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Medical Staff By-laws are Contracts? Minnesota Supreme Court Says “Yes”

That sound you just heard was the simultaneous gasp of hospital boards of directors throughout the state of Minnesota. In Medical Staff of Avera Marshall Regional Medical Center v. Avera Marshall, Minnesota’s highest court...more

Supreme Court Holds State Regulatory Board Not Immune From Antitrust Laws

On February 25, 2015, the U.S. Supreme Court determined that the North Carolina State Board of Dental Examiners (“Dental Board”) is not shielded from federal antitrust law under the doctrine of state-action antitrust...more

Court Holds That Physician’s State Law Claim For Disability Benefits Is Preempted by ERISA: Hershan v. Unum Group Corporation

A federal court has held that a radiologist’s state law contract claim for certain disability insurance benefits arose under a welfare benefit plan governed by ERISA and was therefore preempted by ERISA. In Hershan v. Unum...more

Standard Of Reasonableness In Contract With Public Body: Wednesbury Not Applied

In David Krebs v NHS Commissioning Board (As successor body to Salford Primary Care Trust) [2014] EWCA Civ 1540 The Court of Appeal ruled that the NHS Commissioning Board (NHSCB) had not acted unreasonably in terminating a...more

Can an Arbitrator Rule Against a Hospital for Not Violating the Anti-Kickback Statute?

Here’s a nightmare. An arbitrator rules against your hospital for failing to honor an agreement to refer Medicare patients to a home health agency. Why? Because the home health agency paid your hospital good money for the...more

Unanimous Supreme Court Decision Eliminates Presumption That Union Retiree Health Benefits Are Vested For Life

In M&G Polymers USA, LLC v. Tackett, the United States Supreme Court invalidated a judicial presumption - commonly referred to as the Yard-Man presumption - that union retiree health care benefits are vested for life in the...more

Supreme Court Rejects Sixth Circuit's Approach to Retiree Medical Benefits

Ordinary contract principles govern disputes about collectively bargained retiree medical benefits. A Morgan Lewis team secured a major victory for employers when the U.S. Supreme Court, in M&G Polymers USA, LLC v....more

Supreme Court Rejects Analysis of Duration of Retiree Benefits As Contrary to Contract Law

On January 26, 2015, the Supreme Court of the United States resolved a long-standing dispute between the Sixth Circuit Court of Appeals and the remainder of the federal judiciary in a case concerning the extent to which...more

Supreme Court Rejects Yard-Man: Ordinary Contract Principles Apply When Interpreting Retiree Medical Promises

The Supreme Court has unanimously vacated a Sixth Circuit ruling that a collective bargaining agreement (CBA) vested retirees with lifetime medical benefits. M&G Polymers USA, LLC v. Tackett, No. 13-1010, 2015 U.S. LEXIS 759...more

Decision Alert: US Supreme Court Potentially Shifts the Balance in Healthcare Employee Benefits Litigation

Justice Clarence Thomas and a unanimous US Supreme Court decided to vacate a Sixth Circuit decision and hold that the federal courts cannot assume from silence in a union’s collective bargain agreement that retiree group...more

U.S. Supreme Court Rebukes Reliance on Yard-Man In Retiree Health Benefit Dispute

The U.S. Supreme Court ruled that the Sixth Circuit’s reliance on retiree-friendly inferences set forth in UAW v. Yard-Man are incompatible with ordinary principles of contract interpretation and should not be used when...more

Supreme Court Decides M & G Polymers USA, LLC v. Tackett

On January 26, 2015, the U.S. Supreme Court decided M & G Polymers USA, LLC v. Tackett, No. 13-1010, holding that ordinary principles of contract law govern the interpretation of pension and insurance provisions of...more

Traditional Contract Rules Determine Whether Retirees Are Entitled to Lifetime Healthcare Benefits

Yesterday, in a unanimous decision, the U.S. Supreme Court held that courts must apply ordinary rules of contract interpretation when determining whether retiree healthcare benefits vest for life pursuant to the terms of a...more

Minnesota Supreme Court Holds that Medical Staff Bylaws Are an Enforceable Contract

In an opinion released on December 31, 2014, the Supreme Court of Minnesota held that medical staff bylaws can be an enforceable contract and that a hospital’s medical staff (as an unincorporated association) can have the...more

Pennsylvania Nursing Home That Failed To Sign Arbitration Agreement Cannot Seek to Enforce the Agreement

On January 15, 2015, the Pennsylvania Superior Court in Bair v. Manor Care of Elizabethtown, PA, LLC 2015 Pa. Super. 9 (2015) ruled that a nursing home arbitration agreement was not enforceable when the facility did not sign...more

Food Fights Make Bad Law

The axiom "hard facts make bad law" never held so true than in the case of the Minnesota Supreme Court's decision in Medical Staff of Avera Marshall Regional Medical Center vs. Avera Marshall, issued on December 31, 2014. ...more

Minn. Sup. Court: Med Staff Bylaws Are a Contract & Staff May Sue

On the last day of 2014 the Minnesota Supreme Court gave a hospital medical staff a double victory, ruling that (1) medical staff bylaws constitute a contract between the hospital and medical staff members and (2) the medical...more

Often Overlooked, but Effective, Provisions to Consider for your Benefit Plans

The Issue: When benefits under welfare plans – such as health plans and disability plans – are denied, litigation frequently results. In the context of “self-funded” plans (in contrast to “fully insured” plans, which are...more

Provider Beware: HIPAA and State Privacy Laws May Inform Negligence Suits

A recent opinion from the Connecticut Supreme Court illustrates that HIPAA is not the only law that covered entities and business associates must worry about if an unauthorized disclosure of protected health information (PHI)...more

Binding arbitration in managed care contracts - 6 tips to tailor your dispute resolution provisions

The Affordable Care Act is moving millions of previously uninsured patients into commercial managed care health plans. As the healthcare system grapples with complexity of this shift, the size of disputes between healthcare...more

New Jersey Court Supports Peer Review Immunity for Hospital

On November 24, 2014, the New Jersey Appellate Division affirmed a lower court’s decision to dismiss a physician’s lawsuit against a hospital based on federal and state statutory immunity provisions that shield hospitals and...more

D.C. Circuit Upholds Contraceptive Coverage Mandate

Last week, a unanimous three-judge panel of the D.C. Circuit upheld the religious accommodation to the Affordable Care Act’s (“ACA”) contraceptive coverage mandate (Priests for Life v. HHS, D.C. Cir. No. 13-5368, Nov. 14,...more

CFO’s Thirst for Wine Club Invitation Costs Hospital Millions

You can’t make this stuff up. Last Monday a federal court in Rhode Island ordered two insurance companies to pay a $30 million claim by hospital management company Lifespan Corp. Lifespan filed the claim after being ordered...more

District Court Weighs in on Level of Integration Required to Shield Health Care Collaborations from Section 1 Scrutiny

In Medical Center at Elizabeth Place v. Premier Health Partners et. al, Case No. 12-cv-26 (S.D. Oh. Oct. 20, 2014), the Southern District of Ohio held that previously-competing health care systems who join together in a...more

California Court of Appeals Holds That the California Mental Parity Act Covers Residential Care for Anorexia Nervosa Even When the...

In Harlick v. Blue Shield of California (9th Cir. 2012) 686 F.3d 699, the Ninth Circuit interpreted the provisions of the California Mental Health Parity Act (Health and Safety Code § 1374.72) and its implementing regulation,...more

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