The United States Supreme Court recently declined review of the First Circuit Court of Appeals’ ruling that the University of Massachusetts Medical School was an “arm of the state,” and thus, not subject to the federal False...more
On June 16, 2016, the U.S. Supreme Court issued a highly anticipated opinion in Universal Health Services, Inc. v. U.S. ex rel. Escobar, which for the first time expressly recognized implied certification as a viable theory...more
Yesterday, the U.S. Supreme Court issued a long-anticipated decision on the viability of the “implied certification” theory of liability under the False Claims Act (FCA). In Universal Health Services, Inc. v. United States ex...more
The U.S. Supreme Court recently held oral arguments in the case of Universal Health Services, Inc. v. U.S. ex rel. Escobar, No. 15-7, which is set to decide the viability of implied certification under the FCA. As discussed...more
The United States Supreme Court recently granted certiorari in the case of Universal Health Services, Inc. v. U.S. ex rel. Escobar, No. 15-7, which places implied certification under the False Claims Act (FCA) squarely in the...more
Aetna is now facing another set of claims calling into question its determination and payment methodology for out-of-network reimbursement. On September 4, 2015, six surgical centers in Texas (Allied Center for Special...more
9/29/2015
/ Aetna ,
Ambulatory Surgery Centers ,
Denial of Benefits ,
Denial of Insurance Coverage ,
Employee Retirement Income Security Act (ERISA) ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Insurance Industry ,
Life Insurance ,
Out-of-Pocket Expenses
On February 23, 2015, Aetna filed suit in Texas federal court against Robert A. Behar, M.D. and North Cypress Medical Center (North Cypress), alleging that Dr. Behar, the CEO of North Cypress, offered impermissible ownership...more
8/31/2015
/ Aetna ,
Breach of Duty ,
Contingency Fees ,
Employee Retirement Income Security Act (ERISA) ,
Fiduciary Duty ,
Healthcare ,
Healthcare Fraud ,
Hospitals ,
Insurance Industry ,
Lanham Act ,
Life Insurance ,
Malicious Prosecution ,
Out of Network Provider ,
Patient Referrals ,
Real Party in Interest ,
RICO ,
Tortious Interference
The Southern District of New York has spoken on one of the first issues to confront those seeking compliance with the new “60-day rule” under the Affordable Care Act (ACA), and it does not bode well for defendant hospitals...more
8/14/2015
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
CID ,
Civil Investigation Demand ,
Compliance ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare ,
Hospitals ,
Medicaid ,
Medicare ,
Medicare Part A ,
Medicare Part B ,
Medicare Part D ,
Overpayment ,
Overpayment Recovery Time Limits
Aetna Life Insurance Company (Aetna) is going on the offensive against a Northwest Houston hospital with an out-of-network strategy. On February 23, 2015, Aetna filed suit in Texas federal court against Robert A. Behar, M.D....more