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FCA Issues to Watch: FCA Claims Concerning Physician Compensation

by Bass, Berry & Sims PLC on

Physician employment arrangements with hospitals have remained a significant area of regulatory scrutiny in recent months with the announcement of several high profile settlements and decisions in key FCA cases involving...more

“But Our Vendor Handles Everything — How Can We Still Have Fiduciary Liability?”

by Foley & Lardner LLP on

As the rules governing retirement and health plans grow more complex, employers often need professional help in order to keep up with the day-to-day management of the employee benefit plans they sponsor. From third-party...more

The ERISA Litigation Newsletter - January 2017

by Proskauer Rose LLP on

Editor’s Overview - In 2016, we saw a considerable uptick in the number and variety of excessive fee lawsuits commenced against plan fiduciaries of defined contribution plans. We begin the year by taking a look at these...more

Seventh Circuit Recognizes “Substantial Truthfulness” Defense to Tortious Interference Claims under Wisconsin Law

by Foley & Lardner LLP on

As we wrap up another election cycle that has kept “fact checkers” working overtime analyzing the many dubious claims by candidates of all political persuasions, the Seventh Circuit has issued a decision that reminds us of...more

An Expanding Universe of Healthcare Provider Liability: The United States Supreme Court Endorses “Implied False Certification”...

by Seyfarth Shaw LLP on

Seyfarth Synopsis: In Universal Health Services Inc. v. U.S. et al. ex rel. Escobar et al., the United States Supreme Court found a healthcare provider liable under the False Claims Act (“FCA”) for material omissions on...more

Court Orders Cigna to Pay Out-of-Network Surgical Claims

by King & Spalding on

On June 1, 2016, the United States District Court for the Southern District of Texas ordered Cigna to pay nearly $13.7 million to Humble Surgical Hospital, LLC (“Humble”). Of the nearly $13.7 million, almost $11.4 million...more

Do Your Assignment of Benefits Clauses Need a Check-up? Recent Southern District of Florida Decision Highlights the Importance of...

by K&L Gates LLP on

A frequently litigated issue in reimbursement cases brought by in- and out-of-network healthcare providers against insurers under the Employee Retirement Income Security Act of 1974 (“ERISA”) is provider standing. Because...more

The ERISA Litigation Newsletter

by Proskauer Rose LLP on

Editor's Overview - As it is well known, in Cigna Corp. v. Amara, 131 S. Ct. 1866 (2011), the U.S. Supreme Court identified several forms of appropriate equitable relief that may be available under Section 502(a)(3) of...more

New Jersey Superior Court Appellate Division rules that physicians’ damages for breach of contract with hospital are limited to...

by Saul Ewing LLP on

The New Jersey Superior Court Appellate Division recently ruled that the damages a physician-independent contractor can recover are limited to those sustained during a notice period in the physician’s contract. The decision...more

New Jersey Federal Court Allows “Self-Help” Counterclaims Against Potential FCA Whistleblowers To Proceed

Last week, a New Jersey federal court allowed medical device maker Boston Scientific Neuromodulation Corp. (“Boston Scientific”) to proceed with counterclaims against two of its former employees for violating their contracts...more

Summer Fraud and Abuse Roundup

by BakerHostetler on

The federal government was busy over the summer when it came to decisions and settlements under the Stark Law, anti-kickback law and federal False Claims Act. This article revisits recent developments with respect to...more

Sixth Circuit Addresses Plan Assets and Limitations Issues in Holding Service Provider’s Fee Assessments Constituted Self-Dealing

by Goodwin on

The Sixth Circuit held in Hi-Lex Controls, Inc. v. Blue Cross and Blue Shield of Michigan that a service provider was liable as a fiduciary under ERISA for unauthorized fees it assessed against a self-funded health plan. In...more

Third Circuit Adopts Less Demanding FCA Pleading Standard

Last week, the Third Circuit reversed a New Jersey district court’s decision to dismiss a False Claims Act (FCA) qui tam law suit, holding that the court applied an overly demanding pleading standard to relator Thomas...more

Federal and California State FCA Claims Against NEMS Survive Summary Judgment

On May 13, 2014, a California federal court substantially denied summary judgment motions in United States ex rel. Trinh (No. 4:10-cv-01904 [consolidating Nos. C 10-1904 CW, C 12-2895 CW, C 10-2433 CW, C 10-4605 CW] [N.D....more

ERISA Fiduciary Duties and the Tension Between the Affordable Care Act and the Religious Freedom Restoration Act

The Patient Protection and Affordable Care Act ("ACA") has significantly changed the healthcare industry in the United States. Among the many changes is the new requirement that healthcare providers must provide all "Food...more

Hodgson Russ Helps Clients in Largest-Ever False Claims Act Settlement In Risperdal Lawsuits Against Johnson & Johnson

by Hodgson Russ LLP on

The Justice Department announced that Johnson & Johnson will pay $1.273 billion to the federal government and most states to settle a civil False Claims Act investigation into its off-label marketing of its antipsychotic drug...more

In Pipefitters, Sixth Circuit Holds Service Provider Is Fiduciary in Assessing Fee

by Goodwin on

Speed Read - The Sixth Circuit, in a unanimous decision, affirmed a lower court ruling in Pipefitters Local 636 Insurance Fund v. Blue Cross and Blue Shield of Michigan, holding that an entity providing services to a...more

Health Insurance Carriers Must Also Be Careful In What They Tell Plan Participants

I blogged recently warning employers to be careful when enrolling employees in plan benefits because the employer could be responsible to pay life insurance or disability benefits if an employee who is improperly enrolled...more

Constant Email Access Increases Employee Stress

Five days away from email equals less stress. This may sound obvious, but that was the conclusion of a recent study that took away email from thirteen civilian workers at an Army facility outside Boston, according to a...more

The ERISA Litigation Newsletter - September 2012

by Proskauer Rose LLP on

In This Issue: - Editor's Overview - ERISA Preemption in Provider Misrepresentation Claims: An Overview of the Jurisprudence Leading Up to the Fifth Circuit's En Banc Review of Access Mediquip and What Lies...more

TPA is a Fiduciary Under ERISA

A recent Sixth Circuit Court of Appeals decision considered whether a third party administrator of a self-funded medical plan was a fiduciary under ERISA. Under ERISA, fiduciaries owe strict duties of loyalty and prudence to...more

Healthcare Law Results In Refunds To California Employers

The Affordable Care Act, signed into law by President Obama in 2010, has various provisions that kick in starting this year. One provision requires that insurance companies spend a certain percentage of health insurance...more

Healthcare Law Results In Refunds To California Employers

The Affordable Care Act, signed into law by President Obama in 2010, has various provisions that kick in starting this year. One provision requires that insurance companies spend a certain percentage of health insurance...more

ERISA Legal News - 2nd Quarter, 2012 • Volume 3, Number 2

by Dickinson Wright on

In This Issue: IN THIS ISSUE: - Supreme Court’s Decision on Healthcare Reform – What Does This Mean To ERISA Welfare Benefit Plans? ....1 - SELECT CASE SUMMARIES....2 - DICKINSON WRIGHT ERISA...more

The ERISA Litigation Newsletter - May 2012

by Proskauer Rose LLP on

In This Issue: - Editor’s Overview ...1 - Health Care Reform Remains Alive and Well as DOL Enforces ACA through Plan Audits ...2 - Class Warfare — ERISA Class Litigation in Light of Wal-Mart v....more

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