Affordable Care Act


Federal Court Blocks HHS Rule on Sexual Orientation
August 18, 2020 | Eric D. Fader | Affordable Care Act | Hospitals | Legislation and Public Policy | Litigation
The U.S. District Court for the Eastern District of New York has blocked the U.S. Department of Health and Human Services (HHS) from enforcing a new rule that limited sex discrimination in healthcare to discrimination based on gender as determined by biology. The rule, discussed in detail here in June, did not recognize sexual orientation …
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Hospital Price Transparency Rule Upheld
June 24, 2020 | Eric D. Fader | Affordable Care Act | Hospitals | Legislation and Public Policy | Litigation | Private Insurers
On June 23, the U.S. District Court for the District of Columbia ruled against the American Hospital Association and other associations and individual hospitals that had sued the U.S. Department of Health and Human Services (HHS) to block a new price transparency rule that will take effect on January 1, 2021. The rule, which was finalized …
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HHS Finalizes Civil Rights and Anti-Discrimination Rule
June 16, 2020 | Ada (Kozicz) Janocinska | Affordable Care Act | Hospitals | Legislation and Public Policy
The U.S. Department of Health and Human Services (HHS) has finalized a new rule under Section 1557 of the Affordable Care Act in an effort to enforce civil rights laws and protect against discrimination in healthcare. The rule, entitled “Nondiscrimination in Health and Health Education Programs or Activities: Delegation of Authority,” attempts to restore civil …
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Supreme Court Rules in Favor of Health Insurers Under ACA Program
April 29, 2020 | Mark J. Wagner Jr. | Affordable Care Act | Litigation | Private Insurers
On April 27, the U.S. Supreme Court ruled in favor of commercial health insurers that were seeking $12 billion under the Affordable Care Act’s risk corridor program, acknowledging that the ACA “obligated the government to pay the full amount of risk corridor payments.” The ACA established the risk corridor program to mitigate the risks assumed …
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NJ Bills Preserve ACA Protections
January 28, 2020 | Eric D. Fader | Affordable Care Act | Behavioral Health | Legislation and Public Policy | Private Insurers
New Jersey Governor Phil Murphy recently signed into law a package of nine bills that will preserve for state residents many of the provisions of the Affordable Care Act (ACA) even if the ACA itself is ultimately found unconstitutional. The new laws continue a trend among Democratic states that was previously discussed on Rivkin Rounds …
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Life Spine Settles FCA Kickback Case for $6 Million
October 31, 2019 | Eric D. Fader | Affordable Care Act | False Claims Act | Fraud and Abuse | Litigation | Medical Devices and Wearables | Medicare and Medicaid
Spinal implant manufacturer Life Spine Inc. and two of its executives have settled their False Claims Act case by agreeing last week to pay the federal government $6 million. As discussed here, the company and executives had been accused of paying kickbacks to surgeons to use the company’s products. In addition to paying $5.5 million …
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Kickback Charges Lead to False Claims Act Case
August 27, 2019 | Eric D. Fader | Affordable Care Act | False Claims Act | Fraud and Abuse | Litigation | Medical Devices and Wearables | Medicare and Medicaid
The Manhattan U.S. Attorney’s Office recently announced that the U.S. Department of Justice has intervened in a whistleblower suit against Life Spine Inc., an Illinois-based manufacturer of spinal implants, devices and equipment. The lawsuit, which seeks damages and civil penalties under the False Claims Act (FCA), claims that Life Spine paid millions of dollars in …
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CMS Adds Health Plan Ratings to ACA Exchanges
August 20, 2019 | Eric D. Fader | Affordable Care Act | Legislation and Public Policy | Medicare and Medicaid | Private Insurers
The Centers for Medicare & Medicaid Services (CMS) announced on August 15 that health plans offered on health insurance exchanges will be ranked using a five-star quality rating system for the 2020 plan year open enrollment period that begins on November 1, 2019. The ratings will appear on both state-based exchanges and the federal exchange, …
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OIG Audit Reveals NY Medicaid Eligibility Errors
July 25, 2019 | Margarita Christoforou | Affordable Care Act | Legislation and Public Policy | Medicare and Medicaid
Based on a recent audit of payments under New York’s Medicaid program, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) estimated in a report that the state made hundreds of millions of dollars in payments to ineligible or “potentially ineligible” beneficiaries. The audit examined payments to “non-newly eligible” beneficiaries, meaning …
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States Pick Up ACA Slack
July 12, 2019 | Eric D. Fader | Affordable Care Act | Legislation and Public Policy | Private Insurers
With the political battle over the future of the Affordable Care Act (ACA) dragging on in Washington, a number of states have recently taken steps to protect their residents from potential instability in the health insurance market. New Jersey is setting up its own state health insurance exchange to replace the federally run healthcare.gov marketplace, …
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