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Ruling in La. Suit Boost for Out-of-Network Providers |
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Written by Scott Becker
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Friday, 18 January 2008 |
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A recent Federal Appellate Court Ruling from the 5th District regarding a dispute between Blue Cross and some hospitals in Louisiana sets a positive precedent for out-of-network providers and payments. The case started when two hospitals -- who had terminated their Blue Cross contracts due to too-low reimbursements -- filed a complaint with the Louisiana Department of Insurance against the company. In response, Blue Cross sent payment checks directly to patients for services provided by the two hospitals, forcing them to pursue patients for reimbursement -- a difficult task.
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The Tax-Exempt Board Fiduciary Duties in the Context of Evaluating Strategic Alternatives and Sales |
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Written by Scott Becker
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Friday, 18 January 2008 |
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A recent New York State hospital transaction highlights the challenging problem which the Board of Directors of a not-for-profit institution faces in the context of a sales transaction.1 In Manhatten Eye, Ear & Throat Hospital ("MEETH"), the Court denied the petitiion for judical authorization to sell substantially all of the assets of the Manhatten Eye, Ear & Throat Hospital. The Court held that the Manhatten Eye, Ear & Throat Hospital Board had not fulfilled its duties to the not-for-profit corporation. In contrast to a number of other cases involving the sale of not-for-profit assets, the Board was not criticized for failing to find the highest bidder for entering into self-dealing or self-interested transactions. Rather, the Board was criticized for not fulfilling its "duties of obedience" to the corporation's charitable purposes.
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Pharmaceutical Reimbursement Under the Medicare and Medicaid Programs |
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Written by Scott Becker
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Friday, 18 January 2008 |
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Pharmaceutical manufacturers and the federal government are increasingly at odds concerning Medicare's reimbursement of perscriptions drugs. In fact, Medicare only reimburses health care providers and suppliers for drugs perscribed and furnished to patients incident to services rendered.
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Court Holds Joint Collaboration Relationship Between Two Hospitals Per Se Illegal |
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Written by Scott Becker & Richard Rappaport
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Thursday, 17 January 2008 |
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A recent decision rendered by the U.S. District Court for the Southern District of New York is likely to lead many health and hospital systems to restructure and review joint operating and joint collaboration agreements that they have entered into over the past several years. The decision, in State of New York v. St. Francis Hospital, Vassar Brothers Hospital and Mid-Hudson Health, is likely to have a particularly large impact in smaller and mid-size communities.
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Physician-Owned Hospitals |
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Written by Scott Becker
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Friday, 11 January 2008 |
1. There are now nearly 200 hospitals in the country with physician-ownership of one kind or another.
2. This compares with 5,500 to 6,000 ASCs.
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Statement of the New Jersey Board of Medical Examiners on Physician-Ownership |
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Written by Scott Becker
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Friday, 11 January 2008 |
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At its regularly scheduled meeting on December 12, 2007 the Board of Medical Examiners reviewed the recent decision of Judge Robert P. Contillo, J.S.C. in Garcia v. HealthNet and Wayne Surgical Center and entertained an application from the Medical Society of New Jersey and other physician organizations (“Applicant”) seeking the issuance of a Special Advisory Opinion.
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MedPac Study |
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Written by Elissa Koch and Scott Becker
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Wednesday, 09 January 2008 |
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The Medicare Payment Advisory Commission (MedPac) was mandated by last year's Medicare Modernization Act (MMA) to assess the impact of specialty, physician-owned hospitals on general hospitals and how the current diagnosis related group ("DRG") payment system should be updated to better reflect the costs of care. The transcript from the October 28-29, 2004 meeting became available on November 7, 2004. Julian Pettengill, a research director for MedPac, presented the findings.
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Legal Issues
