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Common control or overlapping ownership can change how to identify the "employer" for PPACA purposes
  • Baker & Hostetler LLP
  • USA
  • August 15 2012

This is the third in a series of Executive Alerts in the Special Health Care Reform Series


Providers get rare win in new Texas law protecting out-of-network referrals
  • Baker & Hostetler LLP
  • USA
  • July 2 2015

On June 1, 2015, Texas Governor Greg Abbott signed House Bill 574 into law protecting physicians and other providers from having their participating


340B guidance: eight key points covered entities should consider
  • Baker & Hostetler LLP
  • USA
  • September 10 2015

On August 27, 2015, the Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services (HHS


Texas surgical centers: Aetna improperly denies or underpays out-of-network claims
  • Baker & Hostetler LLP
  • USA
  • September 24 2015

Aetna is now facing another set of claims calling into question its determination and payment methodology for out-of-network reimbursement. On


Ohio's ‘Healthcare Simplification Act' imposes new restrictions on provider contracting and credentialing
  • Baker & Hostetler LLP
  • USA
  • March 28 2008

Ohio House Bill 125the ‘Healthcare Simplification Act'was unanimously approved by the Senate on March 11, 2008, and signed into law by Ohio Governor Ted Strickland on March 25, 2008


OIG sees through a radiology provider's plan and allows preauthorization services
  • Baker & Hostetler LLP
  • USA
  • August 30 2012

The U.S. Office of Inspector General (OIG) issued Advisory Opinion 12-10 on August 23, 2012, finding that a radiology group's proposal to offer free insurance preauthorization services to physicians and patients would be permissible


Insurer Actions Cut the Heart Out of Out-of-Network Providers
  • Baker & Hostetler LLP
  • USA
  • April 21 2016

Aetna Life Insurance Company recently won a $37 million verdict against a group of Northern California surgical centers, Bay Area Surgical Management


Medicaid managed care Proposed Rules: the intersection of private insurance and government programs
  • Baker & Hostetler LLP
  • USA
  • June 8 2015

Approximately a quarter of all Medicaid expenditures is spent on the more than half of all beneficiaries (approximately 39 million by 2011 figures


Waivers of co-pays and deductibles: insurance benefit exclusions grow
  • Baker & Hostetler LLP
  • USA
  • August 13 2015

Recent changes to policy and plan language and increased litigation by third-party payers suggests that out-of-network providers who waive co-pays and


OIG emphasizes proactive enforcement of privacy rule and monitoring of repeat offenders
  • Baker & Hostetler LLP
  • USA
  • November 11 2015

The Office of Inspector General's (OIG) recently released Privacy Standards report assessed the Office for Civil Rights' (OCR) oversight of covered