CIGNA

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Send Lawyers, Guns and Money:* Providers Lining Up Against Anthem/Cigna and Aetna/Humana Mergers

In the wake of Anthem’s proposed acquisition of Cigna and Aetna’s proposed acquisition of Humana, providers are lining up to be heard. Take the American Medical Association (AMA), for example, which is urging federal and...more

Health Insurers Announce Merger Plans; Congress Announces Intention to Review

In the last few months, several of the largest commercial health insurers in the nation have announced their intentions to merge. First, Aetna (currently the nation’s third largest health insurer by revenue) announced its...more

IREG Update - August 2015 #2

Hot Topic: New York Emergency Medical Services and Surprise Bills Law - Earlier this year, New York’s Emergency Medical Services and Surprise Bills Law went into effect (the full text of the bill is available on the...more

Anthem-Cigna Mega Merger Likely Problematic for Providers

Anthem announced on July 24, 2015 that it would purchase Cigna, just three weeks after Aetna agreed to buy Human for $37 billion. The deal is valued at $54.2 billion, and would create the United States’ largest health insurer...more

Health Care Providers Lacked Standing to Sue as ERISA Beneficiaries: Rojas v. Cigna Health and Life Insurance Company

The U. S. Court of Appeals for the Second Circuit has affirmed a dismissal of claims by two physicians and their medical practice asserting standing under ERISA to enjoin an insurer from removing them from its coverage...more

Will Increased Consolidation in the Insurance Industry Yield Opportunities or Challenges for Investors?

A recent flurry of activity in the health insurance industry would seem to indicate that investors can expect significant consolidation in the managed care sector....more

Impact of the Cigna Health Decision on the Use of the Merger Structure in Private Acquisitions

When buying a private company controlled by a private equity sponsor but with a substantial number of other shareholders, a common technique to avoid the need to obtain signatures from all the shareholders to a stock purchase...more

Insurance Antitrust Legal News: Volume 4, Number 3

Auto Insurers Again Seek Dismissal of In Re Auto Body Shop Antitrust Litigation - In early March, the auto insurer defendants in the In re Auto Body Shop Antitrust Litigation renewed their motions seeking the dismissal...more

Fifth Circuit Finds Out-Of-Network Medical Provider Has Standing To Sue Health Plan

The Fifth Circuit recently addressed an out-of-network provider’s right to sue and whether coverage may be conditioned on collections of patient’s out of pocket costs. North Cypress Medical Ctr. Operating Co., et al. v. Cigna...more

The ERISA Litigation Newsletter - April 2015

Editor's Overview - In this month's Newsletter, Robert Rachal discusses recent "church plan" rulings where some federal judges have declined to give deference to long-standing, consistent guidance from the Internal...more

Fifth Circuit: Hospital Enjoys Standing to Seek ERISA Benefits

The Fifth Circuit ruled that an out-of-network medical provider that was assigned a patient’s rights to health insurance benefits has standing to sue a health plan that underpays its portion of the benefits due even if the...more

Re-examining the M&A Playbook for Non-consenting Stockholders in Light of Cigna Health

In a case that is likely to impact M&A structuring for certain transactions, the Delaware Court of Chancery held that (1) stockholder release obligations found only in a letter of transmittal and not in the related merger...more

Delaware Chancery Court Concludes Indemnification and Other Provisions of a Merger Agreement Are Not Enforceable Against...

In November, the Delaware Court of Chancery issued a decision that raises troubling questions about commonly used techniques in private company acquisitions and that, if not modified on appeal or through legislation, could...more

Private Company M&A: Post-Closing Purchase Price Adjustment Provisions: New Decision Holds Some Common Mechanics Unenforceable

In private company acquisitions, it is common for the buyer to require that a portion of the merger consideration be set aside in escrow as an accessible source of funds to cover the buyer’s post-closing indemnification...more

Second Circuit: Class-Wide Reformation Is Appropriate Equitable Relief

In the latest chapter of the Amara saga, the Second Circuit recently affirmed the district court’s class-wide order to reform CIGNA’s cash balance plan, as a means to remedy what the district court previously found to be...more

Court Clarifies Law on Enforceability of Obligations of Non-Signatories in Private Mergers

In a fact-specific case with potential ramifications for future mergers under Delaware law, Cigna Health and Life Insurance Co., a preferred stockholder of Audax Health Solutions Inc., whose shares were extinguished by a...more

Cigna Health and Life Ins. Co. v. Audax Health Sol’ns, Inc., C.A. No. 9405-VCP (Del. Ch. Nov. 26, 2014)

In this action seeking a declaratory judgment regarding the validity of certain provisions in a merger agreement and related contracts, the Court of Chancery granted in part plaintiff’s motion for judgment on the pleadings,...more

Delaware Court Invalidates Release and Indemnification Obligations Against a Selling Stockholder in a Merger Transaction

The Delaware Chancery Court recently invalidated a buyer’s attempt to obtain a release and indemnification obligations from selling stockholders of a Delaware corporation that was acquired in a merger. The ruling will require...more

The Reformed Health Care Industry: Creative Structures and Alliances Can Yield Great Benefits, but Also Great Risks

Since the Affordable Care Act (the “ACA”) was enacted in 2010, the health care industry has been on the edge of its proverbial seat waiting to see which care delivery models are best suited to sustain all the changes: to...more

Ninth Circuit Holds that Monetary “Make-Whole” Relief Is Not Available Absent Loss to Plan or Unjust Enrichment for Defendant...

A Ninth Circuit panel recognized that reformation, equitable estoppel and surcharge were among the “appropriate equitable relief” potentially available under Section 502(a)(3) of ERISA (following dictum in CIGNA Corp. v....more

Third Circuit Issues Opinion On Arbitrability Of Direct And Assigned, Or Derivative, Claims

The Third Circuit recently vacated a lower court’s decision granting a motion to compel arbitration of (1) direct claims by certain cardiac services health providers against CIGNA and...more

Two Federal Circuits Find Health Insurance Claims Outside Scope Of Arbitration Clauses

Because courts apply a presumption of arbitrability when they analyze whether particular claims fall within the scope of an arbitration clause, and arbitration clauses are generally drafted very broadly, I don’t usually get...more

Court Holds That ERISA Plaintiff Cannot Claim Equitable Remedies When the Plaintiff Has Adequate Remedies to Recover Plan...

A federal court has ruled that, although a recent U. S. Supreme Court decision expanded the kinds of equitable remedies available to a plaintiff under ERISA § 502(a)(3), those remedies are still unavailable when the ERISA...more

OIG and MA Plan Sponsor Settle Allegations of Altering Records Submitted During Audit

Bravo Health Pennsylvania, Inc. (Bravo), a Medicare Advantage Plan Sponsor and subsidiary of Cigna Corporation, agreed to pay $225,000 to the Government for allegedly misrepresenting or falsifying information furnished to the...more

Defendants Must Keep Insurance Coverage Considerations in Mind When Settling Class Action Lawsuits

On July 18, 2013, a Pennsylvania appellate court held that class action defendant Cigna Corporation (Cigna) was not entitled to insurance coverage for any part of a settlement it paid to plaintiffs because Cigna did not...more

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