Tag:Health Insurance
NBA Healthcare Fraud Scheme
Krista Solano Associate Editor Loyola University Chicago School of Law, JD 2023 Eighteen former NBA players were charged with defrauding the league’s health and welfare benefit plan. The former players were charged under 8 USC Section 1347, otherwise known as the federal healthcare fraud statute. The fraud scheme submitted $3.9 million in fake claims, for …
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Senate Brings Bipartisan Attempt to Update Health Privacy Regulations
On February 9, a group of senators led by Tammy Baldwin of Wisconsin and Bill Cassidy of Louisiana introduced a new bill, the Health Data Use and Privacy Commission Act (the “Act”), in attempt to revitalize current legislation regarding the protection and use of health data. The bill also has the support of a number of representatives from within the healthcare industry, including Epic, IBM, and Teladoc Health, as well as a number of professional associations like the American College of Cardiology, the Association for Behavioral Health and Wellness, and the Association of Clinical Research Organizations.
Decriminalization Is Not Enough, Abolition Is a Must
In the United States, since the 1980s, the federal prison population has increased by roughly 790%. Specifically, presently within Illinois, there are approximately 76,000 citizens who are incarcerated. In 2014, Illinois appropriated and spent nearly $1.3 billion on prison budgets. Where even though cannabis is now legal, in Illinois, roughly 90 inmates are still incarcerated for offenses relating to the use, manufacturing, and selling of cannabis. According to the Last Prisoner Project, inmates remain incarcerated even though House Bill 1438 establishes that persons who have been convicted on an offense are granted a pardon because the Bill provides no resentencing or commutation procedures, and the process to have sentences pardoned is slow.
In examining the injustices of carceral punishment, statistics like these show that these injustices are not an anomaly, but rather the norm. Because prisons are premised on punishment, rather than transformative healing, health, and prevention, prisons are a human rights issue, rather than a criminal justice issue. Prisons are premised on punishment, rather than transformative healing and health, and prevention. As a result, resources and funding which are currently given to our present system of policing and prisons should be reallocated to tools that actually serve the community, rather than on incarceration.
Advancing Abolition Is a Must — Abolition Means Transformative Wellbeing and Prevention
Policing is a settler colonial creation to control native populations and is exported aboard to teach other empires how to do the same. In 2007, the FBI found that cops averaged roughly four hundred “justifiable homicides” every year, whereas nearly eighty cops were murdered in the line of duty. These disparities have only further developed, where since 2014, cops averaged nearly one thousand homicides each year, and the number of cops killed in the line of duty remained around forty-eight. Policing and prison systems are premised on punishment, rather than transformative healing, health, and prevention. Thus, as stated in Decriminalization Is Not Enough, Abolition Is a Must, resources and funding which are currently given to our present system of policing and prisons should be reallocated to tools that actually serve the community, rather than on incarceration.
Justice is a means through which people can discuss, decide, and create environments that encourage them thrive and it involves the people who are most impacted by those conditions. In that vein, abolition will look different in each community. The goal of abolition should be prioritizing the needs of each community by allowing the community control and ultimate decision-making ability. Abolition allows each community to communicate, prioritize, and enact methods and means that will make that community the best environment for its members. As Dereka Purnell wrote in Becoming Abolitionists, “activists or abolition-curious people will often ask me, ‘What does abolition look like to you?’ My answers change all the time during conversation, especially since I believe that the dreaming and practicing should happen together. This is what I’m thinking about today as I’m writing the conclusion to this book. Every neighborhood would have five quality features: a neighborhood council; free twenty-four-hour childcare; art, conflict, and mediation centers; a free health clinic; and a green team.” Upon community needs, discussion, and approval, funds currently spent on police and prison systems should be reallocated to education, housing, health care, and public spaces.
The Supreme Court Is Not Protecting Women’s Rights, so Will the 49th Anniversary of Roe v. Wade Be Its Last?
In 1973, the Supreme Court ruled in Roe v. Wade that states could not create onerous requirements that interfered with a patient’s right to an abortion up to the point of viability of the fetus, which was around 24 weeks. Roe and Planned Parenthood v. Casey established and protected patients’ rights to privacy and healthcare autonomy in reproductive health. However, as I previously explained in Abort Texas’ New Abortion Law, Texas’ new law erodes that decision. On January 20, 2022, the Supreme Court was presented with the opportunity to address this issue. The Court denied Texas abortion clinics’ request to immediately return to litigation over the Court’s acceptance of Texas’ six-week abortion law. However, the threat to reproductive health is not isolated to Texas; other states have enacted similar laws.
President Biden’s COVID-19 Data-Driven Executive Order to Promote Health Equity
President Joe Biden has issued a number of Executive Orders, many of which address the ongoing COVID-19 public health emergency. On January 21, 2021, President Biden released another pillar of his Administration’s long-term plan to direct the United States out of the throes of the pandemic. The twelfth Executive Order titled, “Ensuring a Data-Driven Response to COVID-19 and Future High-Consequence Public Health Threats” orders the Department of Health and Human Services (“HHS”) Secretary Alex Azar to conduct a nationwide review of the interoperability of public health data systems in an effort to enhance the collection, sharing, analysis, and collaboration of de-identified patient data.
Vertical Healthcare Companies Merging Compliance Programs
Vertical Healthcare Companies Merging Compliance Programs Perri Nena Smith Senior Editor Loyola University Chicago School of Law, JD 2021 In 2020, The Federal Trade Commission (“FTC”) and the Department of Justice (“DOJ”) released guidelines for vertical mergers to give clarity to companies so they can avoid harmful mergers. Healthcare companies are an industry that has been …
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Federal Relief of Regulatory Oversight Burdens in Medicaid Final Rule
he Centers for Medicare & Medicaid Services (“CMS”) refined the Medicaid and Children’s Health Insurance Program (“CHIP”) Managed Care final rules. CMS originally released the final rules in 2016 and another revision in 2018. After several cumulative comments on 2016 and 2018 final rules, CMS attempted to create more flexibility for States with managed care delivery methods. CMS’s third version of the final rules is more of an attempt to clarify and fix technical errors than giving States more flexibility to operate their managed care organizations.
Antitrust & The Competitive Health Insurance Reform Act of 2020
The Competitive Health Insurance Reform Act of 2020 (“CHIRA”) was signed into law on January 13, 2020, shifting not only how health insurance markets operate but lowering the bar for federal government agencies to bring successful actions against anticompetitive behavior. Prior to becoming law, health insurance companies retained robust antitrust exemptions under the McCarran-Ferguson Act (the “Act”). While it does not completely eliminate antitrust exemptions, the passage of CHIRA sent a strong signal that the federal government intended to promote competitive conduct in health insurance markets and limit the scope of these antitrust exemptions. While the upshot is that consumers may benefit from increased access and potentially lower cost, the health insurance industry must begin to adjust its conduct or face contentious litigation.
Developments Surrounding ERISA Preemption
The Employee Retirement Income Security Act (“ERISA”) regulates the administration of employee benefit plans. ERISA aims to protect the interest of employee-beneficiaries by setting minimum standards for employee benefit plans and voluntarily established pensions. The Act’s preemption clause works to prevent states from regulating these same plans. Initially, a state statute was considered to violate the preemption clause when it possessed, “a connection with, or reference to, covered employee benefit plans.” A few years later the standard was modified, states were considered to have violated ERISA preemption if the state, “mandates employee benefit structures or their administration.”