Almost two years ago, the American Academy of Emergency Medicine Physician Group (AAEM-PG) filed suit in the Superior Court of California against Envision Healthcare Corporation (Envision). The suit concerned Envision’s takeover of a contract to provide healthcare services at an emergency department at Placentia Linda Hospital from AAEM-PG.In addition to the damages AAEM-PG is
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Colorado's Peer Review Privilege in Peril
The confidentiality of medical staff peer review has long been a cornerstone of hospital operations, fostering an environment where physicians can candidly evaluate medical care without the looming specter of malpractice exposure. But this established norm is facing a new threat in Colorado, where a ballot proposal aims to gut peer review confidentiality.The Foundation of…
Office of Health Care Affordability Adopts Final Cost and Market Impact Review Regulations for Health Care Transactions
Office of Health Care Affordability Adopts Final Cost and Market Impact Review Regulations for Health Care TransactionsCalifornia’s new Office of Health Care Affordability recently adopted emergency regulations (Final Regulations) implementing the Health Care Market Oversight Program, required under California’s Health Care Quality and Affordability Act (HCQAA). HCQAA, which created the Office of Health Care Affordability…
Peer Review Hearings Are Not Court Trials: California Reaffirms Flexible Nature Of Fair Procedure
Peer Review Hearings Are Not Court Trials: California Reaffirms Flexible Nature Of Fair ProcedureThe California Supreme Court recently issued its decision in Boermeester v. Carry. Though the case deals with fair procedure within a private university’s internal disciplinary proceedings, it provides helpful guidance for peer review bodies navigating medical disciplinary hearings.
Boermeester reiterated the long-standing…
Managed Care Plans Take Note: OIG’s Managed Care Strategic Plan
With the tremendous growth of managed care over the last several years, the Medicare and Medicaid programs have had to transform how they fund health care for approximately 100 million enrollees. According to the Department of Health & Human Services’ Office of Inspector General (OIG), 2022 saw half of Medicare enrollees receive coverage through Medicare…
Introducing Nossaman’s Newest Podcast: Legal Prescriptions
We are excited to announce the launch of our newest podcast, Legal Prescriptions. This audio series will explore recent developments impacting healthcare companies and professionals, including legislation, reform, managed care, litigation, regulatory compliance and privacy. In addition to the innovative minds at Nossaman, we look forward to welcoming industry experts to the conversation to…
Peer Review or Employment? A Framework for Addressing Physician Performance Issues in Hospitals
Peer Review or Employment? A Framework for Addressing Physician Performance Issues in HospitalsCOVID-19 accelerated the trend of physician employment with hospitals, with recent data showing that nearly 70 percent of physicians are employed by hospitals or hospital-affiliated foundations or groups. While physician integration improves quality of care and clinical efficiency, it also blurs the separation…
CA DHCS Announces New MLR Requirements on Subcontractors, Including IPAs, RBOs and RKKs
CA DHCS Announces New MLR Requirements on Subcontractors, Including IPAs, RBOs and RKKsCalifornia’s Department of Health Care Services (DHCS) is in the final stages of establishing new Medical Loss Ratio (MLR) requirements in Medi-Cal Managed Care. Most significantly, the guidelines specify that the MLR program, which previously applied to Medi-Cal managed care plans, will now…
California Health Plans and Insurers, It’s Time to Prioritize Mental Health Parity Compliance
California Health Plans and Insurers, It’s Time to Prioritize Mental Health Parity ComplianceA recent California First District Court of Appeal (“Court”) decision, Futterman v. Kaiser Foundation Health Plan, Inc., (“Futterman”) has shed light on potential liabilities for noncompliance with the State’s mental health parity requirements.[1]
As background, the COVID-19 pandemic served as a catalyst…
Proposed Changes to the Health Breach Notification Rule
On May 18, 2023 the Federal Trade Commission (FTC) released a Notice for Proposed Rule Making (NPRM) for updates to the Health Breach Notification Rule, 16 C.F.R. Part 318 (the Rule). The Rule serves to ensure entities that are not defined as Covered Entities under the Health Insurance Portability and Accountability Act (HIPAA) are…