Healthcare Law & Policy Archive

Payer Acknowledges Improper Out-of-Network Reimbursements

New Jersey patients and providers recently enjoyed a victory in their long-running tug-of-war with payers concerning the reasonableness of out-of-network reimbursements. Last Tuesday, the New Jersey Department of Banking and Insurance (“DOBI”) announced that Healthnet of New Jersey has agreed to pay $41 million to settle charges that it systematically underpaid out-of-network providers between 1996

New California Law Subjects Providers to Steep Fines for Privacy Breaches

Under a bill recently approved by the Assembly and expected to be signed into law, California Healthcare providers could soon be subject to hefty fines and costly civil litigation if they fail to adopt and implement “appropriate administrative, technical, and physical safeguards to protect the privacy of a patient’s medical information.” While A.B. 211 appears

North Carolina to Publish Data Regarding “Confidential” Med Mal Settlements

Under a new North Carolina regulation, details regarding North Carolina medical malpractice settlements will soon be posted online for patients to view. Confidential out-of-court settlements have long been the option of choice for medical malpractice defendants in North Carolina and elsewhere. However, if the North Carolina Board of Medical Examiners gets its way, North Carolina

E-Prescribing Could Save Thousands of Lives Each Year

Regular readers of this blog will recall our recent discussion concerning the new ‘carrot’ of a 2% bonus that is being offered to electronic prescribers by the Centers for Medicare and Medicaid Services (“CMS”). Perhaps you will also recall our blog regarding the Drug Enforcement Agency’s (“DEA”) efforts to make E-prescribing more attractive by eliminating

HHS Proposed Rule Causes Controversy

Yesterday’s blog discussed the background of HHS’ proposed rule, which would penalize institutions that discriminate against providers who refuse to refer patients to abortion providers. As promised, today we’ll focus on the details of the proposed rule, which is entitled “Ensuring that Department of Health and Human Services Funds Do Not Support Coercive or Discriminatory

HHS and ACOG Battle Over OB/GYN Conscience Rights

In a controversial move, last Thursday, HHS proposed regulations that would prevent healthcare providers from being compelled to refer patients to abortion providers if doing so would violate the provider’s conscience. Before diving into the proposed rule, let’s quickly consider the history of this issue. ACOG Opinion On November 7, 2007, the American College of

After years of Litigation, E/M Denials Persist

Notwithstanding years of litigation and multi-million dollar settlements, many healthcare providers continue to experience inappropriate evaluation and management service (“E/M”) denials. Earlier today, I spoke with a provider who had a well-founded complaint regarding his denials, so I want to take a minute to quickly review the basics. E/M is a visit or consultation provided

New Jersey Lawmakers Cap Self – Pay Charges

Uninsured New Jersey patients will soon be seeing lower hospital charges. Earlier this week, New Jersey’s governor signed into law Assembly Bill 2609, which caps the fees that hospitals can charge uninsured patients. According to the New Jersey Commission on Rationalizing Health Care Resources, the constraints contained in this new law will cause a decrease

Reimbursement Denials Expanded for Medical Errors

As we discussed earlier this year, Medicare has created an ever expanding list of hospital-acquired conditions for which it no longer provides reimbursement. This list includes conditions such as pressure ulcers, hospital falls, certain catheter-associated infections, air embolism as a result of surgery, leaving an object in during surgery, providing incompatible blood or blood products

DEA Poised to Remove E-prescribing Hurdle

Physician societies, patient groups and federal and state agencies are rarely on the same page; so, on an occasion where they unanimously and enthusiastically support a common objective, things must move quickly, right? Not quite. For about a decade, electronic prescribing (also known as “e-prescribing”) has been praised for its promises of reducing deaths and