White Paper

Lessons Learned from FCA Settlement Involving Waiver of Medicare Coinsurance Amounts

 
The waiver of copayments, coinsurance, and deductibles owed by patients treated by out-of-network laboratories and other providers is a hot topic in the health care industry. Despite the near absence of clear legal prohibitions on this practice, commercial insurers are aggressively pursuing out-of-network providers who fail to collect amounts owed by their members under a variety of statutory and common law theories.

For example, in 2015, Aetna filed suit against Health Diagnostic Laboratory (HDL), Tonya Mallory (HDL’s former CEO), and BlueWave Health Care Consultants (an independent sales group), alleging that they engaged in a variety of illegal actions, including the failure to collect any amounts owed by Aetna’s members, and that Aetna overpaid for services provided by HDL as a result. While HDL settled, Aetna continues to pursue its claims against Ms. Mallory, who recently failedin her efforts to have the case against her dismissed. However, a recent court decision may give providers some comfort.

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Karen Lovitch is the Practice Leader of Mintz Levin Cohn Ferris Glovsky and Popeo P.C.’s Health Law Practice. She counsels health care clients on regulatory, transactional, and operational issues, including Medicare coverage and reimbursement, the development and implementation of health care compliance programs, and licensure and certification matters. In addition, Karen advises clients on the legal, practical, and fraud and abuse implications of business arrangements and sales and marketing practices.

Agenda

Faculty

Karen S. Lovitch

Mintz Levin Cohn Ferris Glovsky and Popeo P.C.

" Member of the law firm of Mintz, Levin, Cohn, Ferris, Glovsky and Popeo P.C. in the Washington, D.C. office

" Practice Leader of the Health Law section

" Counseled health care clients on regulatory, transactional and operational issues, including Medicare coverage and reimbursement; the development and implementation of health care compliance programs; and licensure and certification matters

" Advises clients on the legal, practical, and fraud and abuse implications of business arrangements

" Expertise includes the anti-kickback statute, the Stark law and state statutes prohibiting kickbacks and self-referrals

" Special expertise in the representation of clinical laboratories and regularly counsels laboratories on compliance issues

" Recognized by Nightingale's Healthcare News as an Outstanding Young Healthcare Lawyer

" Written and lectured on a variety of issues confronting laboratories and others in the health care industry

" Graduate, summa cum laude, West Virginia University

" J.D. degree, magna cum laude, Washington College of Law at The American University

" Contact her at 202-434-7324 or [email protected]

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