Appeals Healthcare

News & Analysis as of

Reconstructive surgery required to future medical expenses

Over the recent years, a lot has been said about the ever-increasing quantum of medical malpractice claims in South Africa in both the public and private sphere. In the public sector alone, the Gauteng Department of Health...more

A "cure" for combination products: 21st Century Cures Act mandates greater transparency of combination product designations

The 21st Century Cures Act ushers in significant changes to the regulatory review of drug/biologic/device combination products. The regulation of combination products has been somewhat unpredictable and muddled over the last...more

Data Breach Class Action Reinstated Against Horizon Healthcare Services Inc.

The U.S. Court of Appeals for the Third Circuit has vacated a district court's dismissal of a data breach class action filed against Horizon Healthcare Services Inc., in the wake of the 2013 theft of two computer laptops...more

Birmingham Medical News: End in Sight for Medicare ALJ Backlog?

As providers who are currently undergoing a Medicare claims appeal know, there is a lengthy delay to having an appeal actually heard by an Administrative Law Judge (“ALJ”). Some estimates indicate that it will currently take...more

Healthcare Law Update: December 2016

Prompt Payment Discounts Not an Anti-Kickback Statute Violation - In United States of Am. et al. ex rel. Ruscher v. Omnicare, No. 15-20629, 2016 WL 6407128 (5th Cir. Oct. 28, 2016), the court of appeals affirmed summary...more

Ohio Supreme Court Decision Permits Immediate Appeals from Discovery Orders Requiring Disclosure of Privileged Materials

In Burnham v. Cleveland Clinic Foundation, Case No. 2015-1127 the Ohio Supreme Court recently issued a decision that will make it easier to file immediate (aka interlocutory) appeals from trial court decisions requiring...more

Cost-Sharing Subsidies Ruling Adds More Uncertainty to Affordable Care Act

Holland & Knight issued an alert in May 2016 regarding litigation by the U.S. House of Representatives against the Obama Administration and the decision of the U.S. District Court for the District of Columbia enjoining any...more

Five Things to Know About CMS's Second Round of Settlements for Hospital Appeals

The Centers for Medicare and Medicaid Services (CMS) announced that beginning December 1, 2016, it is offering to settle certain inpatient-status claims to eligible hospitals willing to withdraw from the administrative...more

Indiana Supreme Court Extends the Stanley Doctrine to State-Sponsored Medical Reimbursements

On October 21, 2016, the Indiana Supreme Court weighed-in on a closely watched case that drew much attention from the defense and plaintiff’s bar alike. Approximately one (1) year ago, I reported that the Indiana Court of...more

Seventh Circuit Hands FTC Another Geographic Market Definition Victory in Chicago Hospital Merger Case

On October 31, 2016, the US Court of Appeals for the Seventh Circuit handed another important victory to the Federal Trade Commission (FTC) and the State of Illinois in a hospital merger case in Chicago, Illinois. This...more

FTC Scores Another Victory in FTC v. Advocate Health Care Network

The Federal Trade Commission (FTC) won another decisive victory in its effort to fight health care provider consolidation when the U.S. Court of Appeals for the Seventh Circuit reversed a district court’s decision denying the...more

Tuomey Settles, Post-Judgment, Alleged Violations of FCA and Stark Law

The Department of Justice and Tuomey Healthcare have announced a $72.4 million settlement in a lawsuit that the DOJ touts as “another achievement for the [DOJ and DHS] Health Care Fraud Prevention and Enforcement Action Team...more

Florida Constitutional Provision Mandating Disclosure of Adverse Medical Incidents Preempted by Federal Patient Safety and Quality...

The First District Court of Appeal in Florida recently held in Baptist Hospital of Florida, Inc. v. Jean Charles, Jr., No. 1D15-0109, October 28, 2015, that a Florida constitutional provision mandating disclosure of adverse...more

Employee Benefits Developments - October 2015

The Internal Revenue Service (IRS), consistent with prior regulations from the Department of Health and Human Resources (HHS), issued supplemental proposed regulations requiring employer sponsored health plans to provide...more

Culture of Safety Wins: Federal Patient Safety Law Preempts Amendment 7

Florida’s First District Court of Appeal issued its opinion in the highly watched case of Southern Baptist Hospital of Florida, Inc. v. Charles et al. The First District Court ruled that the federal Patient Safety and Quality...more

Four Key Takeaways on the Expansion of the Medicare Appeals Settlement Conference Project

On October 15, 2015, the Office of Medicare Hearings and Appeals (“OMHA”) conducted a teleconference to address Phase II of the Settlement Conference Facilitation (“SCF”) Pilot, effective October 1, 2015. SCF, launched in...more

A Split Decision Remains Split; No en banc Review of Amgen v. Sandoz

On October 16, 2015, the Court of Appeals for the Federal Circuit (“Federal Circuit”) opted not to rehear its previously issued split decision in the court’s first analysis of the Biologics Price Competition and Innovation...more

Second Circuit Finds Member Associations Have Standing to Bring Claims on Behalf of Members

Last month the Second Circuit Court of Appeals reversed the U.S. District Court’s decision to deny the New York State Psychiatric Association (NYSPA) standing in its claim against UnitedHealth Group and related entities...more

U.S. Supreme Court Denies Stay of the DOL Wage Rule for Home Care Workers

The Department of Labor (DOL) promulgated a rule that brings home care workers, employed by third parties, within the protection of the Fair Labor Standards Act (FLSA). As a result, those home care workers employed by an...more

Supreme Court Denies Further Stay of Department of Labor's Home Care Rule; Effective Date is Imminent

On August 21, 2015, the U.S. Court of Appeals for the D.C. Circuit upheld the U.S. Department of Labor’s (DOL) Home Care Rule and reversed the lower court’s decisions vacating the new rule. On October 6, 2015, the U.S....more

Companionship Rule Is on Course to Go Into Effect October 13, 2015

The D.C. Circuit Court of Appeals has declined to stay its recent revival of the Final Rule eliminating the companionship and live-in domestic services exemptions for third-party providers. As we previously reported in a...more

Many Home Companionship Workers No Longer Exempt

Agencies and other third-party employers of live-in household employees and home companionship providers, take note: the long-delayed regulations reclassifying many of these workers as non-exempt employees entitled to minimum...more

Court of Appeals to Plan Administrators: Inform Claimants of Time Limits on Front End of Discussions

Recently, in Mirza v. Insurance Administrator of Am., Inc., __ F.3d__ (3d. Cir. 2015), the United States Court of Appeals for the Third Circuit was asked to determine whether plan administrators are required to include a...more

DOL Agrees to 30-Day Grace Period on Enforcement of the Home Care Final Rule

On Friday, the U.S. Department of Labor (DOL) announced that it will not enforce the Final Rule eliminating the companionship and live-in domestic service exemptions for “third-party” providers” until 30 days after the U.S....more

Third Cir. Holds Hospitals May Sue Health Insurers Directly

Before September 11 the Third Circuit Court of Appeals had been out of step with its sister federal circuits when it came to the right of hospitals, physicians and other health providers to sue health insurers that failed to...more

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