Civil Remedies Health Insurance

Read Civil Remedies updates, alerts, news, and legal analysis from leading lawyers and law firms:
News & Analysis as of

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

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

Catch Me If You Can: Fake Doctor’s Application Voids Coverage for Himself But Not for Innocent Co-Insureds

Written like a blockbuster Hollywood film, the U.S. District Court in South Carolina, in Evanston Insurance Company v. Agape Senior Primary Care, et al., 2014 WL 5365679, issued a ruling October 21, 2014, in which it held...more

Doctors, Lawyers and the Controversial Prop 46

What's the most controversial measure on California's November ballot? The insurance regulation bill, Prop 45, may be a good contender – but more than likely the controversy over Proposition 46 will win the contest hands...more

Torts – Effect of The Howell Decision on Liens Brought Under The Hospital Lien Act

Dameron Hospital Association v. AAA Northern California, Nevada, and Utah Insurance Exchange et al. - California Court Of Appeal, Third Appellate District (September 4, 2014) - In Howell v. Hamilton Meats (...more

Insurers, Be Ready To Pay Twice In Texas

Often, an insurance carrier will issue a check to two joint payees — the named insured and either a public adjuster or a mortgagee. What happens when the one payee cashes the check without first obtaining a signature from the...more

Recent Victory on Behalf of Medical Supplement Insurers against California Department of Insurance

As a result of the filing of a Writ of Mandate and Declaratory Relief Action by Barger & Wolen LLP Senior Regulatory Counsel Robert W. Hogeboom and Litigation Partner John Holmes, the California Department of Insurance...more

Undoing MICRA

It has been over thirty-five years since California became a leader in healthcare reform, addressing the malpractice insurance crisis in a measured way. In 1975, the Medical Injury Compensation Reform Act (“MICRA”) capped...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

Mississippi Governor Rescinds Executive Order Requiring Blue Cross of Mississippi to Grant “In Network” Status to Excluded...

In early November, Mississippi Governor Phil Bryant rescinded an Executive Order (Executive Order 1327), issued only weeks earlier, that would have compelled Blue Cross of Mississippi to continue to offer “in-network” status...more

Judge Finds Illinois Insurance Department's Policy Prohibiting Offshoring To Be Improper Rulemaking

On November 27, 2013, the Circuit Court of Cook County, Illinois issued an Order in a lawsuit filed by the American Council of Life Insurers, Inc. ("ACLI") v Andrew Boron, Director of the Illinois Department of Insurance and...more

Medicaid Secondary Payer Provision in Bipartisan Budget Act of 2013 Undercuts Supreme Court Decisions on Allocation of Medicaid...

On December 18, 2013, the U.S. Senate passed the Bipartisan Budget Act of 2013 (H.J. Res. 59), which includes a provision that will fundamentally alter the way Medicaid Secondary Payer claims are resolved. Under the new...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

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

Health Alert (Australia) - September 16 2013

In This Issue: - Judgments - Legislation - Reports - Excerpt from Reports: Australia. Department of Health & Ageing - ..7 September 2013 - Request for expression of interest for a clinical...more

Ninth Circuit Vacates Injunctions Barring HHS From Seeking Prepayment of Medicare Secondary Payer Reimbursements

The United States Court of Appeals for the Ninth Circuit recently vacated injunctions entered by a district court that banned HHS from seeking “up front” reimbursements for Medicare secondary payments from beneficiaries who...more

The Supreme Court Defers to Plan Language in U.S. Airways, Inc. v. McCutchen

Summary - In U.S. Airways, Inc. v. McCutchen, the US Supreme Court recently considered whether certain equitable defenses override the terms of a welfare plan in a plan fiduciary's suit for reimbursement under §...more

Defendants Must Keep Insurance Coverage Considerations in Mind When Settling Class Action Lawsuits

On July 18, 2013, a Pennsylvania appellate court held that class action defendant Cigna Corporation (Cigna) was not entitled to insurance coverage for any part of a settlement it paid to plaintiffs because Cigna did not...more

Florida Legislature Allows Plaintiffs to Contest Their Reimbursement to Medicaid

Effective July 1, 2013, Florida’s Medicaid Third-Party Liability Act now provides a mechanism for recipients of Medicaid to challenge the amount they must reimburse Florida’s Agency for Healthcare Administration (AHCA) after...more

7th Circuit Rules Employee May Recover Monetary Damages In ERISA Claim For Unpaid Benefits Against Insurer Who Denied Coverage...

The Seventh Circuit’s recent decision in Kenseth v. Dean Health Plan, Inc. provides a means for employees to collect monetary relief on their claim for benefits if they can show that the terms of the plan were not clear, and...more

Florida Medicaid Liens After Wos

The 2013 Florida legislature wasted no time responding to the March 20 Supreme Court opinion in Wos v. E.M.A., 568 U.S. __ (2013)....more

A prerequisite to the recovery of fees: How "reasonable and necessary" are your charges?

In State Farm Mutual Automobile Insurance Co. v. Huff, 2013 DJDAR 7379 (2013), the California Court of Appeal for the Fourth Appellate District decided a novel fee case in the medical context, referencing standards used to...more

Health Insurance Carriers Must Also Be Careful In What They Tell Plan Participants

I blogged recently warning employers to be careful when enrolling employees in plan benefits because the employer could be responsible to pay life insurance or disability benefits if an employee who is improperly enrolled...more

Express Plan Terms Allow Self-Insured Plan to Recover Medical Benefits Paid to Employee Post-McCutchen

In Quest Diagnostics v. Bomani, et al., 11-CV-00951 (D. Conn., June 19, 2013), the court granted Quest Diagnostic’s (“Quest”) motion for summary judgment, ruling that Quest, as the fiduciary to its self-insured medical plan,...more

137 Results
|
View per page
Page: of 6

Follow Civil Remedies Updates on: