A Fox Rothschild health care litigation team led by Marc Hewitt, Elizabeth Hedrick and Bob Edmunds secured an important victory for the North Carolina State Health Plan that upholds its selection of Aetna as its third-party administrator. An administrative law judge agreed with the Fox team and rejected claims that NCSHP acted arbitrarily when it selected Aetna to replace Blue Cross and Blue Shield of North Carolina. BCBSNC had administered the NC State Health Plan for more than 40 years. “Despite Blue Cross’s disagreement with the contract decision, we’re gratified that the ALJ recognized that the process of evaluating proposals and awarding the contract was fair and proper at every step. We’re also grateful that no appeal will be taken and this protracted litigation is over because it’s the best result for the Plan’s members and North Carolina taxpayers,” Marc said. Read more: https://bit.ly/4bMw2rc
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Discover the implications of SCOTUS overturning Chevron on healthcare law in the latest post from Anna Akers Hornsby, Lyndsay Medlin, Brad Robertson, and Jack Selden on the Eye on Enforcement blog. Explore how this decision will reshape regulations and judicial oversight in the healthcare industry. [https://lnkd.in/em2rU_7k]
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DNA MEDSOLUTIONS, LLC℠| Healthcare Optimization & Management |Workforce Protection|Healthcare Law-FWA|ASCs Development|CMS Proficiencies Compliance|Real Estate Notary Signing Agent|Value Based|"The Synergy of El and AI"™
The rise of Stark Law violations in the healthcare industry is a significant concern for providers. The intricate provisions of the law, combined with heightened government scrutiny and financial pressures, contribute to the challenge of compliance. Factors such as the growth of healthcare organizations and aggressive enforcement tactics further worsen the situation. Stark Law violations involve various arrangements, from compensation structures to equipment rentals, with severe consequences like civil penalties and exclusion from federal programs. To manage risks, organizations must focus on robust compliance programs, regular risk assessments, thorough training, meticulous documentation, and legal guidance. Are you interested in exploring specific aspects of Stark Law further, such as enforcement trends or its impact on healthcare business models? 👇✍️ #StarkLaw #FWA #theDNAofHealthcareOptimization
10 things to know about rise of Stark law violations
beckersasc.com
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I am in day 2 of arbitration, where the rubber meets the road in applying the principles from the book I co-authored: "A Practical Guide to Reimbursement in Managed Care." Today, we're diving into real-world cases, armed with insights and guidance straight from the pages. Excited to see how these concepts play out in this dispute. Let's bring theory to life and pursue justice with clarity and conviction.
Mackenzie Wallace, Thompson Coburn health care partner, is the current featured author for the American Bar Association! Mackenzie recently co-authored the ABA publication "A Practical Guide to Reimbursement in Managed Care," which provides a detailed account of Medicare reimbursement and payment approaches used across provider types. Mackenzie is an experienced trial attorney representing health care entities, businesses and directors in high-stakes litigation. Hospitals and health care providers turn to Mackenzie for representation in coverage and reimbursement disputes; fraud and civil RICO claims; Texas Prompt Pay Act, qui tam and False Claims Act litigation; and matters relating to the violation of federal and state anti-kickback provisions and Stark laws. Check out her full profile on the ABA website: https://bit.ly/49aqQwn
American Bar Association Featured Author
americanbar.org
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Next Thursday (November 16), #OrangeCounty Associate Laura L. will moderate a #webinar on the virtual #healthcare landscape at the Orange County Bar Association’s (#OCBA) Health Care Law Section Meeting. This informative session, featuring Mike Winsten (Winsten Law Group), will cover how legislative bodies and #healthcare agencies are promoting new #laws needed to regulate #virtual healthcare services. Learn more about this #CLE event on our website. #HealthcareLaw #HealthcareIndustry #CaliforniaLaw #Legislation
Laura Lopez to Moderate OCBA Webinar on Tele-Healthcare Law - Lewis Brisbois Bisgaard & Smith LLP
lewisbrisbois.com
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A 𝗵𝗲𝗮𝗹𝘁𝗵 𝗰𝗮𝗿𝗲 𝗽𝗿𝗼𝘅𝘆 appoints someone to make health care decisions for you when you are unable to make them yourself 📝 It's 𝗶𝗺𝗽𝗼𝗿𝘁𝗮𝗻𝘁 that these documents be drafted by an #attorney so that they reflect your wishes within the bounds of state law ✨ Contact the experts at 𝗞𝗿𝗼𝗹𝗹 𝗣𝗿𝗼𝘂𝗸𝗼𝘂, 𝗟𝗟𝗣 to learn more 💼 #krollproukoullp #livingwill #healthcareproxy #lawfirm #rochesterny
Living Will & Healthcare Proxy Attorney Rochester NY | Kroll Proukou, LLP
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Join us for our webinar, "Value-Based Care Fundamentals: A Guide for Health Law Professionals," on Tuesday, July 30. This 60-minute webinar is for in-house counsel and compliance officers in health systems, providers, ACOs, CINs and related organizations. Hall Render attorney Scott Strickland, along with Michael Berwanger from EmergeOrtho, will discuss the shift towards value-based care, current payment models, legal considerations, VBE safe harbors/exceptions, MIPS reporting and practical tips. Gain critical insights to navigate value-based care complexities and better advise your organizations. Register here: https://lnkd.in/gBukspFJ
Welcome! You are invited to join a webinar: Value-Based Care Fundamentals: A Guide for Health Law Professionals. After registering, you will receive a confirmation email about joining the webinar.
hallrender.zoom.us
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A 𝗵𝗲𝗮𝗹𝘁𝗵 𝗰𝗮𝗿𝗲 𝗽𝗿𝗼𝘅𝘆 appoints someone to make health care decisions for you when you are unable to make them yourself 📝 It's 𝗶𝗺𝗽𝗼𝗿𝘁𝗮𝗻𝘁 that these documents be drafted by an #attorney so that they reflect your wishes within the bounds of state law ✨ Contact the experts at 𝗞𝗿𝗼𝗹𝗹 𝗣𝗿𝗼𝘂𝗸𝗼𝘂, 𝗟𝗟𝗣 to learn more 💼 #krollproukoullp #livingwill #healthcareproxy #lawfirm #rochesterny
Living Will & Healthcare Proxy Attorney Rochester NY | Kroll Proukou, LLP
kropro.law
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A 𝗵𝗲𝗮𝗹𝘁𝗵 𝗰𝗮𝗿𝗲 𝗽𝗿𝗼𝘅𝘆 appoints someone to make health care decisions for you when you are unable to make them yourself 📝 It's 𝗶𝗺𝗽𝗼𝗿𝘁𝗮𝗻𝘁 that these documents be drafted by an #attorney so that they reflect your wishes within the bounds of state law ✨ Contact the experts at 𝗞𝗿𝗼𝗹𝗹 𝗣𝗿𝗼𝘂𝗸𝗼𝘂, 𝗟𝗟𝗣 to learn more 💼 #krollproukoullp #livingwill #healthcareproxy #lawfirm #rochesterny
Living Will & Healthcare Proxy Attorney Rochester NY | Kroll Proukou, LLP
kropro.law
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President at CareAllies – a Cigna company | Focused on connecting care between patients, providers, and payers through value-based care solutions
Providers and other "covered entities" affected by the breach that disrupted nationwide payments and exposed personal information from a large population had one reason to breathe a sigh of relief. The Health and Human Services Department’s Office of Civil Rights clarified that they can delegate the requirement to notify patients of the breach – a resource-intensive task – to Change Healthcare. But the situation is still evolving, and providers that were impacted should make sure that they contact the company to ensure that patients are informed and that the action is completed. Perhaps most importantly, all practices and hospitals that experienced any ramifications should continue to stay informed. United Health Group, which owns Change Healthcare, provided a breach notification on June 20 and some questions still remain about which bad actors possess it. It is prudent to expect that the situation will continue to evolve and will not be completely resolved for some time. The National Law Review https://bit.ly/45ESC3t
Providers Face HIPAA Compliance Questions After Change Healthcare Cyberattack
natlawreview.com
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This recent AHLA podcast will help you see around the corner of how platform PBM policy reforms will take shape, including the likely legal challenges from the platform PBM industry on those reforms.
Rujul Desai appeared on "Speaking of Health Law," a podcast by the American Health Law Association, to discuss the Pharmacy Benefit Manager (PBM) industry. Listen now: https://ow.ly/2sNa50PPMyW
The Evolving Landscape of the PBM Industry
cov.com
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Business Development Manager at Fox Rothschild
1moWhat a win!