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After New York, Florida Curbs Surprise Bills for Emergency and Out-of-Network Services

It is generally understood that if a managed care member utilizes the services of a non-participating provider, the member could incur significant out of pocket expenses. However, there are instances where a member may...more

IREG Update - Insurers and big data

Insurers and big data - Insurance companies are increasingly using “big data” to optimize all aspects of their businesses—from claims processing and marketing to underwriting and pricing. Recognizing this trend among...more

Cadillac Tax: A Levy in Limbo

The future of the Cadillac tax, a key cost-control mechanism and federal revenue source enacted as part of the Patient Protection and Affordable Care Act (ACA), is unclear. Though initially set to take effect in 2018,...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

New ACA, et. al. FAQs Cover Items From “Top” to “Bottom”

On April 20, the “Big Three” agencies (DOL, Treasury/IRS, and HHS) released another set of FAQs (the 31st, for those of you counting at home). Consistent with earlier FAQs, the new FAQs cover a broad range of items under the...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

HHS Sets New Requirements to Limit Surprise Medical Bills from Out-of-Network Providers

The U.S. Department of Health and Human Services (“HHS”) recently released a final rule titled “Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2017” (“Final Rule”)[1] that sets...more

New Affordable Care Act FAQs Released on Rescissions of Coverage, Preventive Care Mandate, Out-of-Network Emergency Service...

The U.S. Department of Labor, the Department of Health and Human Services, and the Department of the Treasury (collectively, the “Departments”) have jointly issued a new set of answers to frequently asked questions about the...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

Health Law Insights Newsletter - Issue 8 - April 2016

McCarter & English, LLP’s Health Care Group presents Issue 8 of the Health Law Insights, which discusses the latest legal issues in the health care industry. NATIONAL - New Payment Model for Part B Drugs Proposed -...more

Health Net Deepens Investigation of Addiction Treatment Centers

As noted in a blog posted earlier this year, addiction treatment providers have been receiving an increased number of requests from payors seeking a range of medical and billing records and other documentation concerning the...more

A&B Healthcare Week in Review

I. REGULATIONS, NOTICES, & GUIDANCE - On April 15, 2016, the Food and Drug Administration (FDA) issued a proposed rule entitled, “Applications for Approval and Combinations of Active Ingredients Under Consideration for...more

Jury Awards Aetna $37.4M in Medical Billing Fraud Case

A California jury in Aetna Life Insurance Company v. Bay Area Surgical Management LLC, et al., 1-12-CV-217943 (Superior Court of Santa Clara County), unanimously awarded Aetna Inc. over $37.4 million in damages, finding that...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

IREG Update - Exemptions of health care sharing ministries from insurance laws and regulations

Exemptions of health care sharing ministries from insurance laws and regulations - Whether because of the cost of the policies, or their religious and political principles, many Americans are looking to avoid enrolling...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 Holds General Liability Covers Defense of Data Breach Class Action

The Fourth Circuit affirmed this week that Travelers Insurance (“Travelers”) must defend Portal, a medical records company, against a class action suit stemming from an alleged cyber “publication” of its customers’ personal...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

Yet Again, OIG Approves Medigap Policy Contracts with Preferred Hospital Network

On March 11, 2016, the U.S. Department of Health & Human Service, Office of the Inspector General (OIG) issued an advisory opinion approving the use of a preferred hospital network as part of Medicare Supplemental Health...more

A&B Healthcare Week in Review

I. REGULATIONS, NOTICES, & GUIDANCE - On April 4, 2016, the Centers for Medicare & Medicaid Services (CMS) issued the Final Calendar Year (CY) 2017 Medicare Advantage Capitation Rates and Medicare Advantage (MA) and...more

Preparing For and Responding To Data Breaches (Presentation)

While companies may be aware of the threats posed to their businesses by a data breach, they should also have a concrete plan in place so that they can respond effectively should one occur. In a recent webinar, attorneys from...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

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