Health Law
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Voting ends Sunday for Kaiser Permanente union in California to greenlight strike
A strike of this size could cripple operations for Kaiser in southern California. Those 24,000 healthcare workers eligible to vote on a strike represent about 31% of the system's nearly 76,000 employees in that area.
By Samantha Liss • Oct. 07, 2021 -
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Doctors slam surprise billing rule that details dispute resolution process
The interim final rule established that existing rates in a provider's geographic area will be a strong anchor for final payment decisions by arbitrators.
By Shannon Muchmore • Oct. 01, 2021 -
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Amid a surge in COVID-19 cases, hospitals need nurses so desparetly they're offering massive sign-on bonuses and staffing firms say open positions for both temporary and permanent nursing roles are at all-time highs
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Centene, Humana sue Merck for 'monopolistic scheme' to delay generics of blockbuster cholesterol drug
The suits allege an agreement between Merck and a generic manufacturer kept lower-cost versions of the drugmaker's widely used pill Zetia off the market for years.
By Samantha Liss • Sept. 24, 2021 -
Carol Highsmith. (2005). "Apex Bldg." [Photo]. Retrieved from Wikimedia Commons.
FTC warns app makers fall under breach notification rule
The agency noted that a breach must be reported regardless of whether it was the result of malicious action. Any unauthorized access, including sharing information without consent, would trigger the rule.
By Shannon Muchmore • Sept. 16, 2021 -
In lawsuit, former employee blows whistle on Aetna's alleged fraudulent provider network that listed dead physicians
The plaintiff discovered that "tens of thousands of children were assigned to [primary care providers] that had no relationship whatsoever to [Aetna]," the suit alleges.
By Samantha Liss • UPDATED: Sept. 15, 2021 at 5:08 p.m. -
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Industry pushes for more time before surprise billing ban enforced
Payers and hospitals say with the COVID-19 pandemic ongoing and key elements still unreleased, it will be difficult to comply by Jan. 1. Key sticking points include arbitration and qualified payment amounts.
By Shannon Muchmore • Sept. 09, 2021 -
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Feds sue UPMC, heart surgeon for billing multiple surgeries at same time
The False Claims Act litigation also accuses the health system of ignoring or minimizing complaints by employees and staff.
By Ron Shinkman • Sept. 07, 2021 -
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Hospitals lose legal challenge over changes to DSH payments
A federal judge sided with HHS, pointing to a portion of the Medicare law that prohibits any administrative and judicial review of how the department arrived at its calculations.
By Samantha Liss • Sept. 01, 2021 -
Sutter to pay $90M in largest False Claims Act settlement against a health system for alleged MA fraud
The record payment comes on the heels of another massive settlement for the nonprofit, adding to the hit on its already stressed bottom line.
By Rebecca Pifer • Aug. 31, 2021 -
Carol Highsmith. (2005). "Apex Bldg." [Photo]. Retrieved from Wikimedia Commons.
New Jersey hospitals appeal FTC merger challenge
Hackensack Meridian Health, the largest health system in New Jersey, wants to to acquire a close competitor. The Federal Trade Commission won an injunction to stop the deal, which is now headed to an appeals court.
By Samantha Liss • Aug. 30, 2021 -
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North Carolina amends certificate of need in bill headed to governor's desk
The laws came under scrutiny as the COVID-19 pandemic gripped the nation last year and overwhelmed hospital resources, raising questions about the value of the restrictions.
By Samantha Liss • Aug. 26, 2021 -
UnitedHealthcare loses Medicare Advantage overpayment suit
An appeals court has reversed a 2018 decision that overturned Medicare's overpayment rule that required insurers to refund reimbursement to CMS within 60 days if they learn a diagnosis lacks medical record support.
By Rebecca Pifer • Aug. 16, 2021 -
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Sponsored by ZelisEverything you need to know about the Machine-Readable Files mandate
Take a look at the requirements and important considerations for the Machine-Readable Files mandate.
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UnitedHealth settles for $15.6M after Labor Department finds mental health cuts, denials
"You should expect to see more investigation," of those not abiding by the federal mental health parity law, a top DOL official said. "I predict this will be a very active issue for us for years to come."
By Shannon Muchmore • Aug. 12, 2021 -
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Delaware caps hospital price growth to fund more primary care
Gov. John Carney signed the multi-pronged healthcare bill on Friday. "As I think about the things, particularly in healthcare that we focus on, there's not much that's more important than this," he said.
By Samantha Liss • UPDATED: Oct. 5, 2021 at 8:43 a.m. -
Lance Cheung. (2018). "20180927-RD-LSC-0093" [Photograph]. Retrieved from Flickr.
Telehealth waivers wind down, restricting some providers from delivering care across state lines
A number of states allowed medical professionals licensed elsewhere to hold virtual visits with their residents during the pandemic. While some are making those rollbacks permanent, others are going back to pre-pandemic rules.
By Hailey Mensik • Aug. 04, 2021 -
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DOJ joins lawsuits alleging Kaiser Permanente committed Medicare fraud
Attempts to "defraud the program cannot continue and will be pursued," DOJ officials said in statement announcing the action against the California-based system.
By Samantha Liss • Aug. 02, 2021 -
Missouri Supreme Court backs Medicaid expansion in unanimous decision
A separate Missouri judge on Tuesday ordered the state to begin enrolling people newly eligible for Medicaid without imposing any further restrictions on eligibility.
By Samantha Liss • UPDATED: Aug. 11, 2021 at 9:46 a.m. -
DaVita, former CEO charged for alleged noncompete conspiracies
The dialysis provider said the charges are unwarranted and rely on "alleged discussions involving former executives that occurred many years ago."
By Hailey Mensik • July 16, 2021 -
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Hospital mergers to get added scrutiny under Biden order
The hospital lobby is against the executive order, which calls on regulators to "enforce the antitrust laws vigorously" and reminds them to challenge prior bad mergers.
By Samantha Liss • UPDATED: July 12, 2021 at 11:09 a.m. -
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Q&ANurse practitioners association past president reflects on pandemic, scope of practice rollbacks
The biggest challenge facing the profession is outdated regulatory barriers that don't allow nurse practitioners to practice at the top of their education and training, Sophia Thomas said.
By Hailey Mensik • July 06, 2021 -
SCOTUS will not hear hospitals' appeal against site-neutral payments
The rule barring hospitals from receiving higher reimbursements for outpatient services compared to other providers was widely challenged, but now stands with the high court's decision.
By Hailey Mensik • June 29, 2021 -
Biden administration aims to further rebuild ACA with proposed rule
The regulation would lengthen the annual open enrollment period, expand the role of navigators and nix Trump-era guidelines for waivers that were criticized for allowing states to skirt coverage requirements.
By Shannon Muchmore • June 29, 2021 -
Missouri judge blocks voter-approved Medicaid expansion
Despite of the win at the ballot box in 2020, the state legislature failed to make funds available to expand the program to about 230,000 low-income adults.
By Samantha Liss • June 24, 2021 -
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New York passes safe staffing law for hospitals, nursing homes
"This law doesn't state that ratios must be stipulated, but inevitably that's what it means," said Judy Sheridan-Gonzales, president of the New York State Nurses Association.
By Hailey Mensik • June 22, 2021
