Kentucky health care providers and patients will soon enjoy a revamped, and significantly improved, telehealth commercial insurance coverage law.  Kentucky Governor Matt Bevin signed SB 112 into law on April 26, 2018, imposing both telehealth coverage and payment parity requirements for Kentucky Medicaid, Medicaid managed care organizations, and commercial health plans in the Bluegrass State. …… Continue reading this entry

On May 9, 2018, the U.S. Department of Justice (DOJ) announced a policy related to resolutions of criminal and civil corporate enforcement.  The new “Policy on Coordination of Corporate Resolution Penalties” was issued by Deputy Attorney General Rod Rosenstein, and instructs prosecutors to “consider the totality of fines, penalties, and/or forfeiture imposed by all [DOJ]…… Continue reading this entry

The following article was originally published in May 2018 Compliance Today and is reprinted with permission. For years, misconduct in scientific research was policed primarily by the Office of Research Integrity (ORI) at the U.S. Department of Health and Human Services.1 After a lengthy and confidential review, an institution suspected of producing false or fraudulent…… Continue reading this entry

Two recent cases illustrate the continuing challenges providers, and in particular hospital providers, face when seeking to collect their charges when dealing with “out-of-network” patients. First Example – A Claim for Services Under an ERISA Plan In the first, a not for publication decision of the 9th Circuit, Eden Surgical Center v. Cognizant Technology Solutions…… Continue reading this entry

On April 23, 2018, the Center for Medicare and Medicaid Innovation issued a Request for Information (the RFI) on a direct provider contracting model for primary care. The RFI seeks input on how direct provider contracting between the Centers for Medicare and Medicaid Services (CMS) and physicians or physician group practices may be designed and…… Continue reading this entry

Congress has taken another step forward to require the federal Drug Enforcement Administration (DEA) to activate a special registration allowing physicians and nurse practitioners to prescribe controlled substances via telemedicine without an in-person exam. The House Energy and Commerce Health subcommittee approved the Special Registration for Telemedicine Clarification Act of 2018, part of a larger…… Continue reading this entry

More than 74 million individuals are enrolled in Medicaid and the Children’s Health Insurance Program (CHIP). Another 28 million are currently uninsured. Due to the repeal of the individual mandate (the requirement under the Affordable Care Act to purchase insurance or face a financial penalty), the uninsured population is projected to increase to 32 million…… Continue reading this entry

A tremendous amount of capital has been, and continues to be, dedicated by private equity sponsors, and private equity backed companies, toward the recapitalization of physician practices. Here are seven important high-level considerations that may impact your approach to these transactions: What is a Recapitalization? In the context of a physician practice, “recapitalization” is a…… Continue reading this entry

Iowa Governor Kim Reynolds recently signed a new bill into law requiring commercial health insurers in the Hawkeye State to cover health care services provided via telehealth to the same extent those services are covered via in-person care.  The law, passed under HF 2305, takes effect January 1, 2019 and applies to all policies delivered,…… Continue reading this entry

An ambitious California proposal to regulate health care rates and curb long-term health care spending was unveiled last week in Assembly Bill 3087 (Proposed Legislation).  The key concept in the Proposed Legislation is the establishment of an independent commission with the authority to set the rates paid for health care services in most commercial contexts. …… Continue reading this entry