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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

No Private Right to Recoup Funds Based on Corporate Practice of Medicine Violation

The United States District Court for the Western District of Washington ruled recently that the state’s corporate practice of medicine doctrine does not provide a private right of action, either express or implied, and...more

Orthopedic Patient Doesn’t Have a Leg to Stand On

It’s well known that Medicare, Medicaid and commercial insurers hate the ever-increasing trend of hospitals buying facilities and practices and then charging provider-based (i.e., higher) rates than the facilities and...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

Supreme Court will hear King v. Burwell

On November 7, the Supreme Court announced it would hear its second significant legal challenge to the Affordable Care Act (ACA). King v. Burwell, expected to be heard this spring and ruled on by the end of June, is a direct...more

California Court of Appeal Rules That California Regulation Section 1300.71(a)(3)(B) Is Not the Exclusive Standard for Valuing the...

Children’s Hospital Central California v. Blue Cross of California (2014) 226 Cal.App.4th 1260, involved a dispute between a hospital and a health plan over the reasonable value of the post-stabilization medical services that...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

Supreme Court Grants Review in ACA Tax Subsidies Case

The Supreme Court announced on Friday that it would hear King v. Burwell, a case challenging whether tax subsidies are available to individuals purchasing health insurance through the Federal exchange rather than State...more

U.S. Supreme Court Agrees to Hear Arguments Involving Federal Health Insurance Exchange Subsidies

On Friday, the U.S. Supreme Court announced that it would review the U.S. Court of Appeals for the Fourth Circuit’s decision in King v. Burwell. In that case, the Fourth Circuit held that tax credits for health insurance...more

Supreme Court to Decide Who Is Entitled to the Federal Health Care Subsidy

Are the federal government’s subsidies to purchasers of health insurance available only to those who purchase insurance from state-run exchanges or to those who purchase from federal health care exchanges as well? Was the...more

Skilled Nursing Care Facility Inadequate Staffing Claims: Recent Coverage Developments in California

Professional liability insurers continue to confront claims alleging inadequate staffing at skilled-nursing facilities. While some policies clearly exclude coverage, others present a much closer question, particularly when...more

Recent Developments in PA and NJ Regarding Scope of Privilege for Health Care Facilities Engaged in Peer Reviews and Self-Critical...

Three recent cases offer guidance to health care entities in Pennsylvania and New Jersey regarding the discovery of documents created in connection with peer reviews, quality of care reviews and adverse event investigations...more

The ERISA Litigation Newsletter - October 2014

Editor's Overview - The first article in this month's newsletter focuses on whether specific language in ERISA employer-provided disability insurance plans confer discretionary authority to plan administrators to...more

Ninth Circuit Holds That Provider Cannot Sue Nonsignatory Insurer for Breach of Contract

On October 10, 2014, the Ninth Circuit affirmed a grant of summary judgment in favor of Manatt client The MEGA Life and Health Insurance Company. In an unpublished memorandum opinion, the Ninth Circuit held that a health care...more

Eighth Circuit Says That Considerations Of Health Care Cost Savings Could Be Proxy For Age In ADEA Suits

The Eighth Circuit recently concluded that an employer may violate the ADEA by terminating an older employee in order to reduce its health care premiums. Tramp v. Associated Underwriters, Inc., 2014 WL 4977396 (8th Cir....more

Summary Judgment Is No Dress Rehearsal

The standard for summary judgment is neither novel nor new. Most of us can recite it from memory: Summary judgment is warranted “if the movant shows that there is no genuine dispute as to any material fact and the movant is...more

Pruitt v. Burwell Ruling Unlikely to have Major Impact on Employers in Near Term

AffOn Tuesday, September 30, federal Judge Ronald White of the Eastern District of Oklahoma ruled in Pruitt v. Burwell that the plain text of the Patient Protection and Affordable Care Act (“PPACA”) does not allow for the...more

A Cautionary Tale for Companies With Potential False Claims Act Exposure

A False Claims Act suit can be a company’s worst nightmare, as it may potentially result in large settlements and awards on account of the statute’s trebled damages provision. However, the nightmare for AmerisourceBergen was...more

The Affordable Care Act — How Did Two Courts Make Opposite Decisions on Tax Subsidies

How did two courts reach opposite decisions about tax subsidies for people who buy insurance through the federal exchanges created by the Affordable Care Act (ACA)? In Halbig v. Burwell, the U.S. Court of Appeals for the...more

Long tail personal injury claims – a floodgate issue in WA?

Yesterday, the Supreme Court of Western Australia Court of Appeal heard argument in an appeal against the decision of Dixon v Clarke [2013] WASC 471....more

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