Aetna recently announced that it is rolling out a national protocol under which it will be reviewing both physician and hospital emergency department claims that include Level 4 or 5 evaluation and management (E&M) codes, and...more
On July 18, 2023, the California Supreme Court held as a matter of first impression that a public interest advocacy organization maintains standing to bring claims under the Unfair Competition Law (“UCL”), if it has incurred...more
The decision provides organizational plaintiffs, including nonprofits and trade associations, with a basis to establish standing to bring UCL claims. In July 2023 the California Supreme Court expanded the ability of...more
Court Reinstates Life Insurance Company's Fraud Claims Over Defunct Laboratory - A New Jersey state appeals court reinstated Aetna Life Insurance Company’s (Aetna) fraud claims against the minority owners of the now defunct...more
Medical providers treating patients covered by ERISA-governed health plans on an out-of-network basis can assert state-law claims to hold plans to their payment promises without running afoul of ERISA’s preemption provision...more
In an important win for healthcare providers, on July 17, 2020, the Third Circuit determined in a published opinion that an out-of-network provider’s direct claims against in insurer for breach of contract and promissory...more
Commercial health plans have made numerous policy changes in response to the COVID-1 pandemic, some of which were done in response to mandates issued by state and federal governments, and others in response to pressures being...more
Last week, the Court of Appeal gave a victory to non-contracted providers of emergency medical services. In San Jose Neurospine v. Aetna Health of California, the court rejected Aetna's position that because the provider "did...more
The healthcare sector (incorporating pharma, medical and biotech) has seen M&A valued at US$256.5 billion across 645 deals in 2019. This is a decrease of 9 percent by volume, but an increase of 121 percent by value....more
Seyfarth Synopsis: The Second Circuit has affirmed summary judgment for the employer, Aetna, in an exempt misclassification overtime claim brought by a nurse reviewer. Agreeing that the plaintiff was properly classified as a...more
“Big data” has become one of the hottest subjects for antitrust enforcers around the globe. There is concern that large tech companies are amassing vast amounts of data and will use that data to entrench their dominant...more
The Federal Trade Commission has issued orders to five health insurers and two health systems requiring them to provide information that will assist the FTC in studying the competitive effects of certificates of public...more
In his 2016 presidential campaign, Donald Trump frequently expressed populist themes, rhetorically criticizing “big business” and “special interests,” and signaled an activist antitrust agenda with his comment in October 2016...more
The court granted Aetna’s motion to compel arbitration of a former employee’s age and disability wrongful termination claims that alleged violations of the Age Discrimination in Employment Act, the Americans with Disabilities...more
Concluding one of the longest merger reviews in history, on September 4, Judge Richard Leon, District Judge for the District of Columbia, issued his final ruling in United States v. CVS Health, approving the proposed...more
Google will pay a “record $170 million fine and make changes to protect children’s privacy on YouTube” as part of a deal it reached this week with the FTC and NY AG’s office, both of whom had accused YouTube of “violating the...more
In an eminent domain proceeding, the property owner and the condemning agency each typically introduce evidence of just compensation through valuation experts. The jury is then required to render a verdict in between the...more
On June 4 – 5, 2019, Judge Richard J. Leon of the U.S. District Court for the District of Columbia held an extraordinary and unprecedented evidentiary hearing to decide whether to enter the proposed Final Judgment in U.S. v....more
The District of Columbia District Court has again deferred its decision regarding whether to approve the merger between CVS Health and Aetna, a $69 billion transaction that was first announced back in December 2017. ...more
Pinterest has set a price range of $15 to $17 a share for its IPO roadshow today that “will value the company below its last private-market peg of $12 billion.” The company also plans to attempt “the sunset version of...more
Florida Introduces BIPA Legislation - A Florida state senator has introduced an identical version of the Illinois Biometric Information Privacy Act (BIPA)....more
Though the merger of CVS and Aetna received conditional approval from the DOJ’s Antitrust Division back in October, the road to final approval has been rocky as the court’s exasperation with the parties appears to grow....more
What is Quality Anyways?: James Hinton, the CEO of Baylor Scott and White, got a good laugh from the audience when he said that he was proud to be one of the five or six hundred hospitals in the nation’s top 100 hospitals....more
After two hearings over the last week, Judge Richard J. Leon of the District Court for the District of Columbia seems to have put the brakes on the well-publicized merger between health care giants CVS and Aetna. ...more
We’re glad the steak dinner went well, but we’re also still anxiously awaiting actual details about what exactly is covered by the pause in the US/China trade war....more