Insurance Limits and Case Value - A Clear Correlation?
The Social Engineering Cyber Exposure
Taking A Proactive Approach to Cyber Security
Underwriting: Art or Science?
Medical PL Risks in Retail Healthcare
Physician Considerations When Prescribing Medical Marijuana
Amy Levine Discusses TNC Insurance Policies at 2015 CIWA Summer Forum
Mark Robinson Discusses Price Optimization at the 2015 CIWA Summer Forum
David Hauge Discusses Insurance Rebates at the CIWA Summer Forum & Annual Meeting
Electronic Medical Records: Help or Hindrance?
Variables Affecting Medical PL Settlement Values
Technology in Healthcare
Prior & Pending Litigation
Nowotny on Private Placement Group Variable Deferred Annuity Contracts for Tax Exempt and Foreign Investors
Nowotny on Private Placement Variable Deferred Annuities
The Intersection of Cyber and D&O Coverage
Nowotny on Private Placement Life Insurance
Is Private/Non-Profit D&O Coverage Under Priced?
Halliburton: Good for the Plaintiffs’ Bar?
D&O in Brazil and Latin America
The federal agency that oversees Medicare’s prescription drug program has alleged that a major U.S. insurance company misled beneficiaries about the pharmacies included in the company’s drug plan, and imposed a $1 million...more
In DuBeck v. California Physicians’ Service, 2015 Cal. App. LEXIS 203 (March 5, 2015, opinion filed), the California Court of Appeal examined whether a health insurer’s conduct constituted a waiver of the right to rescind its...more
The United States District Court for the Western District of Washington ruled recently that the state’s corporate practice of medicine doctrine does not provide a private right of action, either express or implied, and...more
Written like a blockbuster Hollywood film, the U.S. District Court in South Carolina, in Evanston Insurance Company v. Agape Senior Primary Care, et al., 2014 WL 5365679, issued a ruling October 21, 2014, in which it held...more
On October 10, 2014, the Ninth Circuit affirmed a grant of summary judgment in favor of Manatt client The MEGA Life and Health Insurance Company. In an unpublished memorandum opinion, the Ninth Circuit held that a health care...more
When one big industry sues another we learn a lot about how business as usual is conducted.
In this case Humana, a giant health insurer, has sued the medical device company Medtronic, maker of the Infuse bone graft. ...more
Because courts apply a presumption of arbitrability when they analyze whether particular claims fall within the scope of an arbitration clause, and arbitration clauses are generally drafted very broadly, I don’t usually get...more
We are pleased to inform you that our firm, together with our co-counsel Bob Stern of Stern & Montana, obtained a very favorable and significant decision for no-fault insurers on an issue of first impression at the appellate...more
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
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