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Oral COBRA Notice OK?

In a recent District Court opinion, a judge dismissed a COBRA claim against an employer based on the oral notice the employer gave a former employee of her right to continue coverage under COBRA. The court said that the...more

Court Enjoins CMS From Enforcing Dissatisfaction Requirement When a Provider’s Appeal Stems from the MAC’s Failure to Issue a...

On August 6, 2014, the United States District Court for the District of Columbia enjoined CMS, its Medicare Administrative Contractors (MACs), and the Provider Reimbursement Review Board (PRRB) from applying the...more

OMHA Announces Two New Programs to Process Administrative Law Judge (ALJ) Hearings More Efficiently

Earlier this year, the Office of Medicare Hearings and Appeals (OMHA) announced that for most hearing requests received after April 1, 2013, it will be deferring assignment of ALJs. OMHA’s announcement is available on its...more

First Circuit Rules in Favor of Dialysis Operator in Tax Dispute

On August 13, 2014, the United States Court of Appeals for the First Circuit affirmed a district court’s judgment in a tax dispute proceeding that Fresenius Medical Care Holdings, Inc. (Fresenius) was entitled to more than...more

One Step Closer to the Supreme Court: The Fate of Obamacare Premium Tax Credits in the Face of the Circuit Split

Last month, two federal courts of appeals issued opposing decisions on whether the Patient Protection and Affordable Care Act (the “ACA”) permitted subsidies, in the form of premium tax credits, to health coverage bought...more

Eighth Circuit Dismisses Whistleblower's Suit Finding Facts Were Already Publicly Disclosed

In an August 7, 2014 opinion, the Eighth Circuit upheld the dismissal of a whistleblower’s suit alleging that a number of pain pump device makers had violated the False Claims Act (FCA) by marketing their pain pumps for...more

Maine Workers' Compensation Alert: CMS Guidelines Amended to Accept WCB Settlement Determination of MSA Amount After Hearing on...

The Center for Medicare and Medicaid Services (CMS) update to its Workers' Compensation Medicare Set-Aside (WCMSA) Arrangement Reference Guide provides authority by which CMS will now recognize and defer to a Workers'...more

Federal Court Rejects Relator’s Swapping Allegations in False Claims Act Case

This week a federal district court in Ohio ruled in favor of Mobilex USA (Mobilex), the country’s largest mobile medical imaging company, on a motion for summary judgment in a False Claims Act (FCA) suit filed by a former...more

Hopkins v. Kay: Ontario Court of Appeal Considers Order Conclusively Determining Superior Court’s Jurisdiction to be Final

In her July 2, 2014 decision in Hopkins v. Kay, van Rensburg J.A. of the Ontario Court of Appeal considered when an order declining to dismiss an action for lack of jurisdiction will be final or interlocutory. This is...more

HHS Enjoined from Enforcing Self-Disallowance Regulation

On August 6th, the U.S. District Court for the District of Columbia enjoined HHS (along with the PRRB and CMS’s Medicare contractors) from applying HHS’s “self-disallowance” regulation to any appeals filed on the basis of an...more

What’s Scarier than a Compliance Officer Turned Whistleblower? A Whole Association of Them

In U.S. ex rel. Corporate Compliance Assocs. v. N.Y. Society for the Relief of the Ruptured & Crippled the court ruled that the whistleblower failed to meet the False Claims Act’s requirement that allegations be described...more

Proskauer Obtains Dismissal of High-Stakes False Claims Act Suit

On August 7, 2014, Judge Castel of the Southern District of New York dismissed a False Claims Act (“FCA”) complaint that was based primarily on allegations that the defendant Hospital improperly focused on referral revenue in...more

The Hobby Lobby Decision and Religious-Based Exemptions

On June 30, 2014, the United States Supreme Court issued a ruling which held that a closely held, for-profit entity can object to certain aspects of the birth control mandate imposed by the Patient Protection and Affordable...more

Summer 2014 SCOTUS Roundup: Burwell v. Hobby Lobby

To close out our review of the Supreme Court’s summer decisions impacting labor and employment issues, we’ll examine the ramifications of the much-publicized and hotly discussed Burwell v. Hobby Lobby....more

Affordable Care Act Update: Courts Divided on who is Eligible for Subsidies on the Exchange

On July 22, 2014, within 2 hours of each other, two U.S. Courts of Appeal issued conflicting rulings on whether subsidies may be offered in states that use the federal insurance exchange. Background. The...more

Audit Trails: Pitfalls of Electronic Medical Records, Part III

I do not profess to be an expert in the complexities of metadata in an electronic medical record (EMR). In simple terms, it is analogous to leaving footprints in the sand; although these do not wash away with high tide. In...more

No delay of game – Affordable Care Act (ACA) compliance efforts should continue, despite court rulings

Perhaps you have put your compliance efforts on the back burner, hoping the ACA will just go away. We have heard many reasons for this procrastination, including the constitutional challenge to the individual mandate, the...more

No Harm, No Foul – Appellate Court Finds No CMIA Claim Without Actual Injury

California’s Confidentiality of Medical Information Act, Cal. Civ. Code § 56 et seq. (“CMIA”), provides that an individual may recover $1,000 nominal damages (plus actual damages if any) based on the negligent release of...more

Ascertainability Issues Preclude Certification of a Class of Individuals Alleging Violations of the Fair Debt Collection Practices...

The U.S. District Court for the Western District of Michigan denied plaintiffs’ motion for class certification citing plaintiffs’ failure to satisfy Rule 23’s ascertainability, commonality, typicality, and predominance...more

ERISA (8th Circuit): Over-The-Counter Vitamin Supplements Trigger Pre-Existing Condition Exclusion

What sort of “medical treatment” triggers the pre-existing condition exclusion in an ERISA-governed disability policy?...more

For-Profit Companies Find Religion – What’s a Transactional Lawyer to Do?

Last month, the United States Supreme Court ruled in the Hobby Lobby case that closely held for-profit corporations can have “free exercise rights” as “persons” under The Religious Freedom Restoration Act of 1993 (“RFRA”),...more

HEAL Advisory: How Big Is Halbig? The Potential Effects of This Major Ruling Are Numerous and Significant

On July 22, 2014, the U.S. Court of Appeals for the D.C. Circuit and the U.S. Court of Appeals for the Fourth Circuit issued conflicting opinions on a key aspect of the Affordable Care Act ("ACA"). The cases are Halbig v....more

California Court of Appeal Rules Damages Are Unavailable To Plaintiff Patients Where Patient Information On Stolen Computer Was...

Until last week, Sutter Health was looking at a potential jury verdict in excess of $4 billion against several of its affiliated hospitals in a class action suit filed under the California Medical Information Act, California...more

Capital Thinking: Health Care

LEGISLATIVE ACTIVITY - On Monday, July 28, the House Committee on Energy and Commerce, Subcommittee on Health will hold a markup to consider two bills: H.R. ____, a bill to require the Secretary of Health and Human...more

Appellate Court Rules Medical Information Must Actually Have Been Viewed by an Unauthorized Person for a Plaintiff to Recover...

The California Court of Appeal recently held that in order to recover under California’s Confidentiality of Medical Information Act (CMIA), Civ. Code §§ 56 et seq., a plaintiff must plead and prove that the “stolen medical...more

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