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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

Employee Benefits Developments - January 2016

IRS Guidance Addresses Numerous ACA Issues Related to HRAs. Just before the New Year, the IRS issued Notice 2015-87 (Notice), addressing the application of Affordable Care Act (ACA) market reform rules to different...more

Another Day, Another Whistleblower Retaliation Suit

A False Claims Act (“FCA”) retaliation claim, 31 U.S.C. 3730(h), filed January 26, 2016 in federal district court in Oregon, provides a perfect example of the type of challenging cases confronting health care employers today....more

Bad News for ERISA Plan Reimbursements: Chase The Money Before Settlement Funds Dissipate, Supreme Court Rules

This just in…. A big debate was resolved today by the United States Supreme Court: Can an ERISA plan sue to recover medical expenses paid on the participant’s behalf after the settlement funds have dissipated?...more

Supreme Court Decides Montanile v. Board of Trustees of the National Elevator Industry Health Benefit Plan

On January 20, 2016, the U.S. Supreme Court decided Montanile v. Board of Trustees of the National Elevator Industry Health Benefit Plan, No. 14-723, holding that where an ERISA-plan participant has dissipated a third-party...more

Florida 5th DCA Says Referral Relationships Not Protectable

A recent case out of Florida’s Fifth District Court of Appeals raises important raises important issues related to physician non-compete agreements. Let’s take a look: Before addressing the specifics of this case, some...more

Annual Report on EEOC Developments – Fiscal Year 2015

This Annual Report on EEOC Developments—Fiscal Year 2015 (hereafter “Report”), our fifth annual Report, is designed as a comprehensive guide to significant EEOC developments over the past fiscal year. The Report does not...more

Fourth Circuit Says Medical Case Managers Are Exempt Professionals

Over the past several years, the healthcare industry and Department of Labor have clashed over the application of the Professional exemption to the Fair Labor Standards Act’s minimum wage and overtime requirements to various...more

Notice of Plan-Imposed Statute of Limitations for Filing Suit Must Be Included in Adverse Benefit Determination Letters

In Mirza v. Insurance Administrator of America, 800 F.3d 129 (3rd Cir. 2015), the court held that adverse benefit determination letters must include any plan-imposed time limits for seeking judicial review to be enforceable....more

False Claims Act: 2015 Year in Review

This year continued the trend of aggressive False Claims Act (FCA) enforcement by the Department of Justice (DOJ) and high volumes of qui tam lawsuits brought by whistleblowers. In fiscal year 2015, the DOJ marked the fourth...more

Equitable in Name Only?: Tracing a Long and Tortured Path

Knowingly spending money that isn’t yours sounds like a no-no, but depending on how the Supreme Court rules in Montanile v. Board of Trustees of the National Elevator Industry Health Benefit Plan (No. 14-723), certain ERISA...more

You Can’t Take It with You – NY Attorney General Reaches Settlement over Exiting Clinician Taking Patient List

It may not be a big dollar amount ($15,000), but a recent New York Attorney General settlement represents a big issue—interpreting that HIPAA prohibits a health care professional who is changing practices from taking a...more

Once a Waiver, Always a Waiver: Employee’s Agreement to Waive Meal Break Cannot Be Revoked

In Palacio v. Jan & Gail’s Care Homes, Inc. (Ct. of Appeal F070861), published December 7, 2015, the Court of Appeal for the Fifth Appellate Court ruled against a health care worker who sued to recover penalties for meal...more

But We Need You to Work More Than 40 Hours This Week! Overtime and the Health Care Employer

Hospitals and other health care facilities often do not know exactly how many hours each week they may need nurses and other allied health staff to work. Other employees may get sick, have a baby, go on vacation, or patient...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

Complicit in Sin: the Burden of the Opt-Out Form

Does filling out a form burden religious beliefs? We’re about to find out. On November 6, the Supreme Court agreed to review a group of seven cases (led by No. 14-1418, Zubik v. Burwell) brought by religious non-profit...more

Supreme Court Update: Mullenix V. Luna (14-1143) And Order List

Was it Jean-Baptiste Alphonse Karr or Jon Bon Jovi who remarked, "The more things change, the more they stay the same"? (They both did!) Over the last few terms, we've encountered a few steady themes in the Supreme Court's...more

Contracts May Not Be All They're Cracked Up To Be: The Extension Of Legal Protections In Employee Contractual Settings

For many years, employers have generally embraced a policy of utilizing at-will employment as often as possible, where employers and employees can end their relationship with each other at any time and for any (legal) reason....more

Final Curtain Call for Tuomey: Long-Running FCA/Stark Case Settled

After 10 years of litigation, including two trials and appeals to the 4th Circuit Court of Appeals, the U.S. Department of Justice (DOJ) and Tuomey Healthcare System (Tuomey) have entered into a settlement of DOJ's action...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

Seventh Circuit Rejects In-Network Providers’ Bid For ERISA Claims Procedures

Claims by providers seeking to assert the rights of ERISA plan participants have been percolating in courts throughout the country. The Seventh Circuit has now weighed in, rejecting the notion that providers who have payment...more

Chief Justice Denial of Stay Request Clears Way for New FLSA Regulations Affecting Home Care Agencies to Go Into Effect October...

On October 6, 2015, Chief Justice John Roberts of the Supreme Court of the United States summarily denied the emergency stay application filed by the association plaintiffs in Home Care Association of America v. Weil. In the...more

Mintz Levin Health Care Qui Tam Update: Recently Unsealed Whistleblower Cases: October 2015

Trends & Analysis: ..We have identified 15 health care–related qui tam cases that were unsealed since our last Qui Tam Update. Of those, 12 were filed from 2012 to the present. All but two cases had been pending more...more

Fourth Circuit Grants Review of Use of Statistical Sampling in False Claims Act Case to Prove Liability and Damages

On September 29, 2015, the United States Court of Appeals for the Fourth Circuit agreed to hear on interlocutory appeal the controversial issue of reliance on statistical sampling in a whistle-blower action to prove liability...more

Supreme Court Denies Further Stay of Department of Labor's Home Care Rule; Effective Date is Imminent

On August 21, 2015, the U.S. Court of Appeals for the D.C. Circuit upheld the U.S. Department of Labor’s (DOL) Home Care Rule and reversed the lower court’s decisions vacating the new rule. On October 6, 2015, the U.S....more

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