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Do State Med Mal Caps Apply to EMTALA Cases?

State limitations on medical malpractice recoveries seem to be under almost daily attack. The latest serious threat comes from Louisiana, where a federal district court has authorized an interlocutory appeal of his ruling...more

Recovery of Medical Bills: Once Is Enough

Strange as it sounds, Missouri state law allowed federal workers to recover medical bills twice: once under their federal health insurance plan and again from the person (or person’s insurer) responsible for their injuries. ...more

The Downside of the Advice-of-Counsel Defense

Intent is a necessary element of a False Claims Act (FCA) violation. If a defendant reasonably relied on advice of counsel in performing the actions at issue, the intent element is absent. That’s the upside of the...more

Hospital Claim Dismissed for Want of Redressability

The recent decision in Dignity v. Burwell is interesting for three reasons. For one thing, it provides a reminder of the unfortunate fact that the acts (or inaction) of one party can adversely affect the fate of others—as...more

Two Times Twelve Doesn’t Necessarily Equal Twenty-Four

In the august halls of a federal courthouse, things aren’t always what they seem. Say, for example, court rules require that briefs must “be double-spaced and in 12-point font with 1-inch margins.” Knowing that a “point” is...more

Solid Victory for Ind. Med Mal Plaintiffs’ Bar

On April 7 the Indiana Supreme Court handed the plaintiffs’ bar a solid victory in the six-year battle that has raged since issuance of the 2011 Indiana Court of Appeals decision in K.D. v. Chambers. That decision was...more

Medicare Plans Sue Auto Insurers for Illegal Cost Shifting

When Medicare beneficiaries are taken to the ER after an auto accident, they’re likely to have their Medicare cards with them, but not their auto policies. This creates a problem for Medicare because Medicare is supposed to...more

Jurisdiction to Freeze Assets but Not to Thaw Them

A recent Fourth Circuit opinion in a False Claims Act case demonstrates that while the government can freeze defendants’ assets before trial with lightning speed, getting them unfrozen can take anywhere from many years to...more

Hail Mary Passes & Banana Peels

March 23 saw a rare spectacle in the courtroom of the Indiana Supreme Court: lawyers for a medical malpractice case plaintiff, supported by the Indiana Trial Lawyers as amicus, and lawyers for the physician defendant in the...more

Sometimes a Belt & Suspenders Aren’t Enough

Even the most cautious lawyer might think that Columbia North Hills Hospital had done enough to compel arbitration when a former employee sued for sexual harassment, retaliation, and negligence. The trial court thought so. ...more

Indiana Reaffirms Relaxed Rule for Med Mal Complaints

In Indiana a medical malpractice plaintiff doesn’t proceed directly to court. First, a proposed complaint goes to the Indiana Department of Insurance, and the case is heard by a Medical Review Panel consisting of physicians....more

A Contract Be too Good to Be True

If it sounds too good to be true, it probably is. A Florida Supreme Court decision provides a variation on the adage: if a contract looks too favorable to one side to be valid, it probably isn’t. Thirty-nine weeks...more

Government Wants to Settle, Whistleblowers Don’t

What happens when the government wants to settle a False Claims Act case, but the whistleblowers who filed the case don’t? That was the question before the U.S. District Court for the District of Colorado. Airport...more

HHS Secretary Backs Medicare Balance Billing

Generally speaking, patients really dislike balance billing. Sometimes called “surprise billing,” “balance billing” refers to billing a patient for the difference between the health care provider’s charge and the amount a...more

3/20/2017  /  Billing , Health Care Providers , HHS , Medicare

Rare Physician Win in Peer Review Lawsuit

Since enactment of the Health Care Quality Improvement Act in 1986, physicians haven’t usually fared well when they go to court to stop or delay hospital peer review actions, provided the hospitals follow the procedural steps...more

Should Accident Victims Recover their Medical Bills Twice?

Most of us think that accident victims should be able to recover for their medical bills. But recover twice? That issue is at the heart of the case argued before the United States Supreme Court on March 1. The Federal...more

New Medicare Fraud Defense: “My Mom Made Me Do It!”

Charged with 33 counts of Medicare fraud netting some $45 million in false claims, Richard Tinimbang invoked a novel defense: “My mom made me do it!” That, according to Law360, is the gist of the opening statement of...more

Will In-House Attorneys Reach for their Whistles?

The news is full of stories about whistleblowers collecting millions from their former employers. Surely at least a few in-house lawyers fantasize about that kind of payday. After all, who knows better than an in-house...more

When 30 Days Is Not 30 Days

Concerned about a surgeon’s skill, a hospital ordered him to “have five bowel surgery cases proctored,” specifying no time limit. After a month, when the surgeon hadn’t met the five-case requirement, the hospital filed an...more

Far-Fetched Whistleblower Claim of the Month

The hospital industry is accustomed to far-fetched whistleblower claims: allegations that a hospital knowingly submitted false or fraudulent Medicare or Medicaid claims or fired a whistleblower for trying to prevent such...more

Another Challenge to U.S. on Risk Corridor Payments

Molina Healthcare has joined the long line of insurers suing the government for failure to honor its obligations under the Affordable Care Act’s “risk corridor” program. According to Molina’s 84-page complaint filed Jan. 23,...more

Agency Law Takes Center Stage in Psychologist Torture Case

If you think agency law is boring, take a look at the Jan. 27 opinion by a federal court in the torture case brought by three foreign citizens against two psychologists who worked for the CIA. The plaintiffs filed suit under...more

Hospital Insists it Was Malpractice; Patient Disagrees

At first glance it looks like a “Man Bites Dog” headline. The hospital insists that the patient was injured by professional negligence; the patient vehemently disagrees. The argument goes all the way to the state court of...more

Medicare Appeal Proposal Falls Far Short of Court Mandate

For years the hospital industry has been in an uproar over the mountainous backlog of Medicare claim appeals. Current estimates are that a whopping 650,000 claims are at the Administrative Law Judge level awaiting...more

1/25/2017  /  ALJ , Appeals , CMS , HHS , Medicare

CMS Report Blasts Provider Directory Errors

A new report by CMS echoes many patients in criticizing Medicare Advantage (MA) online provider directories for containing too many errors. “Online Provider Directory Review Report” concludes that too often a directory entry...more

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