Data and More Data; Good Data or Not so Good Data?

Good reliable data is necessary for public authorities, aided by medical professionals, to formulate sound strategies for dealing with COVID-19. An understanding of the progression of the pandemic, infection rates, death rates, and other data points will drive community efforts, treatments, outcomes, and economic decisions. But do we have good data concerning COVID-19? What is … Continued

Tossing Aside the Rule of Law, an “Op Ed” By James F. Koehler

Are we tossing aside the rule of law as we respond to the COVID-19 pandemic? I’m beginning to wonder. I can’t help but think the state-by-state designations of essential businesses have been arbitrary, inconsistent, and in some instances driven by politics and opportunity, certainly not by medical necessity. On March 19, 2020, the Cybersecurity & … Continued

COVID-19: Insurance Policy Considerations

As of March 31, the Coronavirus Resource Center of Johns Hopkins University reports that, in the United States, there have been approximately 177,452 people diagnosed with COVID-19 with 3,606 deaths being recorded.  It is an understatement that this new strain of Coronavirus will radically alter life in the United States – and the world – … Continued

ERISA Plan Disclosures Not “Actual Knowledge” Unless Read

ERISA requires plaintiffs with “actual knowledge” of an alleged fiduciary breach to file suit within three years of gaining that knowledge under 29 U. S. C. §1113(2). For plaintiffs without “actual knowledge, a 6-year period applies. The United States Supreme Court addressed the requirements for having “actual knowledge” in a case decided on February 26, … Continued

Balance Billing Defense, an “Op Ed” by James F. Koehler

The authors of this newsletter have followed, and occasionally written about, various state and federal legislative efforts to reign in and address the problem of balance bills, or as the legislators incorrectly name them, “surprise medical bills.” Incorrectly named because in many cases the bills are anticipated by the patient, albeit unknown in amount. “A … Continued

2019 Federal Health Care Legislation – Action or No Action

Funding for the ACA continues to be reduced. “As part of a 1.4 trillion dollar spending package the Senate passed [December 19, 2019] and which President Donald Trump has said he’ll sign, three taxes that were created to fund the Affordable Care Act are set to be repealed. The outgoing fees include the “Cadillac tax,” … Continued

Constitutionality of the ACA – A Brief Timeline and Update

State of Texas, et al. v. United States (N.D. Tex. Case No. 4:18-cv-167-O; 5th Cir. Case No. 19-10011) will follow the traditional litigation path and not be fast-tracked. Here is a look back over the case’s history: December 2017: Congress set the shared responsibility payment at $0 as of January 1, 2019 after enacting the … Continued

Non-Profit Hospitals Profit From Tax-Exempt Status

Approximately 60% of community hospitals are nonprofit hospitals.[1] A nonprofit hospital is a hospital that is granted 501(c)(3) status by the IRS. Nonprofit hospitals benefit from this status by being: Exempt from federal, state and local taxes; Permitted to receive charitable donations; and Allowed to issue tax-exempt bonds. To qualify for 501(c)(3) status, a hospital … Continued

The Fate of the ACA Remains Uncertain

On December 18, 2019, the 5th Circuit Court of Appeals entered its decision in State of Texas, et al. v. United States of America, Case No. 19-10011, which was on appeal from the District Court for the Northern District of Texas. As framed by the 5th Circuit, the narrow questions before the Court were whether: … Continued

Will Federal Surprise Billing Legislation Ever Move Forward?

As 2019 draws to a close, and despite a flurry of activity throughout the year, the House and Senate have been unable to reach agreement with respect to balance billing. Members of the House and Senate introduced a myriad of bills all targeting “surprise medical billing.” They held hearings and negotiations. They spoke repeatedly about … Continued