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New York Federal Court Takes Different Stance on Medical Staff Bylaws

On April 14, MedLaw Blog posted a comment about Villare v. Beebe Medical Center, a case in which a Delaware trial court granted summary judgment on the basis that the medical staff bylaws were held not to constitute a...more

Top franchise cases of 2013

1. In Hanley v. Doctors Express Franchising, LLC, a former franchisee of the Doctors Express franchise system sued Doctors Express, the franchisor, and Rhino 7, a broker involved in the franchise sale, asserting that the...more

Compliance Audit Information May Not Be Attorney Client Privileged

Attorneys routinely advise clients conducting audits and investigations that the audit or investigation should be conducted by outside counsel in order to establish attorney client privilege. ...more

Do Your Plans Include a Time Limit on a Participant’s Right to Sue?

Some, but far from all, employee benefit plans set a limit on the amount of time a participant has to file a lawsuit claiming benefits under the plan. Until recently, however, not all courts would recognize these plan...more

Appeals Court Sides With Hospitals, Rejects Health Plan’s Demand for Refund

The United States Court of Appeals for the Seventh Circuit recently affirmed a Wisconsin district court’s grant of summary judgment in favor of two Wisconsin hospitals, ruling the hospitals were not obligated to repay $1.7...more

Ninth Circuit Sides with Orange County in Retiree Health Benefits Case

A Practice or Policy without Clear Legislative Intent Does Not Create Implied Contractual Right to Retiree Health Benefits - A federal appellate court has affirmed a U.S. District Court’s decision to grant Orange...more

Tenth Circuit Rejects State Law Challenge to FAA Primacy

In the aftermath of AT&T Mobility, LLC v. Concepcion and American Express Co. v. Italian Colors Restaurant, consumer lawyers have frequently argued that arbitration agreements should be invalidated if features other than the...more

Insurance Antitrust Legal News - January 2014 • Volume 3, Number 1

In This Issue: - MISSISSIPPI GOVERNOR RESCINDS EXECUTIVE ORDER REQUIRING BLUE CROSS OF MISSISSIPPI TO GRANT “IN NETWORK” STATUS TO EXCLUDED HOSPITALS: In early November, Mississippi Governor Phil Bryant...more

Valid Assignment Confers Beneficiary Status on Chiropractor

A federal district court in Illinois recently issued a pair of rulings in cases where insurers sought to recoup payments from practitioners. Pennsylvania Chiropractic Association v. Blue Cross Blue Shield Association, 2013...more

Health Plan Class Action Lawsuit Filed in Northern California

Approximately 300 employers and other organizations, many of which are in Northern California, were named as co-defendants in an ERISA class action lawsuit filed on November 22, 2013, in the U.S. District Court for the...more

Business Court Says "Rule Of Reason" Analysis Appropriate To Antitrust Claim By Chiropractors Against Their Independent Practice...

I can think of only three reasons why you might want to know about the Business Court's decision in Sykes v. Health Network Solutions, 2013 NCBC 53: - You are a chiropractor or you live with one. - You are...more

Louisiana Becomes Medical Staff Bylaws Equal Contract State

In Granger v. Christus Health Central Louisiana d/b/a Christus St. Francis Cabrini, the Louisiana Supreme Court ruled that medical staff bylaws are a contract between the hospital and a the medical staff member....more

Recent California Decision Upholds Data Breach Coverage

The U.S. District Court for the Central District of California recently upheld coverage under a commercial general liability policy for a hospital data breach that compromised the confidential medical records of nearly 20,000...more

Influential Appeals Court Rejects Attempt by Former In-House Counsel to Use Privileged Information Against Company in...

The pool of potential qui tam relators may have just shrunk a little, based on a recent decision by the 2nd Circuit Court of Appeals that has put the ability of in-house lawyers to become qui tam relators into serious...more

Second Circuit: in-house counsel may not seek to profit as whistleblowers against former employers

The United States Court of Appeals for the Second Circuit has issued an important ruling restricting in-house counsel from acting as whistleblowers in litigation against their current or former employers. ...more

Insurance Antitrust Legal News - November 2013 • Volume 2, Number 6

In This Issue: - BILL SEEKING TO REPEAL THE MCCARRAN FERGUSON ACT’S ANTITRUST EXEMPTION INTRODUCED IN CONGRESS: On September 18, Congressman Phil Roe (R-Tennessee) introduced legislation (H.R.3121) that would,...more

Arbitration Agreement with a Care Facility is not Enforceable when not Authorized by the Patient Herself

A California court of appeal recently ruled that an agreement to arbitrate disputes between an elderly patient and a nursing facility was not enforceable. The arbitration agreement was signed by the daughter of the patient...more

Medical Device Company Files First Amendment Lawsuit Challenging OIG’s Criticism of Physician-Owned Distributors (PODs)

On October 8, 2013, Reliance Medical Systems, LLC (“Reliance”) filed a Complaint against the HHS OIG in the United States District Court for the Central District of California. The Complaint alleges that OIG’s assertion in a...more

Court of Appeal Upholds Ordinance Regulating Medical Marijuana

A trial court enjoined enforcement of a City of Los Angeles ordinance that regulates the number and geographic distribution of medical marijuana collectives. The court of appeal reversed the trial court’s order finding that...more

New York Appellate Court Affirms No Coverage Under Computer Fraud Coverage

In its recent decision in Universal American Corp. v. National Union Fire Ins. Co. of Pittsburg, PA, 2013 N.Y. App. Div. LEXIS 6278 (N.Y. 1st Dep’t Oct. 1, 2013), the New York Appellate Division, First Department, had...more

U.S. District Court Denies Motion to Dismiss Insurer’s Claims of Overpayment Resulting From Provider’s Waiver of Out-of-Pocket...

In Connecticut General Life Insurance Co. v. Roseland Ambulatory Ctr., LLC, No. 2:12-cv-05941, (D.N.J. Sept. 23, 2013), the United States District Court denied a healthcare provider’s motion to dismiss a claim of overpayments...more

Detroit District Court Certifies Antitrust Class of Registered Nurse

What is the right compensation for a particular job? That’s the question virtually every employer must face. Pay too little, and the employer may not be able to fill a position or must settle for less than the best...more

Justice Department Intervenes in Qui Tam Lawsuit Alleging Antikickback and Stark Violations

The Justice Department recently intervened in a qui tam lawsuit against a home health provider and related individuals, alleging violations of the antikickback statute and the Stark Law, which also constituted alleged...more

PA Court Holds Coverage is Barred Under Professional Liability Policy for False Claim Act Lawsuit Costs

On July 16, 2013, the Pennsylvania Court of Common Pleas (Philadelphia County) granted summary judgment in favor of ACE American Insurance Company, holding that costs arising from False Claims Act Litigation were excluded...more

Court Sides With CMS Stark Regulations on Physician-Owned Under Arrangement Service Providers

On May 24, the U.S. District Court for the District of Columbia in Council for Urological Interests v. Sebelius1 (‘‘CUI’’) sided with the Centers for Medicare & Medicaid Services in a lawsuit brought by a group of urologists...more

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