Read Insurance Law updates, alerts, news, and legal analysis from leading lawyers and law firms:
The Affordable Care Act & the Impact on the C-Suite – Interview with Alden Bianchi, Member, Mintz Levin
The Affordable Care Act: The Structure of Health Plans – Interview with Alden Bianchi, Member, Mintz Levin
Condo Adviser: What is 'FHA approved,' exactly?
Greenberger: Derivatives Legislation Would Seriously Weaken Dodd-Frank
NFA Chairman Chris Hehmeyer Talks Bankruptcy Reform
Ritholtz: Insurance Regulators Should Oversee Derivatives
How to Respond to President Obama's Cybersecurity Executive Order
Ritholtz: 'Dot Com Bonus Envy' Stymies Wall St. Reform
Insurance Lawyer: Very Limited Coverage for Hurricane Sandy
Weekly Brief: Hurricane Sandy, GC Donations, Tweeting Fake News
Crystal Ball Perspective: Will Healthcare Reform be Repealed if Romney Wins the Presidential Election?
Not Prepared for Healthcare Reform? Three things employers need to focus on now.
The Benefits of WRAP Insurance on Large Construction Projects - Ray Buddie
Highlights from Day Three of Health Care Arguments [audio]
Highlights from Day Two of Health Care Arguments [audio]
Highlights from Day One of Health Care Arguments [audio]
Health Care Cases in 90 Seconds
Health Care 5: Will This Be a Landmark Decision?
Health Care 4: Can Congress Force States to Expand Medicaid?
Health Care 2: Can Congress Force Individuals to Buy Insurance?
When it comes to health insurance fraud, Carl Sagan’s obsession with the words – billions and billions — are particularly accurate.
As the government’s role in health care increases, it is inevitable that fraud against...more
On October 15, 2013, a divided three-judge panel of the United States Court of Appeals for the Eighth Circuit rendered a federal False Claims Act ("FCA") judgment against Bayer Healthcare Pharmaceuticals ("Bayer"), based on a...more
Three former employees of Bristol Myers Squibb, Inc. (BMS) brought a qui tam action alleging that BMS violated California’s Insurance Frauds Prevention Act, California Insurance Code section 1871.7 et seq. (IFPA), by giving...more
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
Bravo Health Pennsylvania, Inc. (Bravo), a Medicare Advantage Plan Sponsor and subsidiary of Cigna Corporation, agreed to pay $225,000 to the Government for allegedly misrepresenting or falsifying information furnished to the...more
On July 16, 2013, the Pennsylvania Court of Common Pleas (Philadelphia County) granted summary judgment in favor of ACE American Insurance Company, holding that costs arising from False Claims Act Litigation were excluded...more
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
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
The United States Senate and House of Representatives recently introduced bipartisan legislation designed to reduce fraud, waste, and abuse in the Medicare and Medicaid programs. The legislation, entitled “Preventing and...more
BCBSM Charges Self-funded Customers Hidden Fees starting in 1994 -
Prior to 1994, BCBSM charged its self-funded customers various surcharges and subsidies to prop up its insured lines of business, but those surcharges...more
Proposed rule would substantially increase rewards for fraud tips and enhance billing revocation authority.
On April 29, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule (Proposed Rule) that...more
As previously noted in a recent blog post, defendants should immediately evaluate their insurance coverage upon receipt of a class action complaint. But as one defendant recently discovered the hard way, that evaluation must...more
The United States Supreme Court recently denied certiorari in a Fifth Circuit case, United Healthcare Insurance Co. v. Access Mediquip LLC, that allowed a health care provider to pursue state law misrepresentation claims...more
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
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
The U.S. Department of Justice has sent emails to hospitals across the country regarding implantable cardioverter defibrillators, asking the hospitals to self-audit and estimate possible penalties under the False Claims Act....more
On May 2, DOJ and HHS announced charges against 107 individuals, including doctors, nurses and other licensed medical professionals, across the country for allegedly participating in Medicare fraud schemes totaling $452...more
2012 is already a record-breaking year in health care fraud enforcement. This week Attorney General Eric Holder and Secretary of the Department of Health and Human Services (HHS) Kathleen Sebelius announced the biggest...more
Yesterday the Senate Finance Committee posted an open letter on its website to the health care sector soliciting industry stakeholder insights on ways to combat fraud, waste, and abuse in the Medicare and Medicaid programs. ...more
A hearing titled Anatomy of a Fraud Bust: From Investigation to Conviction held by the Senate Committee on Finance (Committee) on April 24th allowed federal health care agencies to both tout their fraud-fighting successes,...more
On April 10, 2012, the DOJ announced that Tenet Healthcare Corporation will pay $42.75 million to settle civil allegations that Tenet violated the False Claims Act by improperly billing CMS for services provided at inpatient...more
Medical providers must specifically allege the medical plans, the terms breached, and the assignment when pursuing benefits by assignment from their patients under Employee Retirement Income Security Act of 1974 (ERISA). In...more
Denver Health and Hospital Authority, d/b/a Denver Health Medical Center (DHMC), has agreed to pay $6.3 million to settle a False Claims Act suit alleging that, between 2006 and 2009, it “submitted false claims to Medicare...more
British pharmaceutical company GlaxoSmithKline (GSK) announced on November 3, 2011, that it had reached an agreement in principle with the United States government to resolve multiple federal investigations regarding the...more
We represent several independent pharmacies in Alabama who have been damaged by the defendants' efforts to close and/or limit access to the pharmacy network available for school teachers in our state....more