Core Finance Team Affiliates, LLC v. Maine Medical Center—The Distinction Between Quantum Meruit and Unjust Enrichment What is the difference between a claim of quantum meruit and unjust enrichment? This very issue was addressed in Core Finance Team Affiliates, LLC v. Maine Medical Center and is discussed in this article. The legal profession is famously hidebound; for goodness’ sake, they still where robes and wigs in English courts. As a result, they still throw around many Latin phrases, which can lead to confusion. In Core Finance Team Affiliates, LLC v. Maine Medical Center, 2024 ME 78, 2024 Me. LEXIS 85…
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Healthcare Cost Drivers CMS found that overall healthcare spending growth has decreased slightly but is still elevated compared to pre-pandemic levels and is expected to continue to moderately grow. This article examines the factors underlying the forecasts. On June 25, 2025, the Centers for Medicare and Medicaid Services (CMS) released its forecast on U.S. healthcare spending through 2033. The analysis, published in Health Affairs, estimated healthcare spending growth in 2024 and projected the growth into 2033. CMS found that overall healthcare spending growth has decreased slightly but is still elevated compared to pre-pandemic levels, and is expected to continue to…
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Valuation Implications The U.S. government is the largest payor of medical costs, through Medicare and Medicaid, and consequently has a strong influence on reimbursement to healthcare providers. The 2025 proposed fee changes are significant. This article focuses on the proposed fee changes and how these changes may affect valuations of healthcare practices. The U.S. government is the largest payor of medical costs, through Medicare and Medicaid, and consequently has a strong influence on reimbursement to healthcare providers. The prevalence of these public payors in the healthcare marketplace often results in their acting as a price setter and being used as…
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and Business Valuations This article delves into the key factors that shape the value of healthcare services, from cost behavior to pricing strategies, and offers insights into how valuation professionals can navigate this complex terrain. “Healthcare services are a fundamental necessity, and understanding the key drivers of value in medical practices and healthcare businesses is essential for conducting a robust valuation analysis.” This article delves into the key factors that shape the value of healthcare services, from cost behavior to pricing strategies, and offers insights into how valuation professionals can navigate this complex terrain. Healthcare services are delivered within a…
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Center for Medicare & Medicaid Publishes Proposed and Final Rules on Medical Reimbursement Rates The U.S. government is the largest payor of medical costs, through Medicare and Medicaid, and consequently has a strong influence on physician reimbursement. The prevalence of these public payors in the healthcare marketplace often results in their acting as a price setter and being used as a benchmark for private reimbursement rates. Consequently, changes to Medicare and Medicaid payment rates are notable as they may indicate a shift in the greater healthcare reimbursement landscape. Over the summer, the Centers for Medicare & Medicaid Services (CMS) released…
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Regulatory (Part IV of V) As noted in the first installment of this five-part series, an ambulatory surgery center (ASC) is a distinct entity that primarily provides outpatient surgical procedures to patients who do not require an overnight stay after the procedure. ASCs typically provide relatively uncomplicated surgical procedures in a non-hospital, outpatient setting, and most ASC cases are non-emergency, noninfected, and elective. This fourth installment will discuss the regulatory environment in which ASCs operate. [su_pullquote align=”right”]Resources: Valuation of Ambulatory Surgery Centers—Introduction (Part I of V) Valuation of Ambulatory Surgery Centers—Competition (Part II of V) Valuation of Ambulatory Surgery Centers—Reimbursement…
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Reimbursement Environment (Part III of V) The U.S. government is the largest payor of medical costs, through Medicare and Medicaid, and has a strong influence on healthcare reimbursement. In 2017, Medicare and Medicaid accounted for an estimated $705.9 billion and $581.9 billion in healthcare spending, respectively. The prevalence of these public payors in the healthcare marketplace often results in their acting as a price setter and being used as a benchmark for private reimbursement rates. This is particularly true for RHCs, which tend to serve a disproportionately large Medicare population. This third installment in the five-part series on RHCs will…
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What Tax Reform Could Mean for Annuities Republican lawmakers have said a tax overhaul framework would retain incentives meant to encourage retirement security, but uncertainty remains about the direction that reform will take. This article summarizes several ways changes in federal tax laws could affect annuities, charitable giving, and other aspects of retirement planning. To read the full article in ThinkAdvisor, click: Seven Ways the New Tax Fight Could Hit Annuities.
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CBO: Partial Repeal of ACA Could Lead to 18M People Losing Insurance Some 18 million people could lose health insurance in the first year after a partial repeal of the Affordable Care Act, and the number could grow to 32 million by 2026, according to a Congressional Budget Office report. However, Sen. Orrin Hatch, R-Utah, said the analysis represented “a one-sided hypothetical scenario” that did not account for reforms lawmakers could implement. To read the full article in The New York Times, click: Health Law Repeal Could Cost 18 Million Their Insurance, Study Finds.
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Compensation for PCPs is increasing The increasing supply shortage of primary care physicians (PCPs) will have a significant impact on physician compensation. In turn; this will have an equally powerful effect on the valuation of PCP practices.
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How the ACA impacts the valuation of physician-owned hospitals Nick Janiga and David Walline of HealthCare Appraisers, Inc. (HAI) examine how the Affordable Care Act (ACA) affects the valuation of physician-owned hospitals and what the future holds for the 240 such medical institutions across the country.
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Details Found in IRS Explanation Issued Wednesday; $20,000 Figure Based on a Family of Four. In a final regulation issued Wednesday, January 30, 2013, the Internal Revenue Service (IRS) assumed that under Obamacare the cheapest health insurance plan available in 2016 for a family will cost $20,000 for the year. Under Obamacare, Americans will be required to buy health insurance or pay a penalty to the IRS. The news was reported by Huffington Post, CNS News, Catholic News, Investment Watch, Economonitor, Naked Capitalism, Investor Village, and more. The Journal of Accountancy offered detailed analysis of the new regulations, and NPR weighed in…
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2013 California Filings: Aetna: 22 percent. Anthem Blue Cross: 26 percent. Blue Shield of California: 20 percent. Reed Abelson at the New York Times reported last week that health insurance companies across the country are seeking and winning double-digit increases in premiums for some customers, even though one of the biggest objectives of the Obama administration’s health care law was to stem the rapid rise in insurance costs for consumers. More:
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Metropolitan Corporate Counsel interviews Monte I. Dube, Partner, and Elizabeth M. Mills, Senior Counsel, of Proskauer’s Health Care Department in Chicago. Excerpts: What are the current trends in M&A within the healthcare industry? Dube: Increasingly and for multiple reasons, U.S. hospitals and healthcare systems of all types are looking for potential partnerships or affiliations. Financially distressed organizations are seeking capital and expertise to help them weather the storm, and governmental hospitals are looking to privatize, often for the purpose of monetizing assets or balancing the budget. We’re also seeing strong and vibrant hospitals and healthcare systems conclude that they need…