Civil Remedies, Health Law

The High Cost of Paying Physicians for Referrals: Tuomey Healthcare System Faces Penalties of up to $357 Million

by Ari H. Gerstin, Elizabeth F. Hodge | Akerman Senterfitt on 5/17/2013

On May 8, 2013, a jury sitting in the U.S. District Court for South Carolina found that Tuomey Healthcare System, Inc. violated the Stark Law and the False Claims Act (FCA) by illegally paying referring physicians. The jury...more

Jury Ruled in Tuomey Healthcare Retrial that the Hospital Violated the Stark Law and False Claims Act

by King & Spalding on 5/17/2013

On May 8, 2013, a jury concluded that Tuomey Healthcare System, Inc. (Tuomey), a community hospital in Sumter, S.C., violated the Stark law for allegedly improper compensation arrangements in 2005 between the hospital and 19...more

California Appellate Courts Impose Significant Limitations on Plaintiffs’ Claims for Medical Damages

by Marc Brainich | Sedgwick LLP on 5/16/2013

In two recent opinions, the California Court of Appeal has clarified and expanded the scope of the California Supreme Court’s holding in Howell v. Hamilton Meats and Provisions, Inc., 52 Cal.4th 541 (2011), regarding the...more

Sixth Circuit Applies Strict Precondition of Payment Requirement to Reverse $11.1 Million FCA Judgment

by Nicholas Linder, Kirsten Mayer, Arefa Shakeel | Ropes & Gray LLP on 5/15/2013

The U.S. Court of Appeals for the Sixth Circuit, in United States ex rel. Hobbs v. MedQuest Associates, Inc., 711 F.3d 707 (6th Cir. April 1, 2013), recently reversed an $11.1 million False Claims Act (“FCA”) judgment,...more

CMS Proposes Increased Rewards for Reporting Fraud and Abuse

by Ameena Ashfaq, B. Scott McBride | BakerHostetler on 5/7/2013

The Centers for Medicare and Medicaid Services (CMS) recently published a proposed rule modifying certain provisions in their Incentive Reward Program (IRP) to sweeten the incentives for reporting sanctionable conduct....more

Court of Appeal Applies Howell Rule to Future Medical Expenses and Noneconomic Damages

by Samuel Sorich | Barger & Wolen on 5/6/2013

In Howell v. Hamilton Meats & Provisions, Inc., the California Supreme Court ruled that where a plaintiff’s medical care provider, pursuant to a prior agreement with the plaintiff’s health care provider, accepted less than...more

Supreme Court Denies Certiorari in MAO’s Double Damages Case

by Edward Waller | Fowler White Boggs P.A. on 5/3/2013

On April 15, 2013, the United States Supreme Court denied a petition for certiorari brought by GlaxoSmithKline (“Glaxo”) seeking review of a Third Circuit decision in favor of Humana Medical Plan (“Humana”), as a Medicare...more

OIG Issues Revised Provider Self-Disclosure Protocol

by Cameron Ellis, Jay Hardcastle, Judd Harwood, Christopher Puri, Jack Selden | Bradley Arant Boult Cummings LLP on 5/2/2013

On April 17, 2013, the Office of Inspector General (OIG) of the United States Department of Health and Human Services (HHS) revised its Provider Self-Disclosure Protocol (SDP), originally published in 1998, and updated in...more

Monthly Benefits Update - April 2013

by Andrew Malahowski | Franczek Radelet P.C. on 5/1/2013

Health Care Reform: Guidance on Required Future Modifications to SBC, Other Issues - The Internal Revenue Service (IRS), Department of Labor (DOL), and Department of Health and Human Services (HHS) issued new guidance...more

CMS Proposes to Increase Awards for Non-Qui Tam Whistleblowers

by Ellyn L. Sternfield | Mintz Levin - Health Law on 5/1/2013

CMS wants to change the way that it rewards non-qui tam whistleblowers who report alleged fraudulent or unlawful conduct related to Medicare or Medicaid. Using an IRS program as a model, CMS recently proposed rule changes to...more

CMS Aims to Grease the Reporting Wheels for Medicare Fraud and Abuse

by Daniele Capasso, Charles Cohen, Howard Young | Morgan Lewis on 4/30/2013

Proposed rule would substantially increase rewards for fraud tips and enhance billing revocation authority. On April 29, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule (Proposed Rule) that...more

Cross-Border Crashes: How Canadian Healthcare Can Affect Your Settlement

by Law Office of Dean Standish Perkins and... on 4/30/2013

Despite the efforts to prevent accidents, crashes with Canadian drivers are still an all too common occurrence in Washington State. To make matters worse, dealing with Canadian insurance companies can be confusing and...more

Supreme Court Clarifies Subrogation Rights, Emphasizes Need for Precise Plan Language

by J. S. Christie, Andrew Elbon, B. David Joffe, Jessica Jones, Jack Levy, Gordon Earle Nichols, Laura Schiele Robinson, Jay Turner | Bradley Arant Boult Cummings LLP on 4/25/2013

Plan sponsors, particularly those that sponsor self-funded health plans, should review plan document provisions in light of the recent decision of the Supreme Court of the United States in US Airways, Inc. v. McCutchen. In...more

ERISA Legal News - 1st Quarter, 2013 • Volume 4, Number 1

by Kimberly Ruppel | Dickinson Wright on 4/23/2013

In This Issue: - Supreme Court Update: Where Plan Reimbursement Or Recovery Terms Are Ambiguous Or Silent,Equitable Doctrines May Fill The Gaps: US Airways, Inc. v. McCutchen, 569 U.S. ___ (2013). In an...more

Courts of Appeals Continue to Limit the Government’s Aggressive False Claims Act Theories

by Chelsey Hadfield, Ty Howard, Jack Selden | Bradley Arant Boult Cummings LLP on 4/23/2013

This spring saw two significant victories for health care providers in the federal courts of appeals. In both cases, the courts rejected an aggressive government theory under the False Claims Act (FCA), the first related to...more

Supreme Court Upholds Health Plan’s Right To Recover Money from Third Party

by Edward I. Leeds | Ballard Spahr LLP on 4/23/2013

The U.S. Supreme Court has ruled that the clear terms of an employer's group health plan override an employee's equitable defenses in determining the plan's right to recover amounts from a third party. This decision points...more

Blue Cross Must Pay $4M For Dropping Patient-Advocate Doc

by Sylvia Hsieh | Lawyers.com on 4/22/2013

A doctor who claimed health insurer Anthem Blue Cross retaliated against him for being a strong patient advocate, has won a $3.8 million verdict against the insurer....more

Multiple Employer Welfare Arrangements: New Reporting Requirements, Civil Penalties and Other Regulations

by Steven Sebastian, Leigh Ann Wilson | BakerHostetler on 4/19/2013

Generally, a multiple employer welfare arrangement (MEWA) is a welfare benefit program that is sponsored by a group of employers that have common business and industry interests, but not common ownership interests. The...more

Court Rules That Supervision and Enrollment Issues Don't Give Rise to False Claims Act Liability

by Kristen Cilento Carter | Ober|Kaler on 4/19/2013

Following the ever-growing progeny of cases holding that Medicare conditions of participation do not give rise to False Claims Act (FCA) liability, the United States Court of Appeals for the Sixth Circuit overturned an $11...more

The U.S. Supreme Court Upholds Plan Sponsor’s Recovery Of Participant Damages Award

by Jeffrey P. Cairns | Leonard, Street and Deinard - Employee... on 4/18/2013

On April 16, 2013, the U.S. Supreme Court issued its opinion in U.S. Airways, Inc. v. McCutchen finding in favor of U.S. Airways in its quest to recover $66,866 in medical expenses incurred by its employee as a result of a...more

HMO Hit with $524M Verdict for Giving Hep C in Colonoscopies

by Sylvia Hsieh | Lawyers.com on 4/17/2013

A health insurance company rolled the dice with a Las Vegas jury and lost more than half a billion dollars....more

Surprising Risk of Discrimination Claims for Restaurants Moving Away from Meal Customization

by Ali Law Practice LLC on 4/15/2013

Chicago, IL, April 15, 2013 - Many restaurants, especially upscale and higher-end independents, are moving toward prix-fixe menus, tasting menus, and policies that restrict additions, subtractions, and substitutions. Such...more

Howell Rule Applies When Medical Services Were Paid by Medicare, Court of Appeal Concludes

by Barger & Wolen on 4/12/2013

In Howell v. Hamilton Meats & Provisions, Inc. the California Supreme Court ruled that a plaintiff’s recovery of medical damages is limited to the amount paid by the plaintiff’s health insurer and accepted by the health care...more

Religious Institutions Update: April 2013

by Nathan A. Adams IV | Holland & Knight LLP on 4/8/2013

Implementation of the Patient Protection and Affordable Care Act (PPACA) is in full swing. The law requires non-exempt religious organizations with fewer than 50 full-time employees to determine whether they are a large...more

Court of Appeals Rules for Government in DSH Exhausted Benefit Day Appeal

by Thomas W. Coons | Ober|Kaler on 4/5/2013

For the last several years, hospitals and the government have fought hard over where days associated with certain “dual eligible” patients should be placed in the Medicare disproportionate share hospital (DSH) calculation. At...more

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Civil Remedies › Health Law