Private Insurers

Centene’s Proposed WellCare Acquisition May See DOJ Scrutiny
May 2, 2019 | Eric D. Fader | Antitrust | Fraud and Abuse | Medicare and Medicaid | Private Insurers
An April 30 article in Managed Care, “Centene, big in Medicaid managed care, wants to get even bigger,” discussed the business plans of Centene, the largest Medicaid managed care insurer in the U.S.  Rivkin Radler’s Christopher J. Kutner was quoted in the article. Centene is hoping that its proposed acquisition of WellCare Health Plans will …
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HHS Announces New Primary Care Pay Models
April 23, 2019 | Eric D. Fader | Hospitals | Legislation and Public Policy | Medicare and Medicaid | Private Insurers
On April 22, U.S. Department of Health and Human Services (HHS) officials announced the introduction of five optional value-based care models for large and small primary care physician practices. The new payment models will incorporate incentives for keeping Medicare patients healthy, as alternatives to traditional fee-for-service payment structures. Alex Azar, HHS Secretary, and Seema Verma, …
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Amazon’s Alexa Now HIPAA-Compliant
April 18, 2019 | Eric D. Fader | Cybersecurity | Electronic Health Records | HIPAA | Home Health | Hospitals | Medical Devices and Wearables | Private Insurers | Telehealth
Amazon announced in a blog post on April 4 that its Alexa voice assistant’s operating environment now complies with HIPAA. Companies that build functions, or skills, for Alexa will now be able to create skills that involve the transmission of users’ protected health information. The initial group of six participants in an invitation-only program includes …
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New Plan Designs for Medicare Parts C and D are Coming
April 9, 2019 | Christopher J. Kutner | Legislation and Public Policy | Medicare and Medicaid | Pharmaceuticals | Private Insurers
On April 5, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-4185-F) that updates the Medicare Advantage (MA or Part C) and Medicare Prescription Drug Benefit (Part D) programs by promoting innovative plan designs, improved quality, and choices for patients. The final rule will increase MA plan choices for the 2019 …
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New York State Budget Includes ACA-Type Protections
April 3, 2019 | Eric D. Fader | Affordable Care Act | Home Health | Hospitals | Legislation and Public Policy | Medicare and Medicaid | Private Insurers
New York’s state budget for the 2019-2020 fiscal year, approved by the State Legislature on March 31, included provisions that codify into state law the primary consumer protections of the federal Affordable Care Act. In a public announcement, Gov. Andrew Cuomo said, “We have codified many of the protections of Obamacare, so regardless of what …
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New Jersey to Set Up State Health Insurance Exchange
March 26, 2019 | Eric D. Fader | Affordable Care Act | Legislation and Public Policy | Private Insurers
New Jersey Governor Phil Murphy announced on March 22 that the state will create its own health insurance exchange for plan year 2021, replacing the federally run marketplace. Gov. Murphy also gave notice of the change by sending a Declaration of Intent Letter to the federal government’s Center for Consumer Information and Insurance Oversight. …
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“Surprise Bill” Solution is on Senate’s To-Do List
March 20, 2019 | Eric D. Fader | Hospitals | Legislation and Public Policy | Private Insurers
A bipartisan group of U.S. senators is at work on federal “surprise bill” legislation that may be officially proposed within weeks. The proposal will target the common scenario in which an insured individual receives covered healthcare services from an in-network hospital, surgery center, imaging center or laboratory, while an out-of-network healthcare provider also provides non-emergency …
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Fitbit, Solera Health Expand Diabetes Efforts
March 12, 2019 | Eric D. Fader | Electronic Health Records | Medical Devices and Wearables | Private Insurers
Fitbit and Solera Health announced on March 6 that they have expanded their partnership that seeks to reduce the prevalence of type 2 diabetes. Solera, an integrated benefit network, will make Fitbit devices available to all Solera patients who participate in the National Diabetes Prevention Program (DPP). In a study, Solera found that its patients …
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Healthcare: The Next Frontier
March 5, 2019 | Rivkin Rounds Staff | Affordable Care Act | Employer/Employee | Hospitals | Legislation and Public Policy | Private Insurers
A March 1 article in Long Island Business News entitled “Healthcare: The next frontier” discussed the issues raised at a recent roundtable discussion on the current state of the healthcare industry. The panel included Rivkin Radler partners Robert Iseman and Benjamin Malerba; Dr. Zeyad Baker, ProHEALTH Care Associates’ president and CEO; Jeffrey Kraut, executive vice …
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Anti-Assignment Clause Bars Doctor’s Reimbursement Claim
February 20, 2019 | Rivkin Rounds Staff | Litigation | Private Insurers
Rivkin Radler’s Employee Benefit Plan Review included a summary of a case in which the U.S. Court of Appeals for the Eleventh Circuit held that an anti-assignment provision in a group health benefit plan barred direct reimbursement to an Atlanta dermatologist. The patient had executed an Assignment of Benefits in favor of the physician, a …
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