Warning: persons engaged in malicious cyber-enabled activities may be added to the specially designated nationals list

Posted by Daniel O. Jamison on

Healthcare providers have long been aware that there can be severe penalties for submitting claims to a federal healthcare payment program where the services were provided by a person excluded from participation in the program.¬† ¬†Eligibility of personnel to participate in such programs is determined through background checks, with appropriate updating, that include checking the […]

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Must a managed care plan pay for Medi-Cal beneficiary hospital services in accordance with the providing hospital’s full billed charges concerning post-stabilization services not under contract?

Posted by Steven Vartabedian on

In Children’s Hospital Central California v. Blue Cross of California (filed 6/10/14) F065603, Blue Cross, in providing a managed care plan, paid $4.2 million to Children’s Hospital for a 10-month period of coverage without written contract rates for post-stabilization care. Payment was based on the Medi-Cal rates paid by the government. Children’s Hospital sued for […]

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May an HMO be found negligent in the delegation of its statutory duty to reimburse non-contracting emergency physicians?

Posted by Steven Vartabedian on

Emergency room physicians have a legal duty to treat a patient regardless of patient’s inability to pay the physician’s bill. Where patient is enrolled in an HMO (Health Maintenance Organization care service plan), even where the emergency physician is not under contract to the HMO, the obligation to pay for the physician’s services still rests […]

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National Federation of Independent Business v. Sebelius

Posted by Dowling Aaron on

There are approximately 50 million Americans uninsured for healthcare. The Patient Protection and Affordable Care Act (“ACA”) seeks to have about 30-35 million of those covered by private and public health insurance. About half of those will be covered under the “Individual Mandate” that each individual, subject to certain exceptions, purchase health insurance or pay […]

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