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Supreme Court Expands Scope of False Claims Act

by Tim Gaughan | Jul 10, 2023 | Action Reports, MAC News

Unanimous Decision Clarifies Knowledge Requirement for Liability Under False Claims Act Key Takeaway: In False Claims Act cases, the belief of the defendant determines “knowledge,” not an “objectively reasonable interpretation.” On June 1, 2023, the United States...

Student Loan Forgiveness Update: Supreme Court Strikes Down Biden Student Loan Forgiveness Plan

by Tim Gaughan | Jul 10, 2023 | Action Reports, MAC News

Biden Administration Announces New Actions to Provide Debt Relief and Support for Student Loan Borrowers, Alternate Path to Student Loan Relief Through Different Statutory Authority On June 30, 2023, the U.S. Supreme Court struck down the Biden Administration’s...

Updated 2023 Blue Cross Fee Schedule, Effective July 1!

by Tim Gaughan | Jun 28, 2023 | MAC Matters, MAC News

MAC Members Can Access a List of Frequently Used Codes and Their Updated Fees on the MAC Website The new Blue Cross Blue Shield fee schedule, effective Saturday, July 1, 2023, is now available. This new fee schedule applies to services provided to Traditional and...

With Blue Cross EDI Platform Moving to Availity This August, Consider Your Options Carefully

by Tim Gaughan | Jun 28, 2023 | MAC Matters, MAC News

In mid-April, Blue Cross Blue Shield of Michigan (BCBSM) announced that they will move their electronic data interchange services, known as EDI, to Availity®, effective August 2023. Prior to this transition, the MAC Insurance Relations team recommends researching and...

COA: Insurance Code Does Not Require Administrative Appeal as a Precondition to Sue Insurance Company Over Utilization Reviews

by Tim Gaughan | Jun 2, 2023 | Action Reports, MAC News

Published Opinion Holds That Appeals to DIFS Prior to Filing a Lawsuit is Wholly Discretionary “Because the plain language of the operative statutes and regulations permit an administrative appeal rather than require it, [plaintiff] was not required to appeal the...

New Michigan Law Regarding Prior Authorization Takes Effect June 1st

by Tim Gaughan | May 9, 2023 | Action Reports, MAC News

Process Designed to Be Quicker, More Effective, and Transparent By: Stephanie Davidson, MAC Insurance Relations Manager In April 2022, legislation promising prior authorization (PA) reform was signed into law by Governor Whitmer. The goal of the new law (Public Act 60...
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