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2 days ago | 
jdsupra.com | Alison Andersen |David Greenberg |Roberto Martinez
On May 27, Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. (BCBSGA) filed a lawsuit in the Northern District of Georgia US District Court, alleging that a group of health care providers, along with their third-party billing agent, manipulated the federal No Surprises Act’s (NSA) independent dispute resolution (IDR) process.
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2 days ago | 
afslaw.com | Alison Andersen |Molly L. Wiltshire |David Greenberg |Roberto Martinez
In the complaint, BCBSGA accuses Sound Physicians (a large, multistate physician group) and its subsidiaries, together with HaloMD, Inc., of systematically submitting thousands of ineligible disputes to the NSA’s IDR process. BCBSGA alleges the scheme involved falsely attesting to claim eligibility, overwhelming the IDR process, and inflating offers, resulting in millions of dollars being improperly awarded to Sound Physicians on those claims.
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Aug 8, 2024 | 
jdsupra.com | Alison Andersen |Jack Bierig |Caroline English
On August 2, health care providers scored yet another significant victory when the US Court of Appeals for the Fifth Circuit affirmed the vacatur of various federal regulations regarding the arbitration procedures used to resolve billing disputes between providers and insurers under the federal No Surprises Act (NSA).
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Aug 7, 2024 | 
afslaw.com | Aphrodite Kokolis |Caroline English |Alison Andersen |David Greenberg
On In this case, commonly referred to as TMA II, the Fifth Circuit held that the regulations improperly restricted the arbitrators’ authority to consider the various factors specified in the NSA when deciding on reimbursement amounts for out-of-network providers’ services.
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May 8, 2024 | 
natlawreview.com | Alison Andersen
Last week, the US Court of Appeals for the Fourth Circuit issued a decision holding that state health care plans in North Carolina and West Virginia must cover gender-affirming surgeries. A copy of the decision, Kadel v. Folwell, 4th Cir. en banc, No. 22-1721 (April 29, 2024), can be found here. The appellate decision resolved two cases, one involving a North Carolina state health plan for teachers and state employees and the other involving West Virginia’s Medicaid Program.
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Jan 22, 2024 | 
jdsupra.com | Alison Andersen |Jack Bierig |Caroline English
On December 18, 2023, the US Departments of Treasury, Labor, and Health and Human Services (the Departments) issued a rule finalizing the 2024 non-refundable administrative fee parties must pay to access the arbitration process established under the No Surprises Act (the Act). Once finalized, the rule will set the administrative fee at $115 per arbitration and will also finalize the permissible ranges for Independent Dispute Resolution Entity (IDRE) fees.
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Dec 8, 2023 | 
jdsupra.com | Alison Andersen |Jack Bierig |Caroline English
On October 27, the US Departments of Treasury, Labor, and Health and Human Services (the Departments) issued new proposed rules intended to revamp the negotiation and arbitration proceedings established under the No Surprises Act (the Act). Under the proposed rule, the Departments would permit broader batching of eligible claims and implement additional changes to the Open Negotiation and Independent Dispute Resolution (IDR) processes established under the Act.
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Oct 4, 2023 | 
jdsupra.com | Alison Andersen |Jack Bierig |Caroline English
*This is the 11th article in a series analyzing the No Surprises Act and its implementation. To view the entire series, click here. A link to the proposed rule is here. As background, Congress passed the Act to curb bills that patients receive when they are forced to obtain emergency care at an out-of-network facility or non-emergency care from an out-of-network provider at an in-network facility.
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Oct 3, 2023 | 
natlawreview.com | Eric Troutman |Caroline English |Alison Andersen |Michael J. Stortz
The 15th annual Climate Week NYC was hosted by the Climate Group from Sept. 17-24 in partnership with the United Nations (U.N.) General Assembly. Long before then, the world was on notice that things were going to be different this year. NASA recently announced that the summer of 2023 was Earth's hottest since global records were first kept in 1880. There is a substantial likelihood that 2023 will be the hottest year on record.
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Sep 8, 2023 | 
jdsupra.com | Alison Andersen |Jack Bierig |Caroline English
On August 24, 2023, health care providers in Texas scored yet another victory when a federal court vacated additional portions of the Biden Administration’s rulemaking under the federal No Surprises Act (the Act). This marked the second time in August alone that a federal court in Texas struck down rulemaking issued by the US Departments of Treasury, Labor, and Health and Human Services (the Departments) under the Act.
