News & Analysis as of

Blue Cross

Manatt, Phelps & Phillips, LLP

Achieving a Racially and Ethnically Equitable Health Care Delivery System in Massachusetts: A Vision and Proposed Action Plan

OVERVIEW - This report proposes a vision and plan for action—collectively a statewide Health Equity Action Plan—for achieving a racially and ethnically equitable health care delivery system in Massachusetts. The report is...more

ArentFox Schiff

Investigations Newsletter: Texas Clinical Laboratory and Owner to Pay $5.7 Million to Resolve Outstanding FCA Judgment

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Texas Clinical Laboratory and Owner to Pay $5.7 Million to Resolve Outstanding FCA Judgment - Defunct BestCare Laboratory Services LLC and its founder will pay $5.7 million to settle an outstanding 2018 False Claims Act...more

Fox Rothschild LLP

Business Court Holds Clause Curbing Limitations Period Means Exactly What Contracting Parties Said it Did

Fox Rothschild LLP on

While an insurance carrier “labor[ed] valiantly” to rescue claims over $3.1 million in overpayments to a hospital in its network, the Business Court held it failed because the contract at issue “clearly and unambiguously”...more

ArentFox Schiff

Investigations Newsletter: Surgeon To Pay Up to $43 Million for FCA Fraud

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Surgeon To Pay Up to $43 Million for FCA Fraud - A Michigan vascular surgeon, Vasso Godiali, was sentenced to 80 months in prison for defrauding health care programs in connection with his submission of false claims for...more

Mintz - Health Care Viewpoints

EnforceMintz — 2022 Saw the Expansion of EKRA Outside of the Addiction Treatment Setting

The Eliminating Kickbacks in Recovery Act of 2018 (EKRA) is a criminal statute that prohibits paying or receiving anything of value in exchange for the referral of patients to recovery homes, clinical treatment facilities, or...more

ArentFox Schiff

Federal District Court Certifies Transgender Discrimination Class Action Against Third-Party Administrator Under the Affordable...

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Earlier this month, the US District Court for the Western District of Washington certified a class of individuals who were denied gender-affirming care by a third-party administrator, Blue Cross Blue Shield of Illinois...more

Bradley Arant Boult Cummings LLP

Now I Know My CBDs – Louisiana Court Favors Employee Terminated for Failing Marijuana Test

This country’s relationship with cannabis is a complicated one, and as is often the case in complicated matters, words matter. Marijuana and hemp are different strains of the Cannabis sativa L plant. So, “cannabis” is a...more

Spilman Thomas & Battle, PLLC

Unprecedented: COVID-19 Litigation Insights, Volume 3, Issue 3

Early Covid-19 Disability Ruling Offers Blueprint for Lawsuits - "The Montgomery, Ala.-based court is one of the first tribunals to weigh in on the issue." - Why this is important: As we enter into the third year of...more

Pillsbury Winthrop Shaw Pittman LLP

Developments in Association Law 2020-2021

A review of key legal developments for nonprofit organizations at the federal and state levels in 2020 and 2021. Antitrust Torrey v. Infectious Diseases Society of America, No. 17-190 (E.D. Tex. Sept. 1, 2021), No. 407 &...more

Arnall Golden Gregory LLP

Federal Court Sides with Plaintiffs on Motion to Dismiss $40+ Million Dollar Suit for Unpaid and Underpaid Claims

Attorneys Matthew M. Lavin and Aaron R. Modiano recently secured a complete denial of Blue Cross & Blue Shield of Michigan’s Motion to Dismiss a $40+ million dollar lawsuit brought on behalf of behavioral health providers for...more

Holland & Hart - The Benefits Dial

Doctor, Doctor . . . Health Plan Litigation Update

For individuals who work with employer-sponsored benefit plans, the past 18 months has been packed with new developments from federal and state legislatures as well as executive branch initiatives and regulatory guidance....more

Patrick Malone & Associates P.C. | DC Injury...

Plaintiffs’ fortitude: It’s an admirable must when battling corporate fat cats

While too many of us get overdosed with clownish depictions - from doctors, hospitals, insurers, and corporations, especially Big Pharma firms - of how the civil justice system operates, it’s always worth a reminder of the...more

Akerman LLP - Health Law Rx

Healthcare Antitrust – What to Expect in 2021

The year 2020 was an eventful one in the world of healthcare antitrust. The year began with the announcement of the precedent-setting settlement of the California Attorney General’s action against Sutter Health and ended with...more

Patterson Belknap Webb & Tyler LLP

Major Development in BCBS Association Antitrust Litigation

Antitrust litigation has been ongoing for several years in the U.S. District Court for the Northern District of Alabama against one of the biggest business associations in America, the Blue Cross Blue Shield Association...more

Health Care Compliance Association (HCCA)

Blue Cross Blue Shield nears settlement for $2.7 billion

Compliance Today (December 2020) - The Blue Cross Blue Shield insurance group has negotiated a possible settlement to sweeping antitrust lawsuits that alleged the group benefited from anticompetitive measures that...more

Akerman LLP - Health Law Rx

“Historic” Settlement of Blue Cross Blue Shield Association Antitrust Action May Significantly Boost Competition in Health...

After over 8 years of hard-fought litigation, the Blue Cross and Blue Shield Association, together with its 36 Blue Cross/Blue Shield members (“the Blues”), recently announced a proposed settlement of class action antitrust...more

Mitchell, Williams, Selig, Gates & Woodyard,...

Hazardous Waste Enforcement: U.S. Environmental Protection Agency and Blue Cross Blue Shield of Louisiana Enter into...

The United States Environmental Protection Agency (“EPA”) and Blue Cross Blue Shield of Louisiana (“Blue Cross”) entered into a September 22nd Administrative Compliance Order on Consent (“Order”) addressing alleged violations...more

Foley & Lardner LLP

Does Payer Coverage Drive Genomic Test Utilization in the United States?

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Does payer coverage of genomic testing drive utilization? That is the question The Personalized Medicine Coalition (“PMC”) asked and answered in its recent report “Understanding Genomic Testing Utilization and Coverage in the...more

K&L Gates LLP

K&L Gates Triage: Michael P. V. BCBS Of Texas

K&L Gates LLP on

In this week’s episode, Gary Qualls discusses a recent case decided in the Western District of Louisiana, which highlights how the application of the arbitrary and capricious standard as applied to payor coverage...more

Buchalter

From Frying Pan to Fire: Strategic Issues When Reimbursement Disputes Turn Into Criminal Investigations

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Early on the morning of June 13, 2017, over one hundred federal agents raided facilities across southern California belonging to behavioral health provider Sovereign Heath. The agents provided search warrants indicating that...more

Buchalter

DOJ Criminal Health Care Enforcement: It’s Not Just for Federal Programs Anymore

Buchalter on

On July 10, 2020, in United States v. Ruan, the Eleventh Circuit affirmed the convictions of two Alabama doctors for running an opiate “pill mill.” Among many other things, the government charged that the doctors used...more

Rivkin Radler LLP

Employee Relations Law Journal – From the Courts

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North Carolina District Court Permits Plan’s Lawsuit Against Third Party Administrator to Continue A federal district court in North Carolina has ruled that a plan subject to the Employee Retirement Income Security Act of...more

King & Spalding

COVID-19 Spurs Significant Policy Changes by Commercial Plans

King & Spalding on

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

Epstein Becker & Green

The Impact of the Coronavirus on the Provider-Payor Relationship

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As the coronavirus spreads throughout the country, hospitals and other health care providers are finding themselves inundated with patients. Those providers who are in-network with payors have and will likely continue to...more

Health Care Compliance Association (HCCA)

Report on Patient Privacy Volume 20, Number 1. Privacy Briefs: January 2020

Report on Patient Privacy 20, no. 1 (January 2020) - ? A cybersecurity breach temporarily halted cancer radiation treatment services at the Cancer Center of Hawaii on Oahu,[1] the center said. The center, which provides...more

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