Showing 103 posts in Health Care Reform.
Health Plans Take Notice: Compliance with HIPAA Administrative Simplification Rules is still Required
On Jan. 2, 2014, the Department of Health and Human Services (“HHS”) issued a proposed rule related to the Administrative Simplification requirements of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). Specifically, it delayed the date by which health plans must certify compliance with certain operating rules imposed by the Affordable Care Act (“ACA”).
The ACA required the Secretary of HHS to adopt operating rules related to claims status, eligibility, electronic funds transfers ("EFT") and health care payment and remittance advice transactions ("ERA"). Health plans (and other covered entities) were required to comply with the claims status and eligibility operating rules by Jan. 1, 2013 and the EFT and ERA operating rules by Jan. 1, 2014. Additionally, health plans were required to file a statement with HHS certifying that the health plan is in compliance with the operating rules. This certification statement was due by Dec. 31, 2013. Read More ›
Categories: Billing/Payment, Compliance, Health Care Reform, HIPAA, Insurance, Privacy, Providers
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Pivotal Question for 2014: Are you a Large Employer?
While originally scheduled to start in 2014, now beginning in 2015, "large employers" will be required to provide adequate health care coverage to their full time employees or pay a penalty. This requirement is known as health care reform’s Employer Mandate. In order to assess whether your company is subject to the Employer Mandate, you must first determine whether your company is a "large employer." Read More ›
Categories: Employee Benefits, Employment, Health Care Reform
The Michigan Health Insurance Marketplace: How did the Rollout Go?
Technical glitches. Partisan rancor. Breathless media coverage. The rollout of the online Health Insurance Marketplaces (also known as Exchanges) did not lack for drama or controversy. The unveiling of the Marketplaces, one of the key elements of the Patient Protection and Affordable Care Act, was perhaps the most anticipated and controversial website launch in history. The website www.healthcare.gov was flooded with traffic from the moment it opened on October 1, 2013 and many interested consumers ran into trouble. While most of the extensive media coverage of the Marketplaces focused on problems nationally, we wanted to take a look at how Michigan’s Marketplace (and consumers) fared. Read More ›
Categories: Health Care Reform, Health Insurance Exchange
Notice of Insurance Marketplace - Due Date Approaching
An October 1, 2013 deadline is looming for many employers to give employees written notices under the Patient Protection and Affordable Care Act (PPACA, commonly known as the health care reform act.) Read More ›
Categories: Health Care Reform
Michigan Senate Approves Medicaid Expansion
The Michigan Medicaid expansion saga has seemingly come to an end, as the Republican-led state Senate narrowly approved Medicaid expansion on Tuesday, August 27 in a 20-18 vote. Eight Republicans joined 12 Democrats to pass a bill that will bring billions of dollars in federal dollars to Michigan to implement a major element of the Patient Protection and Affordable Care Act. Under this bill, approximately 400,000 additional Michigan residents will be eligible for Medicaid coverage.
The vote came after lengthy debate in the Senate on the measure, and passed after "eleventh hour" legislative maneuvering. The Michigan House, which previously passed a Medicaid expansion bill, will likely approve the Senate version of the bill next week. If passed, it will be sent to Governor Snyder's desk for his signature.
Categories: Health Care Reform, Medicare/Medicaid, Providers
Michigan Senate Panel Moves Three Alternative Medicaid Bills Out of Committee
In early July, we updated our readers regarding the status of the Medicaid expansion debate in Michigan. At that time, a House-passed bill - supported by Governor Snyder - languished in a Senate committee because it was blocked by Senate Republicans who opposed the measure. Get an update ›
Categories: Health Care Reform, Medicare/Medicaid, Regulatory
Health Care Providers Face Steep Penalties for Medicare/Medicaid Fraud
So far, July has been a busy month for health care fraud enforcement across the country.
On July 18, Divyesh Patel, owner of Alpine Nursing Care Inc. in North Randall, Ohio, was sentenced to two years in prison after pleading guilty to one count of conspiracy to commit health care fraud and four counts of health care fraud. Patel was also ordered to pay total restitution of $1,939,864 to the Medicaid Program in Ohio. According to court documents, Patel hired Belita Mable Bush as the office manager despite knowing that Bush had been convicted of a health care-related felony and excluded from involvement in billing federal health care programs. From June 1, 2006 to October 18, 2009, Patel conspired with Bush to defraud Medicaid by billing for services that had never been performed or that had been performed by excluded individuals. The conspiracy resulted in losses of approximately $1.9 million to the Medicare and Medicaid programs. Bush was convicted on similar charges and will be sentenced next month. Read about more cases ›
Categories: Fraud & Abuse, Health Care Reform, Hospitals, Medicare/Medicaid, Physicians
Pioneer ACOs Find Blazing New Trails Isn't Always Easy
According to a recent Modern Healthcare article, up to 9 of the 32 Pioneer Accountable Care Organizations ("ACOs") may be leaving the program. Four have already notified providers of such withdrawal. Of the 9, 4 of the departing ACOs tentatively say they will be joining Medicare's lower- risk ACO alternative – the Medicare shared savings program. The deadline for deciding whether or not to remain in the Pioneer program is July 31, 2013. Read More ›
Categories: Accountable Care Organizations, Health Care Reform, Hospitals, Medicare/Medicaid, Physicians
Large Employers Rejoice! PPACA’s Employer Mandate Delayed until 2015
On July 2, 2013, the Obama administration declared that it was delaying the effective date of the Patient Protection and Affordable Care Act’s Employer Mandate until January 1, 2015. The Employer Mandate, which was scheduled to become effective on January 1, 2014, required all large employers to offer health care coverage to their full-time employees or pay a penalty. Most importantly, this delay means that the penalties to large employers for failure to provide health insurance coverage will not be enforced for another year. You may read the full statement issued by the U.S. Department of Treasury here. Read more about his announcement ›
Categories: Employment, Health Care Reform, Insurance
Medicaid Expansion Debate in Michigan Rages On
A key component of the Patient Protection and Affordable Care Act ("PPACA") involves expanding Medicaid to anyone who earns up to 133 percent of the poverty level. In its landmark ruling last year the Supreme Court, while upholding PPACA, ruled that states could not be compelled to expand the joint federal-state Medicaid program.
State legislatures and governors across the country have considered whether to expand Medicaid, with only 23 states and the District of Columbia implementing an expansion according to the (We have identified that the following link is no longer active, and it has been removed.) Under the PPACA, 100 percent of the cost of the Medicaid expansion will be covered by the federal government from 2014 through 2016. The federal government's contribution will gradually decline until reaching 90 percent in 2022 and beyond. What's happening in Michigan? ›
Categories: Health Care Reform, Insurance, Medicare/Medicaid, Regulatory
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Best Lawyers® 2021
Congratulations to the attorneys of the Health Care practice group at Foster Swift Collins & Smith, PC for their inclusion in the Best Lawyers in America 2021 edition. Firm-wide, 44 lawyers were listed. Best Lawyers lists are compiled based on an exhaustive peer-review evaluation and as lawyers are not required or allowed to pay a fee to be listed; inclusion in Best Lawyers is considered a singular honor. Health Care practice group members listed in Best Lawyers are as follows:
- Jennifer B. Van Regenmorter, Holland
To see the full list of Foster Swift attorneys listed in Best Lawyers 2021, click here.