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Sixth Circuit Addresses Plan Assets and Limitations Issues in Holding Service Provider’s Fee Assessments Constituted Self-Dealing

The Sixth Circuit held in Hi-Lex Controls, Inc. v. Blue Cross and Blue Shield of Michigan that a service provider was liable as a fiduciary under ERISA for unauthorized fees it assessed against a self-funded health plan. In...more

Third Circuit Adopts Less Demanding FCA Pleading Standard

Last week, the Third Circuit reversed a New Jersey district court’s decision to dismiss a False Claims Act (FCA) qui tam law suit, holding that the court applied an overly demanding pleading standard to relator Thomas...more

Federal and California State FCA Claims Against NEMS Survive Summary Judgment

On May 13, 2014, a California federal court substantially denied summary judgment motions in United States ex rel. Trinh (No. 4:10-cv-01904 [consolidating Nos. C 10-1904 CW, C 12-2895 CW, C 10-2433 CW, C 10-4605 CW] [N.D....more

ERISA Fiduciary Duties and the Tension Between the Affordable Care Act and the Religious Freedom Restoration Act

The Patient Protection and Affordable Care Act ("ACA") has significantly changed the healthcare industry in the United States. Among the many changes is the new requirement that healthcare providers must provide all "Food...more

Hodgson Russ Helps Clients in Largest-Ever False Claims Act Settlement In Risperdal Lawsuits Against Johnson & Johnson

The Justice Department announced that Johnson & Johnson will pay $1.273 billion to the federal government and most states to settle a civil False Claims Act investigation into its off-label marketing of its antipsychotic drug...more

In Pipefitters, Sixth Circuit Holds Service Provider Is Fiduciary in Assessing Fee

Speed Read - The Sixth Circuit, in a unanimous decision, affirmed a lower court ruling in Pipefitters Local 636 Insurance Fund v. Blue Cross and Blue Shield of Michigan, holding that an entity providing services to a...more

Seventh Circuit: Insurer Was Proper Defendant to an ERISA Benefits Claim, but Setting High Co-Payment Not a Fiduciary Act or De...

In Larson v. United Healthcare Ins. Co., __ F.3d __, 2013 WL 3836236 (7th Cir. 2013), the Seventh Circuit upheld the dismissal of plaintiffs’ putative class action claims that health insurers violated Wisconsin state law...more

The Sixth Circuit Reminds Claim Administrators Of The Dangers Of A Breach of Fiduciary Duty When Handling Plan Assets

The Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001, et seq., was passed with the goal of protecting plan assets so that those assets would be available for plan participants and beneficiaries. See...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

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

Constant Email Access Increases Employee Stress

Five days away from email equals less stress. This may sound obvious, but that was the conclusion of a recent study that took away email from thirteen civilian workers at an Army facility outside Boston, according to a...more

The ERISA Litigation Newsletter - September 2012

In This Issue: - Editor's Overview - ERISA Preemption in Provider Misrepresentation Claims: An Overview of the Jurisprudence Leading Up to the Fifth Circuit's En Banc Review of Access Mediquip and What Lies...more

TPA is a Fiduciary Under ERISA

A recent Sixth Circuit Court of Appeals decision considered whether a third party administrator of a self-funded medical plan was a fiduciary under ERISA. Under ERISA, fiduciaries owe strict duties of loyalty and prudence to...more

Healthcare Law Results In Refunds To California Employers

The Affordable Care Act, signed into law by President Obama in 2010, has various provisions that kick in starting this year. One provision requires that insurance companies spend a certain percentage of health insurance...more

Healthcare Law Results In Refunds To California Employers

The Affordable Care Act, signed into law by President Obama in 2010, has various provisions that kick in starting this year. One provision requires that insurance companies spend a certain percentage of health insurance...more

ERISA Legal News - 2nd Quarter, 2012 • Volume 3, Number 2

In This Issue: IN THIS ISSUE: - Supreme Court’s Decision on Healthcare Reform – What Does This Mean To ERISA Welfare Benefit Plans? ....1 - SELECT CASE SUMMARIES....2 - DICKINSON WRIGHT ERISA...more

The ERISA Litigation Newsletter - May 2012

In This Issue: - Editor’s Overview ...1 - Health Care Reform Remains Alive and Well as DOL Enforces ACA through Plan Audits ...2 - Class Warfare — ERISA Class Litigation in Light of Wal-Mart v....more

New York Court Finds Clinic Not Liable for Employee's Disclosure of PHI

A federal district court dismissed an action against an employer alleging vicarious liability for an employee’s dissemination of a patient’s protected health information (PHI) related to treatment for a sexually transmitted...more

Health Law Alert - April 2011

Insurance companies have been using computer technology to target providers with greater effect, but not always with the correct result. If you are a specialist who utilizes a set of medical codes more than any other codes,...more

“Whistleblowing Under the Dodd-Frank Act”

The Dodd-Frank Act includes new and expanded whistleblower protections as well as bounty hunter provisions that are designed to increase the referrals of larger fraud actions by incentivizing employees, contractors, and many...more

Asset Protection 101 for Financial and Legal Advisors

Honored and rresented by the Financial Planning Association of America (FPA) at their annual meeting last fall, this article was written at the request of ADVISOR TODAY - the Journal of the National Association of Insurance...more

Fifth Circuit Reverses Lower Court Polinet Decision and Reaffirms Broad Immunity for Hospitals and Physicians in Peer Review Cases

In a case that has been closely watched around the nation for several years, the Fifth Circuit Court of Appeals has reaffirmed hospitals? and physician peer reviewers? broad immunities from damages claims under the 1986...more

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