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Early Termination of Annuities Not Permitted

Since investing can be a risky business with investments dropping in value from time to time, investors seeking steady income with minimal risk are sometimes attracted to an annuity’s guaranteed-income feature. A recent case...more

4th Cir. Sides with Surgeon in Disability Policy Dispute

On May 5 the Fourth Circuit reversed a District Court decision upholding Lloyd’s of London’s rescission of a Maryland surgeon’s disability policies. Lloyd’s had rescinded the policies because the surgeon gave false answers...more

Iowa Supreme Court Affirms Ruling for Health Insurer in Antitrust Dispute

In late February, the Iowa Supreme Court affirmed a lower court ruling in Mueller v. Wellmark, ending a seven year battle over whether the health insurer’s agreement with employers operating “self-funded” insurance plans to...more

Insurance Antitrust Legal News: Volume 4, Number 3

Auto Insurers Again Seek Dismissal of In Re Auto Body Shop Antitrust Litigation - In early March, the auto insurer defendants in the In re Auto Body Shop Antitrust Litigation renewed their motions seeking the dismissal...more

All or Nothing: Federal Court Decides Exclusion from ‘Some’ Patients Insufficient for Refusal to Deal Claim

A federal district court in the Eighth Circuit dismissed claims brought against a physician-hospital organization and an insurer alleging that the defendants violated federal antitrust laws by refusing to deal with certain...more

Fifth Circuit Finds Out-Of-Network Medical Provider Has Standing To Sue Health Plan

The Fifth Circuit recently addressed an out-of-network provider’s right to sue and whether coverage may be conditioned on collections of patient’s out of pocket costs. North Cypress Medical Ctr. Operating Co., et al. v. Cigna...more

Recent Federal Court Ruling: No ERISA Preemption of Texas Prompt Pay Law Regarding Payment Deadlines; Texas Legislature May Act on...

What's new. A Texas federal district court has ruled that ERISA does not preempt or prohibit application of the Texas Prompt Pay ("TPP") law to Third Party Administrators ("TPAs") of self-funded benefit plans. Judge Lynn...more

Manatt on Health Reform: Weekly Highlights - March 2015 #5

This week, Medicaid expansion gains traction in Montana, California submits its waiver application to renew DSRIP and to propose several new delivery system transformation and alignment initiatives, and the Supreme Court...more

Hospital Wins First Round Against Largest Rival in Antitrust Suit Alleging Illegal Exclusive Dealing Agreements with Insurers

The waves of change affecting health care providers include reimbursement and funding developments, the impact of the Affordable Care Act, technological and medical advances, provider network design transformations imposed by...more

Federal Court Allows Hospital’s Antitrust Claims to Proceed on Narrow Market Definition

Winning an antitrust lawsuit hinges on defining the “relevant market,” and this case may prove the point. Methodist Health Services Corporation notched the first win in its battle against Saint Francis Medical Center as a...more

Late Notice of Claim Costs Kentucky Hospital $10 Million

A federal court in Kentucky ruled on March 17 that Ashland Hospital had forfeited $10 million of insurance coverage because it was late in notifying its insurance company of the claim....more

My Day at the U.S. Supreme Court: King v. Burwell

Describing her recent Supreme Court experience as “my Super Bowl,” Susan Feigin Harris offers her personal account and analysis of the oral arguments in King v. Burwell. I was ready to go: hat, gloves, boots and parka. A...more

Insurer’s Agreements with Providers Are Not Per Se Antitrust Violations

The Iowa Supreme Court refused to categorize a health insurer’s agreements with providers in Iowa and its participation in the national Blue Cross and Blue Shield (BCBS) network as per se violations of the antitrust laws. ...more

Cancellation and Delay Waive Right to Later Rescind Ab Initio

In DuBeck v. Cal. Physicians' Service (No. B250129, filed 3/5/15), a California appeals court held that Blue Shield’s initial decision to cancel a healthcare policy for application misrepresentations constituted a waiver of...more

Could Eight Words Spell the End of “Obamacare” ?

The Supreme Court heard arguments yesterday in the latest challenge to federal health care reform. And this challenge, though highly technical, is anything but minor – it could unravel the entire infrastructure of federal...more

King v. Burwell: What a Subsidy Shutdown Would Mean for Consumers, Insurers, Providers and States

Editor’s Note: On Wednesday, March 4, the Supreme Court heard oral arguments in King v. Burwell, a case that will determine whether the Affordable Care Act (ACA) permits individuals who buy individual health insurance...more

Manatt on Health Reform: Weekly Highlights - March 2015

Media is abuzz with speculation on the potential impact of King v. Burwell—arguments begin tomorrow, March 4th, at 10 a.m. Many consider the case the greatest threat to the Affordable Care Act since SCOTUS upheld the...more

Has the Supreme Court Given Advance Notice How It Will Decide King v. Burwell?

On Wednesday, March 4, 2015, the Supreme Court will hear argument in King v. Burwell, the most publicized case in some time. Most readers are aware that the issue is whether certain tax subsidies essential to the proper...more

Oral Argument in King v. Burwell Concludes; Debates Ensue

At approximately 10:00am EST this morning, the Justices of the U.S. Supreme Court heard oral argument in King v. Burwell – the highly publicized case whose final decision may “end Obamacare as we know it!” (as one excitable...more

Data Breach Plaintiff Given Second Chance to Certify Class Action Suit

Recently, the Pennsylvania Superior Court ruled in favor of data breach plaintiff Avrum Baum, giving him a second chance to certify a class action suit against Keystone Mercy Health Plan. Baum brought suit against the...more

Nation’s Highest Court Schedules Oral Arguments in King v. Burwell

A Supreme Court of the United States (SCOTUS) spokesperson announced on December 22, 2014, that the Court will hear oral arguments in King v. Burwell on March 4, 2015. This means that not only could the highest court soon...more

California’s Insurance Fraud Prevention Act: 3 unsettled issues the health sector should understand

California’s Insurance Frauds Prevention Act, Ins. Code §§ 1871 et seq. (IFPA), is an unusual false claims statute. It allows “interested persons” (aka whistleblowers or relators) to file false claims lawsuits based on the...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

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

Detailing Provisions of “Obamacare” Affecting Individuals

In Fact Sheet 2014-09, November, 2014, the IRS provides details on “Obamacare”, technically known as the Affordable Care Act (the “ACA”). However, the Fact Sheet does not discuss a case currently before the U.S. Supreme...more

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