, 2018. The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment, or SUPPORT for Patients and Communities Act, H.R.6, was
Continue Reading Federal Legislation Addresses National Opioid Crisis, Will Impact the Entire Healthcare Industry
Section 2718(e) of the Public Health Service Act, which was enacted as part of the Affordable Care Act, updated Medicare payment policies to require that “each hospital operating within the United States, for each year, establish (and update) and make
Continue Reading CMS Requires Hospitals to Publish Standard Charges on the Internet
