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Employee Benefits Developments - March 2014

On January 9, 2014, the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (collectively, the “Departments”) issued additional health care reform guidance in the form of Frequently Asked Questions...more

Appeals Court Sides With Hospitals, Rejects Health Plan’s Demand for Refund

The United States Court of Appeals for the Seventh Circuit recently affirmed a Wisconsin district court’s grant of summary judgment in favor of two Wisconsin hospitals, ruling the hospitals were not obligated to repay $1.7...more

The Eleventh Circuit Declares That CAFA’s Amount-In-Controversy Requirement Can Be Satisfied In Declaratory Relief Cases

On February 14, 2014, the Eleventh Circuit Court of Appeals held that the Class Action Fairness Act’s (CAFA) $5,000,000 amount-in-controversy requirement can be satisfied where the plaintiff seeks only declaratory relief. S....more

Lawsuits Over Health Exchange Premium Subsidies Challenge Heart of Reform Law

Royal Oakes was quoted in a Jan. 5th, 2014, Business Insurance article, Lawsuits Over Health Exchange Premium Subsidies Challenge Heart of Reform Law, by discussing a pair of lawsuits aimed at limiting availability of premium...more

Insurance Antitrust Legal News - January 2014 • Volume 3, Number 1

In This Issue: - MISSISSIPPI GOVERNOR RESCINDS EXECUTIVE ORDER REQUIRING BLUE CROSS OF MISSISSIPPI TO GRANT “IN NETWORK” STATUS TO EXCLUDED HOSPITALS: In early November, Mississippi Governor Phil Bryant...more

Judge Issues Preliminary Injunction Barring UnitedHealthcare from Terminating Certain Physicians From Medicare Advantage Plans

The United States District Court for the District of Connecticut recently granted Fairfield County Medical Association’s and Hartford County Medical Association’s (collectively, the “Associations”) motion for a preliminary...more

Valid Assignment Confers Beneficiary Status on Chiropractor

A federal district court in Illinois recently issued a pair of rulings in cases where insurers sought to recoup payments from practitioners. Pennsylvania Chiropractic Association v. Blue Cross Blue Shield Association, 2013...more

Health Plan Class Action Lawsuit Filed in Northern California

Approximately 300 employers and other organizations, many of which are in Northern California, were named as co-defendants in an ERISA class action lawsuit filed on November 22, 2013, in the U.S. District Court for the...more

Supreme Court to Resolve Circuit Split in Health Care Reform Cases

The Supreme Court will review two of the numerous lawsuits challenging the Affordable Care Act’s (ACA) requirement that group health plans and insurers cover, without cost-sharing, contraceptives and/or abortifacients (the...more

Recent California Decision Upholds Data Breach Coverage

The U.S. District Court for the Central District of California recently upheld coverage under a commercial general liability policy for a hospital data breach that compromised the confidential medical records of nearly 20,000...more

Claims Administrator Not Liable Under ERISA For Alleged Failure to Follow ACA’s Enhanced Benefit Claim Procedures

A federal court in New York appears to have issued the first published decision addressing alleged violations of the enhanced benefit claim procedures arising out of the Affordable Care Act (ACA). The new procedures contain...more

U.S. District Court Finds Halifax Hospital Violated the Stark Law in Summary Judgment

A United States District Court in the Middle District of Florida recently granted partial summary judgment in favor of the United States in connection with its motion against Halifax Hospital Medical Center (Halifax...more

Health Alert (Australia) - 18 November 2013

In This Issue: - Judgments - Legislation - Reports - Excerpt from Reports: Australia. Private Health Insurance Administration Council - 13 November 2013 - Industry consultation – Second round...more

Health Alert (Australia) - 11 November 2013

In This Issue: - Jugments - Legislation - Reports - Excerpt from Judgments: Queensland 2 September 2013 - Tabanas v Medical Board of Australia [2013] QCAT 522 - Health practitioners –...more

Florida Court Allows Plaintiff Extensive Communication with Putative Class Members

A recent decision from the Southern District of Florida denied a motion seeking to limit plaintiffs’ ability to contact putative class members to solicit support and evidence in support of a class certification motion. In...more

Insurance Antitrust Legal News - November 2013 • Volume 2, Number 6

In This Issue: - BILL SEEKING TO REPEAL THE MCCARRAN FERGUSON ACT’S ANTITRUST EXEMPTION INTRODUCED IN CONGRESS: On September 18, Congressman Phil Roe (R-Tennessee) introduced legislation (H.R.3121) that would,...more

Second Circuit Affirms Dismissal of Qui Tam Case Based on Attorney’s Use of Confidential Information

The US Court of Appeals for the Second Circuit recently affirmed the decision of the District Court for the Southern District of New York to disqualify Fair Laboratory Practices Associates (FLPA) from its qui tam suit against...more

Challenge to Premium Assistance for Individuals Who Purchase Insurance on Federally Established Exchanges Allowed to Proceed in...

A D.C. district court judge ruled that a case can proceed challenging the IRS rule allowing individuals who purchase insurance on exchanges established by the Federal government (and not by a State) to be eligible for premium...more

NC Medicaid Providers, Are You Required to Seek an Informal Appeal Prior to Filing a Contested Case at OAH?

Recently, numerous clients have come to me asking whether they have the right to appeal straight to the Office of Administrative Appeals or whether they have to attend informal appeals first, whether the informal appeal is...more

District Court Dismisses Whistleblower’s Medicaid Fraud Allegations Against Quest and LabCorp

The U.S. District Court for the Eastern District of Virginia granted Quest Diagnostics Inc.’s (Quest’s) Motion to Dismiss a whistleblower lawsuit under the Virginia Fraud Against Taxpayers Act and the federal False Claims Act...more

Health Alert (Australia) - 28 October 2013

In This Issue: - Judgments - Legislation - Reports - Excerpt from Judgments: Commonwealth - 23 October 2013 - Maiocchi v Royal Australian & New Zealand College of Psychiatrists [2013] FCA...more

State and Federal False Claims Act Defendant Seeks to Prevent Use of Claims Documents in Case Filed By Former Employees

United States ex rel. Bahnsen v. Boston Scientific Neuromodulation Corp., No. 11 CV 1210 (SDW) (MCA) (D.N.J.).: Two former employees of Boston Scientific Neuromodulation Corporation (BSNC) – one from its Customer Service...more

Federal District Court Refuses to Dismiss Former Executive’s FCA Complaint Against Medicare Advantage Organization

The United States District Court for the Northern District of California has denied a motion to dismiss the third-amended complaint in a federal False Claims Act (FCA) lawsuit against Kaiser Foundation Health Plan (Kaiser), a...more

Drug Manufacturer’s Liability Under Insurance Frauds Prevention Act May Not Be Inferred From Alleged Kickbacks to Physicians

Three former employees of Bristol Myers Squibb, Inc. (BMS) brought a qui tam action alleging that BMS violated California’s Insurance Frauds Prevention Act, California Insurance Code section 1871.7 et seq. (IFPA), by giving...more

California Court Finds Advertising Injury Coverage is Triggered by Medical Information Data Breach

On October 7, 2013, a federal district court in California held that the Advertising Injury coverage in a comprehensive general liability policy issued by Hartford Casualty Insurance Company (Hartford) covered two class...more

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