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Showing 7 posts in Hospitals.

On Thursday, the President held a White House event to discuss surprise medical bills, calling on Congress to pass bipartisan legislation to increase price transparency and limit patients’ out-of-pocket medical costs.  During his remarks, President Trump outlined the following policy principles to guide Congress in developing potential legislation: Read More ›

A number of our clients have provided medical care to patients covered by the now-defunct Riverstone Capital LLC multiple employer welfare arrangement (the “Riverstone MEWA”) and have still not been paid. This Alert offers an update on the liquidation proceedings in California federal court, and identifies steps that providers should take in order to protect their rights to payment in the coming months.

As background, Bakersfield, CA-based Riverstone Capital LLC was held after an investigation by the U.S. Department of Labor (DOL) to have mismanaged the Riverstone MEWA. Among other things, Riverstone failed to set adequate premiums, commingled funds, and charged excessive fees to over a hundred employers who hired Riverstone to provide healthcare benefits to their employees and dependents. Because there were insufficient assets to pay claims, Riverstone began to delay the payment of approved claims and "cherry-picked" which claims to pay. DOL found these actions to be serious violations of the Employer Retirement Income Security Act (ERISA), which governs the vast majority of the affected employers’ participating plans. Read More ›

A new round of putative class action lawsuits brought by counsel for patients who received treatment in a hospital emergency room alleging that hospitals charge emergency room patients a hidden and undisclosed “surcharge” or “cover charge” on top of charges for services provided is hitting hospitals throughout California. These suits are the progeny of prior unsuccessful putative class action lawsuits brought by the same plaintiff’s counsel alleging that hospitals’ charges for emergency services are unreasonably high and that the financial arrangements provision within the Conditions of Admission agreement signed by the patients requiring payment of charges are improper and not enforceable. Read More ›

On February 4, 2019, the California Court of Appeal affirmed a judgment awarding plaintiff, Dr. Kenneth Economy, substantial damages for his suspension and subsequent termination of his staff privileges at defendant Sutter East Bay Hospitals. The Court of Appeal held that, because Dr. Economy’s termination, even though done under the provisions of an exclusive contract, was based on “medical disciplinary cause or reason,” he was entitled to prior notice and a hearing in accordance with Business and Professions Code section 809 et seq. This decision flies in the face of the underlying premise for exclusive contracts: the ability for a hospital to enter into a contractual arrangement that allows it to set superior metrics in exchange for exclusive rights to provide services. Clinical issues have long been mandated to be within the purview of the medical staff but exclusive contracting gives hospitals the ability to contract for higher standards of quality of care. The severity of the Economy decision calls into question the accepted approach to exclusive contracts. Read More ›

Anthem Blue Cross recently issued two new internal Medical Policies that may constitute material amendments to Anthem's provider agreement and may have considerable adverse impact on hospitals' reimbursement under their agreements with Anthem.  Read More ›

For media assistance, please contact Maura Fisher at 202-580-7714.