The Centers for Medicare and Medicaid Services (“CMS”) published its Calendar Year 2016 Physician Fee Schedule Proposed Rule (80 FR 41685 et seq.) which, in addition to updating the fee schedule, contains: (1) a proposed new quality measure that an Accountable Care Organization (“ACO”) must meet to qualify for shared savings in the Medicare Shared

It has been the lament of Long Island for many years that we are losing young professionals (the “brain drain”) and burgeoning industries to the rest of the country. The lack of affordable housing, high taxes and a crumbling transportation infrastructure all contribute to this problem. However, local governments are starting to address these concerns

Last month, the New York State Attorney General (“AG”) reached a settlement with Aspen Dental Management, Inc. (“ADMI”) after an investigation revealed that ADMI violated New York laws prohibiting the unauthorized practice of dentistry and dental hygiene, fee splitting and deceptive trade practices.  ADMI’s story is a cautionary tale to which investors and management companies

A decision issued by the New York Court of Appeals early in June extends application of the court-created “preclusion” rule in no-fault insurance cases, which provides that an insurer’s failure to timely pay or deny a claim results in an insurer being precluded from interposing a defense against payment of the claim, except where the

Court Dismisses Wage-and-Hour Claims against Wal-Mart

The plaintiff in this putative class action alleged that, during the time she had been employed by Wal-Mart Stores, Inc., as a pharmacist, she took the home study and test portions of the APHA Immunization Certification Training Course. The plaintiff contended that the training course was “directly related” to

New York’s Top Court Rules On Evidence Medical Provider Must Submit To Obtain Judgment Against No-Fault Insurer

The New York Court of Appeals ruled that a medical provider demonstrated prima facie entitlement to summary judgment in a no-fault insurance action by submitting evidence that payment of no-fault benefits was overdue, and that proof of its

Several months ago, the Colorado Supreme Court, in response to questions certified by the U.S. Court of Appeals for the Tenth Circuit, ruled that the “notice-prejudice rule” did not apply to a date-certain notice requirement in a claims-made insurance policy. See, Notice-Prejudice Rule Did Not Apply to Date-Certain Notice Requirement in Claims-Made Insurance Policy, Colorado

The U.S. Court of Appeals for the Eleventh Circuit, affirming a decision by the U.S. District Court for the Northern District of Georgia, has ruled that an exclusion in a director’s and officer’s (“D&O”) insurance policy barred coverage for an underlying complaint that alleged that wrongful acts of officers and directors of a family-owned corporation

The Rhode Island Supreme Court has ruled that the minor daughter of divorced parents, who lived with her mother but who regularly stayed at her father’s home for overnight visits twice per week, was a resident of the father’s home for the purpose of determining coverage under the provisions of his homeowner’s insurance policy.

The

An appellate court in Illinois, reversing a trial court’s decision, has ruled that an insurance company was not obligated to defend a county and several of its former officials who were sued for malicious prosecution by a wrongfully convicted criminal defendant because his claim arose when he first was arrested, not years later when he

The U.S. Court of Appeals for the Eleventh Circuit has upheld a district court’s decision in favor of a disability insurance carrier, finding that a lawsuit seeking long term disability benefits had been filed after the policy’s three year limitations period.

The Case

Harriet Wilson sued Standard Insurance Company under the Employee Retirement Income Security

In response to a question certified to it by the U.S. Court of Appeals for the Fifth Circuit, the Texas Supreme Court has ruled that the term “suit” in a general liability insurance policy included superfund cleanup proceedings conducted by the Environmental Protection Agency (“EPA”) under the federal Comprehensive Environmental Response, Compensation, and Liability Act of

A New Jersey Bankruptcy Court recently confirmed that questions of insurance coverage arise under state law and typically are not core matters subject to being resolved by bankruptcy courts. The authors of this article discuss the decision and its implications.

A New Jersey bankruptcy court, in In re John A. Rocco Co.,

Russo v. Rozenholc, 2015 N.Y. App. DIV LEXIS 5885, 2015 NY Slip Op 06029 (N.Y. App. Div. July 9, 2015)

While New York law generally requires privity between a client and attorney in order to assert a claim for legal malpractice, in Schneider v. Finmann, 15 N.Y.3d 306, 907 N.Y.S.2d 119 (2010), the New York

The BDO Center for Healthcare Excellence & Innovation and Rivkin Radler explore the rise of quality data as a reimbursement benchmark in this three-part series. Future newsletters will delve into the implications for measurement strategies and compliance.

Quality data is moving to the forefront of healthcare as a critical element of value and will serve