Administrative Law, Civil Procedure, Insurance

Court Grants Unexpected Victory to Providers on Medicare DSH Adjustment

by Thomas W. Coons, Mark A. Stanley | Ober|Kaler on 4/18/2013

The United States District Court for the Eastern District of Pennsylvania’s opinion in Nazareth Hosp. v. Sebelius, slip op. no. 10-3513 furnished a surprising victory to two providers that challenged the calculation of the...more

Recent Changes Impact Appeal of Medicare Denials and Reimbursement Strategies

by Womble Carlyle Sandridge & Rice, PLLC on 4/17/2013

Recovery Audit Contractors (“RACs”) and other Centers for Medicare and Medicaid Services (CMS) contractors are charged with identifying overpayments made by Medicare to healthcare providers. However, with the increase in RAC...more

Judge Invalidates California Regulation on Estimating Replacement Costs for Homeowners Insurance

by Larry Golub, Samuel Sorich | Barger & Wolen on 4/4/2013

On March 25, 2013, Los Angeles Superior Court Judge Gregory Alarcon issued a decision which found the California Department of Insurance’s regulation on estimating replacement costs for homeowners insurance to be invalid. The...more

Subrogation Claims are “Equitable Relief” Governed by ERISA

by D. Michael Reilly | Lane Powell PC - ERISA Law on 3/26/2013

That subrogation claim you have might be governed by ERISA, at least in some circuits… Here’s the case of Thurber v. Aetna Life Insurance Company, __F.3d__ (2nd Cir. March 13, 2013) (Insurer’s counterclaim for return...more

Resubmission of Hospital Claims

by Thomas Hess, Tyler N. Williams | Dinsmore & Shohl LLP on 3/13/2013

On February 13, CGS Administrators, the Parts A and B Medicare Administrative Contractor for Kentucky and Ohio, relayed instructions to Medicare hospitals paid under the Inpatient Prospective Payment System from the Centers...more

Payment Matters: No Judicial Review of Contractor’s Finding of a High Payment Error Rate, a Condition for Extrapolation

by Mark A. Stanley | Ober|Kaler on 2/11/2013

Before a Medicare contractor can use extrapolation to determine an overpayment amount, the Medicare statute requires that it must make a finding that there is a sustained or high level of payment error or that documented...more

U.S. Supreme Court Holds Equitable Tolling Doctrine Does Not Apply To Administrative Appeal Deadline

by Anastasia (Ana) K. Anderson, Renee M. Howard, David B. Robbins | Perkins Coie on 1/28/2013

On January 22, 2013, the U.S. Supreme Court issued a unanimous decision in Sebelius v. Auburn Regional Medical Center, 568 U.S. _____ (2013), holding that hospitals cannot appeal Medicare inpatient reimbursement...more

California Federal District Court Holds Force-Placed Insurance Claims Not Preempted By National Bank Act

by BuckleySandler LLP on 1/7/2013

On December 11, the U.S. District Court for the Northern District of California refused to preempt under the National Bank Act claims that a mortgage lender breached its contract by force-placing a backdated flood insurance...more

The False Claims Act and Healthcare Providers: Key Results from 2012 and Likely Trends for 2013

by Ty Howard | Bradley Arant Boult Cummings LLP on 1/7/2013

From the perspective of False Claims Act (FCA) results, 2012 was a decidedly mixed year for healthcare providers. The bad news was quite bad—increased FCA scrutiny by the Department of Justice (DOJ) led to $3 billion of...more

Business Litigation Report -- December 2012

by Quinn Emanuel Urquhart & Sullivan, LLP on 12/21/2012

In This Issue: Firm News: ..Quinn Emanuel Deutschland Named “IP Law Firm of the Year” and “Patent Law Firm of the Year” by JUVE ..Intellectual Property Trial Lawyer Amar Thakur Joins Quinn Emanuel...more

Payment Matters: Providers Again Win in Medicare Disproportionate Share Adjustment Challenge

by Thomas W. Coons | Ober|Kaler on 12/13/2012

In a 2011 decision, Northeast Hospital Corp. v. Sebelius, 657 F. 3d 1 (D.C. Cir. 2011), the United States Court of Appeals for the District of Columbia Circuit ruled for the providers in a challenge to the Secretary’s...more

Governmental Actions That May Assist Insurance Recovery for Superstorm Sandy Claims

by Lynda A. Bennett, Andrew S. Zimmerman | Lowenstein Sandler LLP on 12/6/2012

Following the widespread destruction caused by “Superstorm Sandy,” the governors of New York and New Jersey declared states of emergency and issued numerous emergency executive orders and directives. Some of these orders have...more

Legal Challenges to ACA Not Quite Finished

by John LeBlanc | Barger & Wolen on 11/26/2012

If you thought that the legal battle over the constitutionality of the Patient Protection and Affordable Care Act ("ACA") was put to rest in NFIB v. Sebelius, you may want to pay attention to Liberty University v. Geithner. ...more

Court Denies Whistleblowers Motion for Summary Judgment Finding Agreements Specific Enough to Meet Anti-Kickback Statute Safe...

by King & Spalding on 11/26/2012

On October 29, 2012, the federal District Dourt for the Middle District of Florida denied a whistleblower’s summary judgment motion alleging that certain agreements failed to meet the safe harbors established under the...more

Missouri Court of Appeals Reverses and Renders Summary Judgment, Holding Insurer Not Liable For Indemnity Because TCPA Statutory...

by Burr & Forman on 11/9/2012

Plaintiff insurance company appealed the trial court’s summary judgment order in favor of Defendants who had settled an underlying action involving the allegedly unsolicited transmission of more than 10,000 faxes in violation...more

Sixth Circuit Overturns $82.6 Million Medicare Fraud Judgment

by McDermott Will & Emery on 11/5/2012

Based on the recent decision in United States, ex rel. Williams v. Renal Care Group, Inc., medical service providers in the Sixth Circuit that have established separate corporate entities to maximize corporate profits and...more

California Supreme Court Depublishes Decision that Found Claims Adjusters Not Exempt from California's Overtime Pay Requirement

by Barger & Wolen on 10/30/2012

On July 23, 2012, we reported that the California Court of Appeal (Second Appellate District) held in Harris v. Superior Court that claims adjusters for two insurers were not exempt from California’s overtime compensation...more

Proposed DHHS Settlement: Medicare Home Health, Skilled Nursing Service, and Therapy Service Coverage

by Manatt, Phelps & Phillips, LLP on 10/25/2012

In a proposed settlement to a nationwide class action lawsuit, the Department of Health and Human Services ("DHHS") has agreed to remove the unlawful "rule of thumb" implemented through Medicare's administrative review...more

Supreme Court Will Not Review Sixth Circuit Ruling That Government May Seek Full Reimbursement of Medicare Payments to Beneficiary...

by King & Spalding on 10/17/2012

On October 1, 2012, the United States Supreme Court said it would not review a decision by the U.S. Court of Appeals for the Sixth Circuit which ruled 2-1 that, upon settlement by a Medicare beneficiary with a third-party...more

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Administrative Law › Civil Procedure › Insurance