Civil Procedure Health Insurance

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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

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

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