Private Insurers


Second Circuit Cases May Affect Insurers’ Ability To Fight No-Fault Fraud
March 9, 2020 | Rivkin Rounds Staff | Fraud and Abuse | Litigation | Private Insurers
Rivkin Radler’s Evan Krinick authored a March 6 article in the New York Law Journal, “Second Circuit Cases May Affect Insurers’ Ability To Fight No-Fault Fraud,” that discussed two pending cases relating to New York no-fault insurance carriers. Both cases involve a healthcare provider that filed hundreds of new arbitration proceedings or collection lawsuits against …
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No Cost-Sharing for Coronavirus Testing in NY
March 5, 2020 | Eric D. Fader | Hospitals | Legislation and Public Policy | Medicare and Medicaid | Pharmaceuticals | Private Insurers | Telehealth
On March 2, New York Gov. Andrew Cuomo announced new regulations on New York health insurers regarding coverage for coronavirus testing and related matters. The State Department of Financial Services (DFS) directive requires insurers to waive cost sharing for COVID-19 testing at emergency room, urgent care and office visits. In addition, Medicaid patients will not …
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Ransomware Attacks on Healthcare Industry Ramp Up
February 26, 2020 | Eric D. Fader | Cybersecurity | Electronic Health Records | HIPAA | Hospitals | Private Insurers
A recent article in HIPAA Journal, “Ransomware Attacks Have Cost the Healthcare Industry at Least $157 Million Since 2016,” discussed a new study by Comparitech that examined ransomware attacks on the healthcare industry. In the past three years, at least 172 ransomware attacks on healthcare entities in the U.S. have affected 1,446 facilities, providers and …
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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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Sutter Health to Pay $575 Million in Antitrust Settlement
December 23, 2019 | Eric D. Fader | Antitrust | Hospitals | Litigation | Private Insurers
Sutter Health, a northern California health system, will pay $575 million to settle allegations that it violated federal antitrust laws. The settlement comes on the heels of Sutter’s recent $45 million settlement of alleged Stark Law violations, as discussed here. Under the preliminary settlement, which is pending court approval, Sutter will be required to reform …
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HHS Releases Price Transparency Rules
November 21, 2019 | Eric D. Fader | Hospitals | Legislation and Public Policy | Medicare and Medicaid | Private Insurers
On November 15, the U.S. Department of Health and Human Services (HHS) announced the release of two healthcare price transparency rules. One is a final rule requiring hospitals to make available online all standard charges for items and services, including discounted rates negotiated with third-party payers. The second is a proposed rule that would require …
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Primary Care Payment Model Delayed to 2021
November 4, 2019 | Eric D. Fader | Hospitals | Legislation and Public Policy | Medicare and Medicaid | Private Insurers
The Center for Medicare & Medicaid Innovation, part of the Centers for Medicare & Medicaid Services, recently released its Request for Applications for the new “Primary Care First” payment model. The program will now begin in 2021 rather than the 2020 start date that was originally proposed in April, as discussed here. CMS said it …
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NY DFS Proposes “Surprise Bill” Amendment
October 15, 2019 | Eric D. Fader | Hospitals | Legislation and Public Policy | Private Insurers
On October 10, the New York State Department of Financial Services released a proposed amendment to the state’s Out-of-Network Law. If approved, the amendment would require insurance companies and healthcare providers to comply with several new requirements to better protect consumers from “surprise” medical bills. Insurers that receive a claim for services rendered by a …
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CMS Updates Medicare Plan Finder Tool
September 24, 2019 | Cassandra Rivais DiNova | Legislation and Public Policy | Medicare and Medicaid | Private Insurers
As Medicare open enrollment approaches, the Centers for Medicare & Medicaid Services (CMS) announced on August 27 the launch of a redesigned Medicare Plan Finder tool. This new tool makes it easier for customers to compare pricing, coverage, and drug plans of Medicare, Medicare Advantage, Medigap, and Part D programs. The Plan Finder tool is …
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Kaiser to Present at PLI Life Sciences Program
September 17, 2019 | Rivkin Rounds Staff | Cybersecurity | Electronic Health Records | FDA | False Claims Act | Fraud and Abuse | Legislation and Public Policy | Litigation | Medical Devices and Wearables | Medicare and Medicaid | Pharmaceuticals | Private Insurers
On October 10, Rivkin Radler’s Jeff Kaiser will be a panelist at the Practising Law Institute (PLI) program, “Life Sciences 2019: Navigating Legal Challenges in the Drug and Device Industries.” Jeff will speak on “Enforcement Trends Impacting the Drug and Device Industries,” including developments under the False Claims Act, federal Anti-Kickback Statute, off-label promotion, and …
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