The American College of Emergency Physicians has filed suit against HHS over a provision in the Affordable Care Act health law they say lets insurers get away with underpayments for out-of-network emergency care, Modern Healthcare reported.
Tag Archives: HHS
Don’t panic about House v. Burwell.
The Affordable Care Act obligates the federal government to reimburse health plans for cutting their low-income customers a break on their out-of-pocket payments. Whether or not there’s an appropriation for the cost-sharing reductions, that statutory obligation is enforceable in court—specifically, in the Court of Federal Claims.
Health plans that get stiffed can therefore sue the federal government for the cost-sharing reductions. Winning those cases should be easy: the plans will just have to show that they’re owed money under the ACA. And here’s the kicker: Congress has permanently appropriated the money to pay court judgments, even if it hasn’t appropriated money for the cost-sharing reductions.
The right question isn’t whether health plans will get paid. It’s when.
Two-midnight rule coming to an end; hospitals in line for one-time payment
Hospitals instead will receive a one-time payment of 0.6 percent next year to offset the 0.2 percent reduction implemented from 2014 through 2016.
Wyeth and Pfizer Agree to Pay $784.6 Million to Resolve Lawsuit Alleging That Wyeth Underpaid Drug Rebates to Medicaid
Opioid Epidemic Spurs Rethink On Medication And Addiction
New Health Policy Brief: Medicare’s New Physician Payment System
Two-midnight rule coming to an end; hospitals in line for one-time payment
What You Don’t Know About Your Doctor Could Hurt You
What Risk Adjustment Does — The Perspective Of A Health Insurance Actuary Who Relies On It
Obama budget would lift HHS spending to $1.1 trillion, entice Medicaid expansion
HENRY KOTULA 