Spending to Save

On September 22, 2022
When COVID-19 arrived in 2020, during the early days of the pandemic, patients were driven by fear to avoid hospitals, as those facilities were inundated with victims of the coronavirus. As a result, chronic diseases went untreated, and complications arose. Early signs of catastrophic diseases – which (if caught early) could be dealt with – went undiagnosed.

More Twists to the IDR Process in the No Surprises Act?

On August 25, 2022
The latest final rule on the No Surprises Act has finally been released by the U.S. Departments of Health and Human Services, Labor, and Treasury. There are some important clarifications made in this latest rule, including confirmation that the Qualifying Payment Amount (QPA) is no longer the presumptive out-of-network rate.

Marietta Memorial Hospital Employee Health Benefit Plan v DaVita Inc. - Dialysis Carve-Out

On August 2, 2022
In one of last month’s momentous Supreme Court cases, Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita Inc., the justices confronted the legal question of whether the health plan covering employees of a small Ohio hospital contained a dialysis carve-out discriminating against participants with end-stage renal dialysis (ESRD). The Court, in a 7-2 decision, ruled that there was no such discrimination because the dialysis carve-out neutrally applied to all outpatient dialysis claims, not just those involving ESRD, and thus did not violate the Medicare Secondary Payer Act (MSP). While the Court’s ruling in favor of Marietta Memorial Hospital was surely a major victory for health plans implementing dialysis carve-outs, as well as plan sponsors, the contextual background to this case speaks to some critical underlying issues in the healthcare industry.

HHS Proposes Rules for 1557 Covered Entities

On August 1, 2022
On July 25, 2022, HHS announced a proposed rule that would strengthen the protections granted by Section 1557 of the ACA in various contexts. In line with the administration’s previous interpretations of the Supreme Court’s holding in Bostock v. Clayton County, HHS reinforces that 1557’s protections against discrimination based on “sex” extend to sexual orientation and gender identity.

The Forum Redux

On July 21, 2022
After a three-year hiatus, The Phia Forum resumed on July 11th, exclusively geared toward Independent Consultation and Evaluation (“ICE”) clients, many of whom have been using Phia’s health care cost containment services for over two decades. During the two days of events, the first of which occurred at The Phia Group’s new office in Canton, Massachusetts, “ICE” clients enjoyed seminars highlighting enhancements to current services while learning how new developments in healthcare—and American legal landscape— will impact their businesses.

One Lesson We Must All Learn from Dobbs v. Jackson Women's Health Organization

On July 14, 2022
Many – from neighbors to the media – are buzzing about the Dobbs v. Jackson Women's Health Organization decision, handed down by the Supreme Court. Of course, many (most?) of those people discussing this case might not even know the name of the case; referring to it instead as the “Roe v. Wade” case, or the case that overturned Roe.

Transparency in Coverage Compliance? | The Phia Group

On June 16, 2022
It’s Almost July 1st – Are You Ready for Transparency in Coverage Compliance?

A Love Letter to Plaintiffs’ Attorneys Everywhere

On June 7, 2022
You know, in the modern information and technological age it is rather easy to forget that we are not in Kansas, anymore, i.e. the 1990s; anything you say or do on the internet can be accessed by the masses, can and will be used against you, and it will never go away. On the same token, it is important to understand the intended audience and perspective of the speaker and even perhaps get to know the person before you judge them based on what I, personally, would consider a (negligent, at worst) throw away phrase.

The Baby Formula Shortage and Preventive Care

On May 31, 2022
The baby formula shortage in the United States has been worsening for months. Our country’s supply was already squeezed by a perfect storm of pandemic-related supply chain issues and inflation costs. Then, with the detection of dangerous bacteria leading to the sickening and death of several infants, Abbott Nutrition shut down its Michigan plant in February – a plant that formerly supplied nearly one-fifth of all the baby formula in the country.

Limits of Arbitration Provisions on Participant ERISA Claims

On May 9, 2022
A recent sixth circuit decision shows limits of arbitration provisions on participant ERISA claims. Read our blog to find out the latest actions taken.

Medical Tourism Increases from Abortion Law | The Phia Group

On May 3, 2022
Trying to find out why medical tourism has increased? Read our blog to learn about medical tourism and the reason why it may be increasing.

State Law Development: Abortion Restriction | The Phia Group

On April 27, 2022
Looking for more information on abortion restrictions? You can read about different case studies involving the supreme court and their precedence.

The Mess in the American Healthcare System | The Phia Group

On April 25, 2022
Do you have someone to relate to when it comes with the health care system? This blog discusses some of the hardships people go though with healthcare.

California Law Still Governs Most Surprise Bills

On April 14, 2022
Learn about the letter California recently issued detailing the relationship between the No Surprises Act and their existing balance billing protections.

Texas’ New Pre-Authorization Exemption Law

On April 4, 2022
Learn about the new pre-authorization exemption law in Texas and whether this would prohibit health plans from incentivizing pre-authorization.