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

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

Medical Malpractice and Healthcare Quarterly - Winter 2015-2016

DELAWARE MOVES TO MAKE TELEMEDICINE MORE ACCESSIBLE - On July 7, 2015, Governor Jack Markell signed into law House Bill No. 69 (DE LEGIS 80 (2015), 2015 Delaware Laws Ch. 80 (H.B. 69)), which amends various provisions of...more

2015 – The Health Law Year in Review

With 2015 in the books, we are pleased to reflect on some of the major developments over the past year in the field of health law. The year was marked by changes in Medicare payment models—from government pronouncements...more

Health Update - December 2015

Lessons from Hawaii's Trailblazing ACA 1332 Waiver Proposal - Editor's Note: On September 9, Hawaii became the first state to post a draft 1332 waiver proposal for public comment. While Hawaii's proposal focuses on the...more

Second Circuit Reminds Healthcare Providers to Seek Relief from Insurance Companies Under Their Own Contracts, Not the Insureds’...

In Rojas v. Cigna Health and Life Ins. Co., 793 F.3d 253, 258 (2d Cir. 2015), the Second Circuit joined several other circuits in holding that “healthcare providers are not ‘beneficiaries’ of an ERISA welfare plan by virtue...more

HHS Appeals Adverse Decision on Fixed Indemnity Attestations

As expected, on Monday, November 9, 2015, the U.S. Department of Health & Human Services (HHS) filed a Notice of Appeal from the decision issued by Judge Royce Lamberth of the United States District Court for the District of...more

Seventh Circuit Reverses Injunctive Relief for Chiropractic Association

On October 1, 2015, the United States Court of Appeals for the Seventh Circuit reversed what was previously regarded as a victory for the Pennsylvania Chiropractic Association. The case, Pennsylvania Chiropractic Association...more

Seventh Circuit Rules ERISA Does Not Preempt State Law Prohibiting Discretionary Clauses

In Fontaine v. Metropolitan Life Ins. Co., No. 14-1984, 2015 U.S. App. (7th Cir. Sept. 4, 2015), the Seventh Circuit affirmed a U.S. District Court for the Northern District of Illinois decision holding that Illinois’s...more

U.S. Third Circuit Allows Providers to Sue Health Insurers Directly

For many years, the United States Court of Appeals for the Third Circuit was out of step with its sister Courts of Appeal when it came to the issue of suing health insurance companies for failing to cover the medical expenses...more

Second Circuit Reinstates Mental Health Parity Case Against UnitedHealth

In late August the U.S. Court of Appeals for the Second Circuit reinstated a lawsuit by a physician association against a third-party plan administrator. The case against UnitedHealth Group and related entities (United) had...more

Third Cir. Holds Hospitals May Sue Health Insurers Directly

Before September 11 the Third Circuit Court of Appeals had been out of step with its sister federal circuits when it came to the right of hospitals, physicians and other health providers to sue health insurers that failed to...more

Third Circuit Rules Failure to Disclose Deadline to File Suit in Denial Letter Warrants Setting Aside Limitations of Suit...

The Third Circuit ruled on August 26, 2015, that if a claim administrator fails to disclose in its final denial letter any plan-imposed deadline to challenge the denial in court, then that deadline will be set aside in favor...more

ERISA (Sixth Circuit) — Medical Reviews: You Need to Explain WHY You are Rejecting the Treating Physician’s Opinions; and Don’t...

You already know that you do not have to give special deference to the opinions of treating physicians. But you need to explain why the treating physician’s opinions are being rejected....more

Supreme Court Update: King V. Burwell (14-114)

The Supreme Court once again came to the rescue of Obamacare—or as Justice Scalia now calls it, in light of the Court's second intervention, "SCOTUScare". This Update will bring you analysis of this morning's decision in King...more

Apples From Applesauce? Implications of the Supreme Court's Ruling on Obamacare

Can you make apples out of applesauce? A first look at implications of the United States Supreme Court's decision (once again) in favor of the Affordable Care Act....more

King v. Burwell: The Supreme Court Rules in Favor of the Administration and the Affordable Care Act Survives

The U.S. Supreme Court has once again ruled in favor of the Affordable Care Act (ACA). At issue in King. v. Burwell was whether the landmark legislation allows federal subsidies to be given to low-income consumers residing...more

SCOTUS Upholds Obamacare Federal Subsidies: A First Glance Analysis

A First Glance analysis of the United States Supreme Court's decision upholding Obamacare subsidies by Robert Projansky, partner at law firm Proskauer in New York, and head of the firm’s Health Care Reform Task Force....more

Supreme Court Upholds Obamacare’s Federal Subsidies for Health Insurance

Supporters of Obamacare are celebrating today as the Supreme Court in King v. Burwell rejected a lawsuit against the Affordable Care Act (ACA). In a 6-3 decision, the Court held that the federal government may continue to...more

King v. Burwell – Will the Supreme Court Tip the ACA Dominos? Part 2

In our previous blog post, we evaluated the legal issues at stake in King v. Burwell. We will now examine some of the ramifications of a Supreme Court decision that goes against the Obama Administration, assuming such were to...more

King v. Burwell – Will the Supreme Court Tip the ACA Dominos? Part 1

The health care industry has been closely watching four cases challenging whether federal subsidies could be used to reduce costs to consumers for health insurance purchased on an Affordable Care Act (ACA) Exchange in a state...more

Kentucky Federal Court Sustains Hospital Insurer’s Denial of Claim Due to Untimely Notice, Declines to Require Insurer Show...

The U.S. District Court for the Eastern District of Kentucky recently held that an insurer properly denied coverage to a hospital because the hospital gave untimely notice of the claim. In Ashland Hospital Corporation v. RLI...more

Insurer Seeks Declaratory Judgment Against Policyholder for Data Breach

Late last month, Columbia Casualty Company instituted a declaratory judgment lawsuit in the United States District Court for the Central District of California against its insured, Cottage Health System. Columbia Casualty...more

Insurer Escapes Antitrust Suit, But Hospital Must Continue the Fight

A large regional health insurer extricated itself from an antitrust suit, leaving the dominant local hospital to square off alone versus an ambulatory surgical center (ASC). The U.S. District Court for the Southern District...more

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

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