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DOJ and North Carolina Challenge Anti-Steering and Tiering Provisions in Managed Care Contracts

The Department of Justice’s antitrust division (the “DOJ”)and the State of North Carolina (“NC”) jointly sued, on June 9, 2016, Carolinas HealthCare System (“CHS”), the largest healthcare system in North Carolina, over...more

Connecticut Health Law Legislative Update

Current law permits a hospital, health system, or medical school to organize and become a member of a medical foundation, which can practice medicine through its employees or agents who are physicians, chiropractors,...more

U.S. Department of Justice Sues North Carolina Hospital System for Insisting on Anti-Steering Provisions in Insurance...

On June 9, 2016, the Antitrust Division of the United States Department of Justice (“DoJ”) filed a complaint against the Charlotte-Mecklenburg Hospital Authority, d/b/a Carolinas Health Care System (“CHS”) in the United...more

DOJ and NC File Antitrust Suit Challenging Anti-Steering Restrictions in Payor Contracts

A popular weapon used to contain health care expenditures is the creation by payors and employers of tiered provider networks, which by differentiated co-pays attempt to steer insureds to less expensive choices. In...more

Your daily dose of financial news The Brief – 5.4.16

MetLife, accused by regulators of misleading tens of thousands of customers about variable annuities—“a product that retirees seek out for safety,” will pay a $25 million dollar fine for its actions. It’s the second-largest...more

California Insurance Commissioner Approves Centene/Health Net Merger

Since the summer of 2015, a great deal of attention has focused on whether the proposed Anthem/Cigna and Aetna/Humana mergers will be approved by federal and state antitrust regulators. These transactions have been the...more

Hello Insurers – Court says CGL may Cover Privacy Breaches Occurring Prior to 2014

In April 2013, Glens Falls Hospital admitted that the medical records for more than 2,300 of its patients were stored for several months on an unprotected computer server. The hospital’s outside records contractor, Portal...more

Section 1557 of the ACA: The Legal Side of Health Equity

This week marks the end of National Minority Health Month and its 2016 theme of “Accelerating Health Equity for the Nation.” This month, the HHS Office of Minority Health’s goal was to “raise awareness of the health...more

Fourth Circuit Upholds Coverage Under CGL Policy for Data Breach Claims

The United States Court of Appeals for the Fourth Circuit (“Fourth Circuit”) recently concluded that an insurer had a duty to defend a health care company that was sued by individuals whose personal health information was...more

Keeping Coverage Online: Fourth Circuit Confirms Internet Data Breach Claim Triggers Commercial General Liability Policies

In a clear rejection of insurers’ attempts to artificially narrow the broad coverage provided by commercial general liability (“CGL”) policies, the United States Court of Appeals for the Fourth Circuit recently held that an...more

Insurer Must Defend Data Breach Claim Under Traditional Commercial General Liability Policies

On April 11, 2016, the U.S. Court of Appeals for the Fourth Circuit affirmed a ruling by Judge Gerald Bruce Lee of the U.S. District Court for the Eastern District of Virginia that Travelers Indemnity Company of America...more

Insurer Actions Cut the Heart Out of Out-of-Network Providers

Aetna Life Insurance Company recently won a $37 million verdict against a group of Northern California surgical centers, Bay Area Surgical Management, LLC and its affiliates (collectively, Bay Area), for an alleged...more

Covered California Approves New Agent Compensation Standards

Covered California, the state’s Patient Protection and Affordable Care Act (PPACA) public exchange program, will now include greater detail with respect to payments made to insurance agents. The board of Covered California...more

When a Published Data Breach is a Covered Data Breach

Can an inadvertent Internet posting of a patient’s medical information trigger insurance coverage for liability stemming from a data-breach class action? The Fourth Circuit held last week that it can, and it added to the...more

Good News for Corporate Policy Holders: Court Finds Cyber Coverage Under Standard Liability Policy

Corporate policy holders received good news on April 11 when the U.S. Court of Appeals for the Fourth Circuit issued its opinion in the case captioned: The Travelers Indemnity Company of America v. Portal Healthcare...more

Fourth Circuit Finds Potential Coverage For Data Leak As Publication Under CGL Policy

This week, a Fourth Circuit panel in an unpublished decision validated arguments long made by policyholders: that commercial general liability policies may provide coverage for certain data breach liabilities. In this case,...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

US District Court in Southern California Rules No Coverage for HIPAA Investigation

The District Court for the District of Southern California was asked to reconsider its prior decision issued on motions for summary judgment in coverage litigation between Millenium Labs, Inc. (“Millenium”), and its insurer,...more

Summary of HUD's LEAN 232 Program Email Blast Office of Residential Care Facilities (ORCF) February 2016

In an effort to summarize the highlights of the LEAN Email Blasts that we receive, and rarely have time to review in a timely fashion, we at Pepper Hamilton are providing this quick synopsis of the latest LEAN update. Our aim...more

The 2017 Exchange Regulations: Network Adequacy Challenges Remain

The Centers for Medicare and Medicaid Services (CMS) recently issued the final 2017 Benefit and Payment Parameters Rule (Final Rule) and concurrently released a final 2017 Letter to Issuers (Letter to Issuers) in the...more

Compliance With Medicare Secondary Payer Act At Issue In Auto Insurance Case

A recent decision in the District of New Jersey addressed an auto insurer’s obligations to comply with the Medicare Secondary Payer Act. Auto insurers may wish to review their practices and procedures in light of this...more

UnitedHealth Settles NY Attorney General Antitrust Probe

In early January, the New York Attorney General's Office announced that it had reached an agreement with UnitedHealth that would conclude the AG Office's investigation into UnitedHealth's marketing of elder care and nursing...more

OIG Issues (Another) Favorable Advisory Opinion Regarding Medigap/Preferred Hospital Network Arrangement in Advisory Opinion 16-01

On January 7, 2016, the Department of Health and Human Services, Office of Inspector General (OIG) issued Advisory Opinion 16-01, approving yet another insurer’s proposed contract with a preferred hospital network. The...more

Senate Bill Would Strengthen Mandate That People With Disabilities Be Integrated in the Community

Senator Charles Schumer (D-NY) recently introduced the Disability Integration Act of 2015 (DIA) in the U.S. Senate. If passed, the bill would require states and health insurers to provide services to people with disabilities...more

eCommerce Regulation, Bitcoin, Anti-Money Laundering, Shadow Insurance, 401(k) Litigation [Expect Focus – Vol. IV, Fall 2015]

IN THE SPOTLIGHT - - California Passes Life and Annuity Electronic Transactions Law LIFE INSURANCE - - Under a Spotlight, "Shadow Insurance" Lawsuit Fails Scrutiny - NAIC Evaluates Insurer’s Use of Variable...more

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