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Religious Freedom, Contraceptive Services, and The ACA: The Dilemma of the Self-Certification Provision

On February 21, 2014, the Seventh Circuit Court of Appeals, in a 2-to-1 decision, denied a preliminary injunction enjoining the federal government from enforcing the self-certification provisions of the Affordable Care Act...more

ERISA (7th Cir.): Beneficiary and Attorney Who Ignore Subrogation Lien for Medical Bills Paid by ERISA Plan “Better Call Saul”

You have seen this one before: The ERISA plan pays hundreds of thousands of dollars in medical bills and secures an equitable lien. Then, the ERISA plan beneficiary settles a tort claim, but refuses to reimburse the ERISA...more

Oklahoma Supreme Court Upholds New Discrimination Damages Caps as Constitutional

In late February, 2014, the Oklahoma Supreme Court, in MacDonald v. Integris Health, 2014 OK 10, upheld November 2011 amendments to the Oklahoma Anti-Discrimination Act (OADA), which abrogated common law remedies for victims...more

Long Island Radiology Group Settles FCA Allegations That It Billed Medicaid And Medicare For Unnecessary Tests For $15.5M

A company operating diagnostic testing facilities in New York has agreed to pay $13.65 million to the federal government and $1.85 million to New York and New Jersey for a total of $15.5 million in penalties to settle claims...more

Shaking Down the Thunder from the Sky: Notre Dame’s Challenge to the Contraception Mandate

The Supreme Court will inevitably decide to what extent the Religious Freedom Restoration Act protects religiously affiliated employers from providing insurance coverage for contraceptive services, as is generally required...more

Health Care Reform: Seventh Circuit Rejects Notre Dame’s Request For Injunction Against ACA Contraception Mandate While Supreme...

A three-judge panel on the Seventh Circuit Court of Appeals rejected the University of Notre Dame’s request for a preliminary injunction that would permit the university to avoid complying with the ACA‘s contraception mandate...more

Benefits Litigation Update - January 2014

In this issue: - Will Section 510 of ERISA Restrict Workforce Structuring under the Affordable Care Act? - A New Threat to Sponsors and Fiduciaries: Equitable Remedies After Amara - First ERISA Decision...more

California Lawyer 2013 Roundtable Series: False Claims

The Federal False Claims Act — Originally Intended To Stop Fraud Against the Union Army during the Civil War — seemed destined to fade into history after 1943, when Congress limited the rewards and evidence it allowed. But...more

Does District Court Dismissal of Declined Qui Tam Threaten Future DOJ False Claims Enforcement?

The U. S. Department of Justice (DOJ) has taken the unusual step of appealing a federal district court’s dismissal of a declined qui tam brought under the federal and multiple state false claims acts (FCA). Could the...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

Nurse Anne Mitchell’s Whistleblowing Almost Blew Out Whistleblowing in Texas

The Winkler County nurses trials began with two nurses, Anne Mitchell and Vicki Galle, filing an anonymous complaint with the Texas Medical Board regarding the substandard care provided by Dr. Rolando Arafiles Jr. When...more

Religious Institutions Update - July 2013

Have you ever wondered how the United States Constitution came to incorporate "free exercise of religion" in the First Amendment? James Madison wrote the initial draft of the Bill of Rights. He and other Federalists initially...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

Tenth Circuit Rules in Favor of Religious For-Profit Corporations in Birth Control Litigation under the Affordable Care Act

In Hobby Lobby Stores, Inc. et al. v. Sebelius, et al.,1 an en banc panel of the U.S. Court of Appeals for the Tenth Circuit held that Hobby Lobby Stores Inc. and Mardel Inc., two for-profit corporations owned and operated by...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

NJ Jury Renders $2.1 Million Punitive Damage Award in Whistleblower Case

In a recent lawsuit before the Superior Court of New Jersey in Hudson County, a jury unanimously awarded $2.1 million in punitive damages to a hospital lab technician after finding his employer retaliated against him for...more

Seventh Circuit Makes Damages More Available for Employees Given Wrong Information About Benefits

Kenseth v. Dean Health Plan, Inc., represents a significant departure from the decades of law prior to Cigna v. Amara holding that employees could not recover for misrepresentations by employers over benefit coverage if the...more

Group Health Plan Can Enforce Reimbursement Rights Against Trustee

On the heels of the United States Supreme Court’s recent holding in U.S. Airways v. McCutchen, where the Court held that a group health plan’s reimbursement rights are not automatically subject to equitable defenses, it...more

Wielding A Scalpel, Court Grants Injunction In Favor Of Surgical Instrument Manufacturer

Headquartered in Kalamazoo, Michigan, Stryker Corporation is a manufacturer of surgical instruments, including image guided "navigation software and hardware" that enables surgeons to precisely insert implants or perform...more

High Court Holds Equitable Defenses Do Not Trump ERISA Plan’s Clear Reimbursement Language

The Supreme Court’s April decision in U.S. Airways, Inc. v. McCutchen resolves a circuit split on the issue of a medical plan’s right to reimbursement of medical expenses from a plan participant who recovers on a personal...more

Monthly Benefits Update - April 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

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

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

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

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

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

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