Avoiding Balance Billing and the Waiving Copays and Deductibles Liability


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Title: Avoiding Balance Billing and the Waiving Copays and Deductibles Liability


Presenter: Rachel Rose, JD, MBA

Time: 1.07 hours


Description: Routinely writing off out-of-network or government program co-payments or deductibles, without meeting individual financial hardship exceptions, will most certainly land you in hot water-unless you know exactly how to comply with the fraud, waste, and abuse laws. In this webinar, Rachel Rose, Attorney at Law, helps you recognize these legal requirements and monitor your waivers to avoid compliance violations and penalties.




  1. Understand relevant definitions.
  2. Discuss healthcare industry billing, coding, and claims.
  3. Examine the No Surprises Act.
  4. Recognize how to avoid False Claims Act liability via Stark Law and AKS violations attending copays.
  5. Review and conclude.


Key Topics:


  • Copay vs Deductible
  • OIG Special Bulletin August 2002
  • Balance Billing
  • September 7, 2020 – ABA Article
  • Professional Courtesy
  • Professional Courtesy and Stark Law
  • U.S. Health Industry Overview
  • U.S. Healthcare System History
  • New York 1933
  • Blue Shield
  • HMOs
  • Kaiser
  • Medicare and Medicaid
  • Medicare Part D, CHIP, & ACA
  • HMO vs PPO vs POS
  • HIPAA Requirements
  • Claims Forms
  • Coordination of Benefits
  • No Surprises Act – Enacted as Part of the Consolidated Appropriations Act
  • Surprise Billing
  • Consolidated Appropriations Act
  • No Surprises Act
  • Air Ambulance Service
  • Cost Sharing and Payment Methodologies
  • Patient Cost Sharing Responsibilities
  • The Multi-Agency Interim Final Rule
  • Federal Register
  • Five Areas Addressed in the Interim Rule
  • Cost Sharing
  • Emergency Services
  • Emergency Medical Condition
  • The NSA’s Independent Dispute Resolution Process
  • IDR Process
  • CMS – No Surprises Act Items
  • Relevant Case – False Claims Act, AKS, and Stark




Rachel V. Rose, JD, MBA - Principal.




Ms. Rose has a unique background. Throughout her career, she has accumulated knowledge in a multitude of fields, with an emphasis on various facets of healthcare. Her experiences include:

  • working on Wall Street and at one of the "Big Four" consulting firms;
  • producing for the Chairman of the Reform and Oversight Committee on Capitol Hill;
  • interning at the Department of Health and Human Services;
  • compiling policy papers at the Royal College of Nursing in London;
  • consultative work as a top performing representative for the pharmaceutical and medical device industry;
  • clerking for the Honorable Linda R. Allan (6th Judicial Circuit, FL).


Prior to opening her law firm, she was Director of Business Development and Assistant General Counsel for a healthcare advisory company.


She is extensively published and presents on a variety of healthcare, False Claims Act and securities law topics including: cybersecurity, qui tam, physician reimbursement, ICD-10, access to care, anti-kickback and Stark laws, U.S. Supreme Court cases impacting the medical device industry, international comparative healthcare laws, and the HIPAA/the HITECH Act.

Presently, she is the immediate past-chair of the Federal Bar Association's Corporate and Associations Counsel Division (2014-2016), one of eighteen lawyers, who serves on the Federal Bar Association's Government Relations Committee. Ms. Rose has co-authored The American Bar Association's books - The ABCs of ACOs and What Are International HIPAA Considerations?, as well as being a co-editor of American Health Lawyers Association’s Enterprise Risk Management Handbook (2nd Edition). Ms. Rose is also an Affiliated Member of the Baylor College of Medicine's Center for Health Policy and Medical Ethics, where she teaches bioethics and is on the University of Houston Law School's Healthcare Law Advisory Board.



  • Bachelor of Arts- History (The Pennsylvania State University)
  • Master of Business Administration (Vanderbilt University)
  • Doctorate of Jurisprudence (Stetson University College of Law); Editor, The Journal of International Law and Aging


Honors and Awards

  • National Scribes Award
  • The William F. Blews Pro Bono Service Award
  • Federal Bar Association Fellow
  • Named to Texas Bar College
  • National Women Trial Lawyers Association - Top 25,, 2018 and 2019
  • Houstonia Magazine's Top Lawyers- Healthcare Law, 2018 and 2019



  • Texas