Appeals Healthcare

News & Analysis as of

Supreme Court Rules That Providers and Suppliers Cannot Challenge Medicaid Reimbursement Rates in Federal Court

On March 31, 2015, a 5-4 plurality of the Supreme Court of the United States ruled that Medicaid providers do not have a private right of action under the Medicaid statute to challenge reimbursement rates. The Supreme Court’s...more

Laypersons’ Observations of Hospital Staff’s “Lack of Urgency” in Treating Relative Sufficient to Sustain Claim for Negligent...

In Keys v. Alta Bates Summit Medical Center (filed 2/23/2015, certified for publication 3/25/2015, No. A140038) the California Court of Appeal, First District, affirmed a jury verdict for Plaintiffs on a cause of action for...more

Should Health Care Providers Pay Attention to the Seventh Circuit’s New Definition of “Referral”? – Part One

The Seventh Circuit Court of Appeals, in the case of United States v. Patel, just expanded the definition of “referring” under the federal Anti-Kickback Statute (“Statute”). In light of this case, health care providers should...more

FAR Part 12 Applies to CMS Orders on Federal Supply Schedule Contract

On Tuesday, March 10, 2015, the Court of Appeals for the Federal Circuit reversed and remanded a decision by the Court of Federal Claims, which permitted the Centers for Medicare and Medicare Services (CMS) to include...more

Appellate Court Notes

SC18928 - Rathbun v. Health Net of the Northeast, Inc. - In Connecticut, the Department of Social Services manages the federal Medicaid act and awards contracts to Medicaid managed health care providers. The defendant...more

A Cautionary Note On That "Companionship Services" Rule

As we have previously reported, a federal district court for the District of Columbia recently vacated new U.S. Department of Labor regulations promulgated under the Fair Labor Standards Act, which (1) barred third-party...more

Ninth Circuit Affirms Divestiture of Consummated Physician Practice Acquisition

The U.S. Court of Appeals for the Ninth Circuit affirmed an Idaho federal district court’s decision ordering the divestiture of a physician practice group that had been acquired by a competing health system. The case, which...more

California's Patients' Rights Statute Limits Statutory Damages to a Maximum of $500, Not $500 Per Violation

In Lemaire v. Covenant Care California, LLC, 2015 WL 340677, the Second District Court of Appeal held that while patients may sue nursing facilities under California Health & Safety Code §1430(b) for violation of federal and...more

Health Law Pulse - February 2015

On January 23, 2015, the United States Department of Labor (DOL) filed a notice of appeal with the United States Court of Appeals for the District of Columbia (District Court) challenging two rulings in the case of Home Care...more

In Highly-Anticipated Decision, Ninth Circuit Affirms That Hospital-Physician Group Merger in St. Luke’s Violated Section 7 And...

On February 10, 2015, the Ninth Circuit issued its highly-anticipated decision at the intersection of health care and antitrust, affirming the lower court’s finding that a hospital-physician group merger completed nearly...more

Ninth Circuit Holds that Acquisition Violates Antitrust Laws

On February 10, 2015, the U.S. Court of Appeals for the Ninth Circuit affirmed a district court decision finding that the merger of two healthcare providers in Idaho violated antitrust laws. St. Alphonsus Medical Center-Nampa...more

California Health Care Employees Cannot Waive Entitlement to Second Meal Period When Working In Excess of 12 Hours

Narrowly construing the California Labor Code provisions on meal periods, the California Court of Appeal struck down a provision in the Industrial Welfare Commission Wage Orders that allows health care employees working...more

California Court Decision on Meal Breaks May Cause Health Care Industry To Go To Code Blue

Executive Summary: A new California Court of Appeal decision has invalidated a 22-year-old healthcare industry exception that had given the industry some flexibility with respect to how it provided its employees working...more

Ninth Circuit Affirms Divestiture Order in St. Luke’s/Saltzer Medical Group Acquisition

In an opinion issued February 10, 2015, the U.S. Court of Appeals for the Ninth Circuit affirmed a year-old decision by the Idaho District Court which held that St. Luke’s Health System’s acquisition of the Saltzer Medical...more

DC Court Rejects Unilateral DOL Regulation of Home Care Workers in Sharply Worded Rebuke; DOL to Appeal

In a pair of welcomed decisions for third-party employers in the home care industry, Judge Richard J. Leon of the D.C. Federal District Court vacated major provisions of the U.S. Department of Labor’s (DOL) Home Care Final...more

Illinois Supreme Court Debates Constitutionality of Nursing Home Tax

During its November term, the Illinois Supreme Court heard oral argument in Grand Chapter, Order of the Eastern Star of the State of Illinois v. Topinka. Grand Chapter is a direct appeal from the Circuit Court’s holding that...more

Florida High Court Clarifies Harmless Error Standard in Civil Appeals

On November 13, 2014, the Florida Supreme Court answered the following certified question of great public importance in the negative: “In a civil appeal, shall error be held harmless where it is more likely than not that the...more

Ninth Circuit Rules Assignee Health Care Providers May Sue Health Plans Under ERISA for Payment of Benefits

In an opinion with mixed implications for both insurers and health care providers, the U.S. Court of Appeals for the Ninth Circuit recently ruled that when plan beneficiaries assign their claims for payment of benefits to...more

One Last Shot at Meeting October Deadline on Two-Midnight Appeals

On October 27, 2014, the Centers for Medicare & Medicaid Services (CMS) made a concession—a very small one—to hospitals racing against the looming October 31, 2014, deadline for accepting the offer of 68 cents on the dollar...more

Special (Limited) CMS Offer to Settle Claims on Appeal

With little fanfare just before the Labor Day weekend, CMS announced a program in which it would enter into administrative agreements with eligible providers in exchange for the providers’ withdrawal of pending appeals...more

Federal Appeals Courts Issue Contradictory Rulings on Federal Marketplace Subsidies under Affordable Care Act

Two federal appeals courts issued contradictory rulings on the validity of subsidies for the purchase of health insurance under the federal marketplace established pursuant to the Affordable Care Act (ACA). On July 22, a...more

Health Alert (Australia) - July 28, 2014

In This Issue: Judgments; Legislation; and Reports. Excerpt from Judgments: New South Wales (NSW) - 22 July 2014 - Lane v Northern NSW Local Health District (No 3) [2014] NSWCA 233 - This...more

Health Law Blog: Court Strikes Down Tax Credit Provision for Low Income Americans Participating Through Federal and Federal/State...

Yesterday, the United States Court of Appeals for the District of Columbia ruled the IRS’ interpretation of a key ACA provision is invalid. Specifically, the court found that the IRS did not have the authority to interpret...more

Self-Insured Health Plans May Be Required To Allow Health Care Providers Access To Their Claims And Appeals Process

In a precedent-setting case, a district court in the Northern District of Illinois recently ruled that in-network chiropractors were considered “beneficiaries” under the Employee Retirement Income Security Act of 1974 (ERISA)...more

Provider Reimbursement Review Board Issues 60 Day Deadline to Supplement Record in All DSH Medicaid Eligible Days Appeals

On May 23, 2014, the CMS Office of Hearings released Alert 10, notifying providers of an important new 60 day deadline concerning certain appeals before the Provider Reimbursement Review Board (PRRB or Board). By the end of...more

31 Results
|
View per page
Page: of 2

All the intelligence you need, in one easy email:

Great! Your first step to building an email digest of JD Supra authors and topics. Log in with LinkedIn so we can start sending your digest...

Sign up for your custom alerts now, using LinkedIn ›

* With LinkedIn, you don't need to create a separate login to manage your free JD Supra account, and we can make suggestions based on your needs and interests. We will not post anything on LinkedIn in your name.
×