News & Events

The Time is Now for Reference-Based Pricing Plans

As if the standard issues facing businesses related to healthcare were not enough, businesses now have to deal with the COVID-19 pandemic. As it was, annual premiums were on the rise – increasing 5% in 2019 and predicted to increase 6% in 2020.[1]… Read More
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Section 1332 Waivers-Reinsurance

Section 1332 of the Affordable Care Act (ACA) allows states to apply for a State Innovation Waiver to pursue innovative strategies for achieving high quality, affordable health insurance and to to alter key ACA requirements in the individual and smal… Read More
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U.S. District Court Holds Department of Health and Human Services’ Price Transparency Rule is Constitutional

In November 2019, the Centers for Medicare and Medicaid Services (CMS), an agency within the Department of Health and Human Services, issued a Rule entitled Medicare and Medicaid Programs: CY 2020 Hospital Outpatient PPS Policy Changes and Payment Ra… Read More
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Looking for an Exit?

Before the onset of COVID-19, there existed a seller’s market for businesses. Clean, profitable businesses were in short supply. An abundance of private equity and historically low interest rates drove multiples to levels this author had not previo… Read More
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Surprise Medical Billing Statutes Ignore Fundamental Right

Surprise medical billing has been a key issue targeted by legislators across the country, including by the U.S. House and Senate. Surprise medical bills arise when a patient inadvertently receives care from an out-of-network provider, such as when a… Read More
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Balance Billing and COVID-19

On March 27, 2020, the President signed into law the Coronavirus Aid, Relief, and Economic Security Act (the “CARES Act”). The CARES Act has many components, one of which was to make $175 billion in Provider Relief Funds available to hospital fac… Read More
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Data and More Data; Good Data or Not so Good Data?

Good reliable data is necessary for public authorities, aided by medical professionals, to formulate sound strategies for dealing with COVID-19. An understanding of the progression of the pandemic, infection rates, death rates, and other data points… Read More
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Tossing Aside the Rule of Law, an "Op Ed" By James F. Koehler

Are we tossing aside the rule of law as we respond to the COVID-19 pandemic? I’m beginning to wonder. I can’t help but think the state-by-state designations of essential businesses have been arbitrary, inconsistent, and in some instances driven b… Read More
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COVID-19: Insurance Policy Considerations

As of March 31, the Coronavirus Resource Center of Johns Hopkins University reports that, in the United States, there have been approximately 177,452 people diagnosed with COVID-19 with 3,606 deaths being recorded. It is an understatement that this n… Read More
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ERISA Plan Disclosures Not "Actual Knowledge" Unless Read

ERISA requires plaintiffs with “actual knowledge” of an alleged fiduciary breach to file suit within three years of gaining that knowledge under 29 U. S. C. §1113(2). For plaintiffs without “actual knowledge, a 6-year period applies. The Unite… Read More
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