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Eleventh Circuit Finds Insurer Liable for Medicare Lien Notwithstanding Insurer's Efforts to Satisfy the Lien in Settlement, also...

In a case with far-reaching implications, the Eleventh Circuit Court of Appeals issued an opinion concluding that the Medicare Secondary Payer Act (MSP) permits a private insurance company/PART C Medicare Advantage...more

11th Circuit Awards Humana Double Damages Under Medicare Secondary Payer Act

Humana Medical Plan, Inc. v. Western Heritage Insurance Co., case number 15-11436. Liability insurers beware, as the 11th Circuit held that Medicare Advantage Organizations (MAO) are entitled to the same rights...more

Health Plan Case Managers Entitled to Overtime Pay

Managed care companies help insurers and government programs coordinate healthcare plans by making coverage determinations for participants. In many situations, case managers conduct utilization reviews to determine the...more

Settling Defendants Beware: Eleventh Circuit Holds Settling Insurer Liable for Failure to Protect Medicare Payments Made by...

Congress created an uproar among personal injury tort defendants and their insurers when it passed the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) less than 10 years ago. The $1,000 per day fine for failure to...more

DOJ Sues to Block Health Plan Mergers

The U.S. Department of Justice (DOJ), joined by attorneys general from several states, filed a lawsuit last Thursday in the U.S. District Court for the District of Columbia seeking to block two major mergers between health...more

Injunction Enjoining Enforcement of HHS Attestation Rule Affirmed

The Court of Appeals for the District of Columbia affirmed the District Court’s decision in Central United Life v. Burwell on July 1, 2016. This decision is very significant for those assessing the future strength of, and...more

New ADA and GINA Wellness Regulation Changes Complicate Wellness Program Compliance Analysis and Risks

Wellness programs should all be reviewed considering the Americans with Disabilities Act (“ADA”) and the Genetic Information Nondiscrimination Act (“GINA”) regulatory changes because noncompliance with the new requirements do...more

House of Representatives v. Burwell: Another Blow to Obamacare

Federal Judge Rosemary Collyer’s May 12, 2016 ruling in House of Representatives v. Burwell, found that the Obama administration (the “Administration”) has been improperly funding an Obamacare subsidy program. House of...more

A District Court Just Dealt a Blow to the ACA. Employers, Don’t Get Excited!

On May 12, 2016, the United States District Court for the District of Columbia issued an opinion in U.S. House of Representatives v. Burwell et al., No. 14-1967 (D.D.C. May 12, 2016), enjoining the federal government’s use of...more

Jury Awards Aetna $37.4M in Medical Billing Fraud Case

A California jury in Aetna Life Insurance Company v. Bay Area Surgical Management LLC, et al., 1-12-CV-217943 (Superior Court of Santa Clara County), unanimously awarded Aetna Inc. over $37.4 million in damages, finding that...more

Important Court Decision For No-Fault Insurers -- Federal Court Rejects Argument To Limit Insurers’ Right To Seek Judicial Relief...

We are pleased to inform you of a very favorable recent caselaw development in the no-fault insurance area, in which our firm played a significant role. Specifically, on March 24, 2016, in the case of Liberty Mutual Fire...more

IREG Update - The emerging regulatory battleground over long-term care insurance rate increases

The emerging regulatory battleground over long-term care insurance rate increases - As class action lawsuits challenging premium rate increases on long-term care (LTC) insurance have faced dismissal in recent years,...more

Obamacare in the Courtroom: In the Matter of Double Recovery

The Patient Protection and Affordable Care Act (ACA), a/k/a Obamacare, was drafted to make health care and health insurance more affordable and more available to more Americans as well as to relieve some of the burden on...more

Medical Malpractice and Healthcare Quarterly - Winter 2015-2016

DELAWARE MOVES TO MAKE TELEMEDICINE MORE ACCESSIBLE - On July 7, 2015, Governor Jack Markell signed into law House Bill No. 69 (DE LEGIS 80 (2015), 2015 Delaware Laws Ch. 80 (H.B. 69)), which amends various provisions of...more

Seventh Circuit Reverses Injunctive Relief for Chiropractic Association

On October 1, 2015, the United States Court of Appeals for the Seventh Circuit reversed what was previously regarded as a victory for the Pennsylvania Chiropractic Association. The case, Pennsylvania Chiropractic Association...more

UnitedHealthcare Services Denied Injunction Against Out-of-Network Physician Seeking to Bar Balance Billing of the Patient

In UnitedHealthcare Servs., Inc. v Asprinio (2015 NY Slip Op 25298), decided on August 31, 2015, in the Supreme Court of Westchester County, UnitedHealthcare suffered a set-back against attempts to prevent balance billing by...more

ERISA (3rd Circuit): Even a Voluntary Settlement Can Mean “Some Success on the Merits” When Awarding Attorney Fees?

You know that a court has discretion to award attorney fees under ERISA if a party shows “some degree of success on the merits.” But how do you define “success”? A new third circuit case reminds one of that old Milton...more

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

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