Reimbursements

News & Analysis as of

Noodle This! The Yin and Yang of Two Courts, Two Antitrust Cases, Two Class Certification Motions, Two Daubert Challenges, Two...

Noodle this: Two significant orders on class certification in antitrust matters issued last week. Both were heavily influenced by the threshold determination of Daubert challenges to the plaintiffs’ expert evidence. In one...more

11th Circuit Affirms Decision that Insurer Is Not Estopped from Denying Pre-Tender Costs

In EmbroidMe.com, Inc. v. Travelers Prop. Cas. Co. of Am., No. 14-10616, 2017 U.S. App. LEXIS 368 (11th Cir. Jan. 9, 2017), the Eleventh Circuit had occasion to consider whether an insurer had an obligation to reimburse its...more

Members of Ophthalmologist Group Charged with Illegal Boycott of Health Plan

An ophthalmologist cooperative in Puerto Rico settled charges with the Federal Trade Commission (“FTC”) last week that it orchestrated an illegal boycott of a health plan. The FTC alleged that the cooperative urged its...more

New Initiatives for the New Year: Highlights of the OIG’s 2017 Work Plan

On November 10, 2016, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) issued its 2017 Work Plan. The 2017 Work Plan outlines the areas of special concern to the OIG and...more

Health Care Institutions

Originally published in Haig, Business and Commercial Litigation in Federal Courts, Fourth Edition §§ 87:1 et seq. © 2016 American Bar Association. This chapter discusses federal court litigation relating to health care...more

New Law Allows Small Employers To Establish Stand-Alone Health Reimbursement Accounts

President Obama recently signed the 21st Century Cures Act (the Cures Act) which contains numerous health-care related provisions. One such provision allows small employers, beginning on and after January 1, 2017, to...more

EMPLOYMENT LAW UPDATE: Health Reimbursement Arrangement

In 2016, the law prevented employers from providing reimbursements to employees who purchase non-employer related health insurance. However, that is changing for employers with less than 50 full-time employees or the...more

Some Small Employers May Reimburse Employees' Premium and Other Uninsured Medical Expenses

The IRS previously determined that employers are not allowed to reimburse employees for premium expenses incurred for an individual health insurance policy or directly pay such premiums without violating the Patient...more

21st Century Cures: Not Just a Biomed Bill

The 21st Century Cures Act signed into law on December 13, 2016 is gaining significant attention as landmark legislation promoting medical innovation. But the massive Cures Act goes much further and includes some relief...more

Practical Considerations for Medical Practices Considering Converting Their Vascular Access Centers Into Medicare-Certified...

On November 2, 2016 the Centers for Medicare & Medicaid Services (CMS) released the 2017 Medicare Physician Fee Schedule (MPFS) Final Rule. Although the impact of the Final Rule on nephrology reimbursement is projected to be...more

Claim for Failure to Reimburse Reasonable Business Expenses Not Barred by EPL Policy’s Wage and Hour Exclusion

Don’t be too surprised if you see a “wage and hour” exclusion in your employment practices liability insurance policy, especially if you have employees in California. While these exclusions purport to bar coverage for claims...more

CMS Issues Final Rule on Off-Campus Hospital Department Reimbursement

As of January 1, 2017, hospitals will receive lower Medicare reimbursement for items and services provided at certain off-campus provider-based facilities. This Alert provides an overview of the new reimbursement framework...more

Appeals court rules overtime pay does not include per diem amount

Recently, the Tenth Circuit Court of Appeals – the federal court of appeals that covers Oklahoma – ruled that employers do not have to include reimbursement payments for daily meals for traveling employees as part of the...more

Preemption by Any Other Name Would Smell as Sweet: The Exemption for “Pervasive and Intricate Regulation” by Another Field of Law

Courts often opine on the relationship between N.C. Gen. Stat. § 75-1.1 and other bodies of law. In a recent case, a federal court announced a rare holding of that type: a holding that another body of law regulates an area so...more

Appellate Court Notes

Supreme Court Advance Release Opinions: SC19516 - Doe v. Boy Scouts of America Corp. SC19516 Concurrence - Doe v. Boy Scouts of America Corp. SC19516 Concurrence - Doe v. Boy Scouts of America...more

Refusal to Pay Claims to Gain Negotiating Leverage Is Abuse of Discretion Under ERISA, Court Says

A federal district court found that Cigna Healthcare abused its discretion, and thus was liable under section 502(a)(1)(B) of ERISA, when its primary motivation for refusing to pay a hospital’s claims was to enhance its...more

California Environmental Law & Policy Update - September 2016 #5

Environmental and Policy Focus - Shell Oil settles charges regarding claims for underground tank cleanup reimbursements - Sacramento Bee - Sep 23 - Shell Oil Co. has agreed to settle charges that it...more

Vermont to Launch a First-in-the-Nation All-Payer System for All Healthcare Providers

As recently reported by Modern Healthcare and other major healthcare news outlets, the Obama administration has granted tentative approval for Vermont to establish an all-payer reimbursement system. If granted final approval,...more

Shell Pays Big for Double Dipping with the UST Fund

Last week, the California State Water Resources Control Board (State Water Board) announced that it permanently banned 100 of Shell Oil Company’s underground storage tank (UST) claims from the California UST Cleanup Fund...more

Litigating California Wage & Hour and Labor Code Class Actions

Introduction and Overview - Since the turn of the century, there has been a huge increase in the number of class action lawsuits alleging violations of California’s overtime laws or other Labor Code statutes and wage and...more

The Ping FCPA Enforcement Action: Lessons for the Compliance Practitioner

The Securities and Exchange Commission (SEC) settled a Foreign Corrupt Practices Act (FCPA) enforcement action against an individual earlier this month when it announced the resolution of a matter involving Jun Ping Zhang,...more

News from Second and State

Yesterday was the first day of fall, and it seems the summer is truly behind us. The House of Representatives reconvened this week for the final stretch of the 2015-2016 legislative session. This week most of the action...more

The Limited Applicability of the Severin Doctrine

A recent Armed Services Board of Contract Appeals (ASBCA) decision discusses the Severin doctrine and its impact on subcontractor pass-through claims, confirming that this defense to liability may only be used in very limited...more

California Joins New York and Florida, Passes Out-Of-Network Legislation

Last month the California legislature passed AB-72, which amends the Health & Safety Code to address reimbursement for out of network (OON) providers who provide services at in-network facilities, such as hospitals and...more

Sixth Circuit Vacates Class Settlement, Finding that Sealed Documents Prevented Objectors from Assessing Settlement’s Fairness

This summer, the Sixth Circuit rejected class action litigants’ filing of the bulk of their class settlement documents under seal. Shane Grp., Inc. v. Blue Cross Blue Shield of Mich., 825 F.3d 299 (6th Cir. 2016). The Sixth...more

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