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Pruitt v. Burwell Ruling Unlikely to have Major Impact on Employers in Near Term

On Tuesday, September 30, federal Judge Ronald White of the Eastern District of Oklahoma ruled in Pruitt v. Burwell that the plain text of the Patient Protection and Affordable Care Act (“PPACA”) does not allow for the...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

Expect Focus - Regulators Are Watching: New Products, New Opportunities, New Risks - Volume III, Summer 2014

In This Issue: - IN THE SPOTLIGHT ..Standard CGL Policy Form Adds Data Breach Coverage Exclusion - LIFE INSURANCE ..Class Claims Against Lincoln National Barred in Section 419 Action – Again ...more

Employee Benefits Developments - September 2014

CASES - Post-Retirement Medical Benefits Under Siege. A recent spike in retiree benefit litigation is evidence of a growing interest among employers in strategies designed to contain, reduce, and eliminate the current...more

Identify Yourself! Deadline for Health Plan Identifiers is Fast Approaching

One of the lesser-known health plan requirements adopted by the Patient Protection and Affordable Care Act (ACA) has an initial deadline that is fast approaching, and most employers will need to take action to ensure that...more

Health Plans Petition the Supreme Court to Determine Whether FEHBA Preempts State Anti-Subrogation Statutes

The Federal Employees Health Benefit Act (FEHBA) governs federal employee health plans and contains a broad preemption clause comparable to the one found in ERISA.1 Despite the similarity, state and federal courts are split...more

The Affordable Care Act — How Did Two Courts Make Opposite Decisions on Tax Subsidies

How did two courts reach opposite decisions about tax subsidies for people who buy insurance through the federal exchanges created by the Affordable Care Act (ACA)? In Halbig v. Burwell, the U.S. Court of Appeals for the...more

OIG Issues Special Advisory Bulletin on Pharmaceutical Manufacturer Copayment Coupons

On September 19, 2014, the Department of Health and Human Services Office of Inspector General (“OIG”) issued a Special Advisory Bulletin on Pharmaceutical Manufacturer Coupons (the “Advisory Bulletin”) warning pharmaceutical...more

Long tail personal injury claims – a floodgate issue in WA?

Yesterday, the Supreme Court of Western Australia Court of Appeal heard argument in an appeal against the decision of Dixon v Clarke [2013] WASC 471....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

Medigap Policy Contract with Preferred Hospital Networks Approved by OIG

On August 18, 2014, the U.S. Department of Health & Human Services, Office of Inspector General (OIG) issued another advisory opinion approving a licensed insurance broker’s proposal to establish a preferred hospital network...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

May v. AT & T Umbrella Benefit Plan No. 1: Independent Physician Reviews of the "Paper File" Under Fire

On August 25, 2014, the Ninth Circuit upheld a District Court decision that an ERISA administrator’s denial of a short-term disability (STD) benefit claim may not be based solely on an independent physician’s review of the...more

New Jersey Court Turns the Screws on the Insured, Holding That “Your Product” Exclusion Bars Coverage For Defective Product Claim

In Titanium Industries, Inc. v. Federal Ins. Co., No. A-1922-12T1, 2014 WL 4428324 (N.J. Super. Ct. App. Div. Sept. 10, 2014), the court held that the commercial general liability policy issued by defendant Federal Insurance...more

2014 Comprehensive Report

Historically, the “Short Session” of the North Carolina General Assembly focuses on state budget corrections and adjustments. Frequently, legislators will also work on additional legislation while they are in Raleigh. This...more

Fatal Blow to Healthcare Reform? Courts split on federal tax credit

On July 22, 2014, two federal courts came down on opposite sides of an issue that may have far-reaching consequences about the future of the Patient Protection and Affordance Care Act ("PPACA"). At stake is whether the PPACA...more

Mental Health Parity Act: A Litigation Update

The Federal Mental Health Parity and Addiction Equity Act (the “Federal Parity Act”), like many similar state parity laws, mandates that financial requirements (e.g., copayments, coinsurance, or deductibles) and treatment...more

Corridors Fall 2014 - Medicaid Reform – House Bill 1181, the Medicaid Modernization Act

With about 2.3 million North Carolina residents receiving Medicaid services for at least part of 2013, Medicaid reform is a top priority for the General Assembly. The significant funding allocations required to supplement the...more

Manatt on Medicaid: Arkansas—A Leading Laboratory for Healthcare Payment and Delivery Reform

Increasingly, states are moving beyond their traditional Medicaid programs to embrace new roles as leaders of statewide payment and delivery system transformation. The search for statewide solutions is fueled by cost...more

U.S. Court of Appeals for the District of Columbia Circuit to Rehear ACA Subsidy Challenge

On September 4, 2014, the D.C. Circuit vacated a panel decision in Halbig v. Burwell (Civ. No. 14-5018) striking down the federal government’s provision of premium subsidies to individuals purchasing coverage through the...more

HealthCare Fraud and Courtesies: What to Know Before Waiving a Copayment

Many healthcare facilities and physicians waive the insurance copayment for physicians and their families (known as professional courtesy) or other patients. Yet, despite how prevalent the practice is and the limited...more

Pennsylvania gets a green light to pursue Medicaid expansion under an alternative model

The Centers for Medicare and Medicaid Services (CMS) has approved Pennsylvania’s demonstration proposal to expand Medicaid to adults with incomes through 133 percent of the federal poverty line. The state is the 28th...more

D.C. Circuit Court of Appeals Agrees to Hear Halbig ACA Case Before Full Court

Following up on our Week 22 ACA Countdown to Compliance post, the D.C. Court of Appeals granted the government’s petition for en banc review in Halbig v. Burwell, which held low income subsidies to purchase coverage through...more

Full D.C. Circuit to Rehear ACA Premium Tax Credit Case

The full U.S. Court of Appeals for the D.C. Circuit has vacated the 2-1 panel decision issued July 22, 2014, in Halbig v. Burwell, which struck down the Internal Revenue Service (IRS) Rule providing for Affordable Care Act...more

Manatt on Medicaid: Pennsylvania Receives Federal Approval to Implement Medicaid Expansion

On August 28, 2014, the Centers for Medicare and Medicaid Services (CMS) approved Pennsylvania’s application under Section 1115 of the Social Security Act to implement a Medicaid expansion effective January 1, 2015, through a...more

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