Civil Remedies, Health Law, Civil Procedure

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

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

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

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

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

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

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

Claims Administrator Does Not Have to Pay Statutory Penalties for Failing to Provide Requested Documents

by D. Michael Reilly | Lane Powell PC - ERISA Law on 3/26/2013

You know already that a plan administrator can be liable for statutory penalties under ERISA for failing to provide requested plan documents....more

Washington Supreme Court: Insurers May Not Reserve the Right to Seek Reimbursement of Non-covered Defense Costs

by Meredith Dishaw, William Knowles | Cozen O'Connor on 3/18/2013

The Washington Supreme Court joined a minority of jurisdictions that hold that insurers may not unilaterally reserve the right to seek reimbursement for defense costs paid in defending non-covered claims through a reservation...more

Misrepresentation Law and Insurance Coverage In South Carolina

by Stephen Groves | Nexsen Pruet, PLLC on 2/13/2013

1. The Claim - An insurer may use the alleged misrepresentations and/or omissions of an insured in the life, health and disability insurance application process in two ways: (i) affirmatively, by seeking rescission of...more

Tennessee Insurance Legal News - February 2013 • Volume 2, Number 1

by John Anderson, Sr., James M. Burns, Autumn Gentry, Kelly Telfeyan | Dickinson Wright on 2/7/2013

In This Issue: - AUTO REPAIR TRADE ASSOCIATION REQUESTS THAT DOJ INVESTIGATE THE USE OF MOST FAVORED NATION CLAUSES BY AUTO INSURERS: Over the last several years, the use of most favored nation clauses by health...more

Qui Tam Case Study: Dismissal Based On Whistleblower’s Lack Of Standing

by Walter Tache | Carlton Fields on 1/7/2013

Qui tam lawsuits — cases brought by private whistleblowers on behalf of the government — represent a growing risk for businesses that contract with the government or make claims as part of a government program, such as...more

How Requiring Uninsured Patients to Pay Chargemaster Rates Impacts Personal Injury Cases

by Pavlack Law, LLC on 12/21/2012

This week we discuss the Indiana Supreme Court decision in Allen v. Clarian Health Partners, Inc., which held that uninsured patients were required to pay the chargemaster rates and not a reasonable rate. Our analysis focuses...more

The ERISA Litigation Newsletter - December 2012

by Anthony Cacace, Bridgit M. DePietto, Page W. Griffin, Kara L. Lincoln, Brian S. Neulander, Howard Shapiro | Proskauer Rose LLP on 12/20/2012

In This Issue: - Editors' Overview - Supreme Court Revisits Meaning of 'Appropriate Equitable Relief' in US Airways v. McCutchen - Rulings, Filings, and Settlements of Interest ...more

Time to Examine Tennessee’s Collateral Source Rule by William Walton

by William Walton | Butler, Snow, O'Mara, Stevens and Cannada,... on 12/4/2012

Originally published in the Tennessee Bar Association - December 1, 2012. Taking Another Look at Fye v. Kennedy - Damages in tort law are designed to compensate for injury and, in the words of one court, “only for...more

HC58 - Setting down for trial in medical negligence actions

by Cathal N. Young, O'Reilly & Co. Solicitors &... on 11/20/2012

HC58 - Setting down for trial in medical negligence actions Direction pursuant to Order 36 Rule 2 (c) of the Rules of the Superior Courts With effect from this 20th day of November 2012 proceedings in respect of any claim...more

Seventh Circuit Rules that Medical Necessity Trumps State-Imposed Cap on “Optional” Medicaid Coverage

by Gregory Fliszar, Mark Gallant | Cozen O'Connor on 10/24/2012

In a class action lawsuit, the U.S. Court of Appeals for the 7th Circuit recently affirmed a lower court decision granting a preliminary injunction that prevented the state of Indiana from enforcing a $1,000 annual cap on...more

Supreme Court Will Not Review Sixth Circuit Ruling That Government May Seek Full Reimbursement of Medicare Payments to Beneficiary...

by King & Spalding on 10/17/2012

On October 1, 2012, the United States Supreme Court said it would not review a decision by the U.S. Court of Appeals for the Sixth Circuit which ruled 2-1 that, upon settlement by a Medicare beneficiary with a third-party...more

Torts

by Sedgwick LLP on 9/6/2012

UPDATED THROUGH SEPTEMBER 4, 2012 Medical Malpractice – Harmless Error. Question certified: To avoid a new trial in a civil case, does the beneficiary of the error in the trial court have to show on appeal that it is...more

Revolution in Disputes Between Hospitals and Their Physicians?

by Kurt Melchior | Nossaman LLP on 8/24/2012

Originally published in the Daily Journal on August 24, 2012. A new decision of the state Court of Appeal last week may change the way disputes between hospitals and their privileged physicians will play out. In Fahlen...more

Shorts on Long Term Care - August 2012: Heck No, I Won’t Go

by Poyner Spruill LLP on 8/6/2012

My office phone rings and it’s one of my favorite clients. We just finished working on an appeal of a resident discharge and were expecting the Division of Medical Assistance hearing officer decision any day. I felt pretty...more

CMS Solicits Comments Regarding Options for Beneficiaries to Satisfy Their Obligations Under the MSP Statute for Settlements...

by King & Spalding on 6/25/2012

In an Advanced Notice of Proposed Rulemaking (ANPR) published in the Federal Register on June 15, 2012, CMS is soliciting public comments on proposed standardized options for Medicare beneficiaries to resolve their...more

Court Allows Challenge of RAC Recoupment Process

by King & Spalding on 6/18/2012

In a decision issued June 5, 2012, a federal district court allowed suit by a hospital challenging the validity of Medicare regulations providing that a contractor’s decision to reopen an initial determination is not...more

Insurance Legal News - June 2012 • Volume 5, Number 1

by Dickinson Wright on 6/13/2012

In This Issue: - AUTISM COVERAGE MANDATED IN MICHIGAN by Cynthia A. Moore, Member The State of Michigan has approved new laws requiring health insurance companies to cover the diagnosis and treatment of autism...more

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Civil Remedies › Health Law › Civil Procedure