COVID-19 and Telemedicine
As the world navigates through these unprecedented times in trying to slow the spread of the COVID-19 virus, our provider clients are routinely asking, “What now?” On March 16, 2020, ...
Federal Judge Presses Pause of Recoupment
On June 28, 2018, a federal judge in Texas held that the Centers for Medicare & Medicaid Services (“CMS”) was not permitted to recoup 7.6 million dollars in alleged Medicare ...
Will NJ Policyholders Get Their Day in Court?
On June 7, the New Jersey Senate voted 21-14 to approve the New Jersey Insurance Fair Conduct Act, which now pending before the General Assembly. This bill would create a ...
Soothing Stark?
Recently, the Centers for Medicare & Medicaid Services (“CMS”) expressed an openness to relaxing current Stark Law restrictions on physician referrals. Specifically, on June 25, 2018, published a Request for Information (RFI) ...
Third Circuit Affirms the Enforceability of Anti-Assignment Clauses in ERISA Plans, While Also Affirming a Provider’s Right to Proceed in Challenging a Benefit Denial on Behalf of a Patient through a Limited Power of Attorney.
On May 16, 2018, the Third Circuit in American Orthopedic & Sports Medicine v. Independence Blue Cross Blue Shield held anti-assignment clauses in ERISA governed health insurance plans are generally ...
Third Circuit Holds No "Magic Words" Needed in an Assignment of Benefits to Create Derivative Standing under ERISA
On September 11, 2015, in North Jersey Brain & Spine Center v. Aetna, Inc., the Third Circuit held in a precedential opinion that a patient’s assignment of benefits does not ...
NJ Appellate Division Holds that Continued Employment Demonstrates Consent to an Employer’s Mandatory Arbitration Policy
On July 23, 2015, in Jaworski v. Ernst & Young, a three-judge Appellate Division panels upheld language in Ernst & Young’s employment policy that states that employees were deemed to ...
NJ Supreme Court Rules that the Right to a Jury Trial under the NJ Constitution Applies to Private Action Claims under the Insurance Fraud Prevention Act
On July 16, 2015, in Allstate New Jersey Insurance Co. v. Gregorio Lajara, the New Jersey Supreme Court held that the right to a civil jury trial provided by Article ...
New OIG Litigation Team To Focus on Fines, Exclusions from Federal Programs
At the American Health Lawyers Association annual meeting this past week, the Department of Health and Human Service’s Office of the Inspector General announced the implementation of an OIG Litigation ...
OIG Recommends Steps for Compliance by Health Care Governing Boards
The U.S. Department of Health and Human Service’s Office of the Inspector General (OIG) recently provided health care governing boards with some new points of guidance on how to achieve ...
Chiropractors Win Class Certification in Lawsuit against Horizon Blue Cross Blue Shield of New Jersey for Improper Benefit Denials
The United States District for the District of New Jersey has certified as a class action a lawsuit brought on behalf of thousands of chiropractic physicians who were denied reimbursement ...
What Will the King v. Burwell Decision Mean for Health Care Providers?
An upcoming U.S. Supreme Court decision could have a major impact on the health care industry. In King v. Burwell, the plaintiffs believe the text of the Affordable Care Act ...
Next Round of HIPAA Compliance Audits Still on Hold
The next round of the Health Insurance Portability and Accountability Act (HIPAA) compliance audits is still on hold after a three-year delay, and federal regulators are declining to give any ...
Study: 40 Percent of Doctors Opt for Fines Over High-Quality Reporting Compliance
According to a recent report from the Centers for Medicare and Medicaid Services, more doctors are taking part in a reporting system geared toward prioritizing the quality of patient care ...
Texas Hospital to Pay $21.8 Million to Settle Stark Law Case
According to an announcement from the U.S. Department of Justice, Citizens Medical Center in Texas will pay $21.8 million to the federal government to settle allegations of illegal payments to ...