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Often Overlooked, but Effective, Provisions to Consider for your Benefit Plans

The Issue: When benefits under welfare plans – such as health plans and disability plans – are denied, litigation frequently results. In the context of “self-funded” plans (in contrast to “fully insured” plans, which are...more

Provider Beware: HIPAA and State Privacy Laws May Inform Negligence Suits

A recent opinion from the Connecticut Supreme Court illustrates that HIPAA is not the only law that covered entities and business associates must worry about if an unauthorized disclosure of protected health information (PHI)...more

Binding arbitration in managed care contracts - 6 tips to tailor your dispute resolution provisions

The Affordable Care Act is moving millions of previously uninsured patients into commercial managed care health plans. As the healthcare system grapples with complexity of this shift, the size of disputes between healthcare...more

New Jersey Court Supports Peer Review Immunity for Hospital

On November 24, 2014, the New Jersey Appellate Division affirmed a lower court’s decision to dismiss a physician’s lawsuit against a hospital based on federal and state statutory immunity provisions that shield hospitals and...more

D.C. Circuit Upholds Contraceptive Coverage Mandate

Last week, a unanimous three-judge panel of the D.C. Circuit upheld the religious accommodation to the Affordable Care Act’s (“ACA”) contraceptive coverage mandate (Priests for Life v. HHS, D.C. Cir. No. 13-5368, Nov. 14,...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

District Court Weighs in on Level of Integration Required to Shield Health Care Collaborations from Section 1 Scrutiny

In Medical Center at Elizabeth Place v. Premier Health Partners et. al, Case No. 12-cv-26 (S.D. Oh. Oct. 20, 2014), the Southern District of Ohio held that previously-competing health care systems who join together in a...more

California Court of Appeals Holds That the California Mental Parity Act Covers Residential Care for Anorexia Nervosa Even When the...

In Harlick v. Blue Shield of California (9th Cir. 2012) 686 F.3d 699, the Ninth Circuit interpreted the provisions of the California Mental Health Parity Act (Health and Safety Code § 1374.72) and its implementing regulation,...more

Ohio District Court Deems Hospital Alliance a Single Entity Incapable of Conspiring Under the Antitrust Laws

On October 21, 2014, the U.S. District Court for the Southern District of Ohio granted Defendants’ motion for summary judgment, holding that Premier Health Partners (“Premier”) and its affiliate hospitals, Atrium Health...more

Licensing Boards Face Antitrust Laws

States rely heavily on licensing boards to “police” various professions and industries. In the past, these boards have been immune from antitrust claims. But a significant case is about to impact state licensing boards...more

Doctors and Lawyers and Such

When doctors and lawyers get sideways with their business partners, they might dispute whether one or more of them are really “employees.” In a recent case, an anesthesiologist alleged disability and sex discrimination. To...more

Provider of Physical, Speech, and Occupational Therapy Services Agrees to $38,000,000 False Claims Act Settlement

As announced in an recent press release, Extended Care Health Services, Inc. (“Extendicare”), an operator of skilled nursing facilities, and its subsidiary Progressive Step Corporation (“Pro Step”), a provider of physical,...more

Ninth Circuit Holds That Provider Cannot Sue Nonsignatory Insurer for Breach of Contract

On October 10, 2014, the Ninth Circuit affirmed a grant of summary judgment in favor of Manatt client The MEGA Life and Health Insurance Company. In an unpublished memorandum opinion, the Ninth Circuit held that a health care...more

Hospital’s Extortion & Fraud Too Quick to Violate RICO

Danielle Bennion and her co-plaintiffs filed a RICO (Racketeer Influenced & Corrupt Practices Act) action alleging that Mountain View Hospital and co-defendants engaged in a plan of extortion and wire fraud for the purpose of...more

Texas Supreme Court Oral Argument Preview - 10/14

On Tuesday, October 14, 2014, the Supreme Court of Texas will hear argument in the following three cases. Arguments begin at 9:00 am...more

A Cautionary Tale for Companies With Potential False Claims Act Exposure

A False Claims Act suit can be a company’s worst nightmare, as it may potentially result in large settlements and awards on account of the statute’s trebled damages provision. However, the nightmare for AmerisourceBergen was...more

ERISA Litigation Review

The courts have been busy in 2014, addressing a variety of issues in the employee benefits field in decisions that impact everyone from union travelers to ESOP fiduciaries. This advisory summarizes a selection of the 2014...more

Wall v. VistaCare, Inc.: Successor Liability for Medicare Providers

A recent decision in the Northern District of Texas provides helpful guidance for health care corporations looking to limit their potential successor liability for Medicare fraud and overpayments. On August 4, 2014, U.S....more

The Hobby Lobby Decision and Religious-Based Exemptions

On June 30, 2014, the United States Supreme Court issued a ruling which held that a closely held, for-profit entity can object to certain aspects of the birth control mandate imposed by the Patient Protection and Affordable...more

Summer 2014 SCOTUS Roundup: Burwell v. Hobby Lobby

To close out our review of the Supreme Court’s summer decisions impacting labor and employment issues, we’ll examine the ramifications of the much-publicized and hotly discussed Burwell v. Hobby Lobby....more

For-Profit Companies Find Religion – What’s a Transactional Lawyer to Do?

Last month, the United States Supreme Court ruled in the Hobby Lobby case that closely held for-profit corporations can have “free exercise rights” as “persons” under The Religious Freedom Restoration Act of 1993 (“RFRA”),...more

Benefits Litigation Update - Summer 2014

In this issue: - Recent Supreme Court Decisions Revise Rules for Stock Drop Cases - Hobby Lobby and the Questions Left Unanswered - Post-Amara Landscape Continues to Evolve - Supreme Court to...more

Supreme Court Holds That The ACA Mandate To Include Group Health Coverage For Certain Contraceptives Violates The Religious...

On June 30, 2014, the U.S. Supreme Court ruled in a 5-4 decision that closely held, for-profit corporations may claim a religious exemption from the Affordable Care Act’s (ACA) mandate of providing certain types of...more

For-Profit Corporations Can Object to Federal Laws on Religious Grounds

The United Statutes Supreme Court’s recent Hobby Lobby decision holds that for-profit closely held corporations can object, on the basis of sincerely held religious beliefs, to the contraception mandate imposed by the Patient...more

Washington State Supreme Court Limits Attorney-Client Privilege for Healthcare-Provider Corporations

In a major decision that affects healthcare-provider corporations, the Washington State Supreme Court significantly limited attorneys’ ability to engage in privileged conversations with the provider corporation’s employed...more

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