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There has been a lot of talk amongst the plaintiff’s bar relating to Medicare Set-Asides (MSA*) and whether they are required when we recover money for a Medicare-eligible client. As one who takes a particular interest in...more
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
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
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
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
In its recent decision in Peloquin v. Haven Health Ctr. of Greenville, 2013 R.I. LEXIS 9 (R.I. Jan. 14, 2013), the Supreme Court of Rhode Island had occasion to consider the validity of a self-insured retention in a...more
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
In This Issue: - THE DW HEALTHCARE TEAM IS GROWING: With the addition of six new healthcare attorneys, the DW Healthcare Team has expanded its expertise and its depth... - RECOVERY OF LOST PROFESSIONAL...more
In this issue of McNees Insights, I will take a brief detour from the ongoing series, “Planning and Paying for Long-Term Care,” to discuss a recent and significant Pennsylvania case that has generated a great deal of...more
Earlier this month, the U.S. Court of Appeals for the Fourth Circuit held that several nursing homes breached their non-solicitation agreements with a therapy firm, where the nursing homes had assisted a rival therapy firm in...more
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
In Health Net, Inc. v. RLI Insurance Company, et al., Cal. Ct. App. Case N. B224884 c/w B240833, the California Court of Appeal clarified that contract benefits owed by an insured are not covered by a liability insurer...more
The United States Department of Justice announced recently that Walgreens had agreed to settle federal False Claims Act allegations arising out of a prescription gift card program. The $9.2 million settlement concluded an...more
On May 10, the Indiana Supreme Court will hear oral arguments in the case of Abby Allen, et al. v. Clarian Health Partners, Inc., in which the plaintiffs allege that the defendant hospital system’s billing of uninsured...more
It’s surely a sign of economic times that Poyner Spruill’s long term care lawyers have seen a marked increase in the number of clients calling us for assistance with nonpaying residents. While providers have seen...more
California Code of Civil Procedure section 425.13 precludes a claim for punitive damages in an action seeking damages arising out of a health care provider's negligence unless the plaintiff first obtains a court order. To...more
In December, the California Court of Appeal affirmed summary judgment to an insurer that had rescinded its healthcare policy because the insured made material misrepresentations in a policy application. Hagan v. California...more
DEA’s recent position against a national pharmacy chain and a wholesale distributor expands the proactive monitoring and auditing requirements for pharmacies and wholesale distributors to include site visits and possibly...more
The situation is a common one: Mrs. Smith received treatment from her long-time physician, Dr. Goodbody. Mrs. Smith's insurance company does not have Dr. Goodbody as one of its in-network providers. Dr. Goodbody is an...more
Two recent Florida Supreme Court decisions have resulted in major gains for nursing home residents and their families. Both Shotts v. OP Winter Haven and Gessa v. Manor Care of Florida struck down a segment of nursing home...more
On Wednesday, December 28, 2011, the First District Court of Appeal affirmed the trial court's granting of summary judgment in Hagan v. California Physicians' Service dba Blue Shield of California, et al, Case No. A130809...more
According to the U.S. Court of Appeals for the First Circuit in Berkshire Medical Center, Inc. v. U.W. Marx, Inc., an owner is at some point legally entitled to run out of patience, at least where defective work is concerned....more
The Virginia State Bar’s Standing Committee in Legal Ethics recently issued a legal ethics opinion declaring it unethical for plaintiff’s lawyers to agree to indemnify a defendant and/or his insurer for any third party lien...more
Dr. Festus Dada alleges herein that Dr. Kali P. Chaudhuri, William Thomas, and others conspired to deprive him of his ownership interest in Temecula Valley Physicians Medical Group. The complaint further alleges that...more
Filed Oct. 31 in Riverside County Superior Court, the lawsuit alleges that Dr. Kali P. Chaudhuri, who is a majority stakeholder in the Integrated HealthCare Holdings, Inc. (IHHI), which owns the Western Medical Centers of...more
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