News & Analysis as of

Reporting for ACA Mandates: Final Forms and Additional Guidance

The IRS has finalized the 2015 forms and instructions for reporting under the individual and employer mandates and issued additional guidance on these new reporting requirements. The following forms are now available...more

ERISA – Subrogation: Summary Plan Descriptions Can Be A “Controlling Document” Requiring Reimbursement… Sometimes

You already know that when a Summary Plan Description conflicts with ERISA plan language, the ERISA plan language controls. But what happens when all you have is a Summary Plan Description (SPD), and… no ERISA Plan? Can...more

CMS Publishes Long-Awaited PAMA Proposed Rule

On September 25, 2015, the Centers for Medicare & Medicaid Services (CMS) announced publication of the proposed rule (the “Proposed Rule”) implementing substantial changes to the Medicare Clinical Laboratory Fee Schedule...more

Rhcs And Fqhcs – It’s Time To Take A Second Look At Alternate Payment Methodology

In July of 2014, Kentucky Medicaid established an Alternate Payment Methodology (“APM”) for all Federally-Qualified Health Centers (“FQHCs”) and Rural Health Clinics (“RHCs”) as an alternative to the all-inclusive encounter...more

[Event] Labor & Employment Law Update & Happy Hour - Oct. 7, Palo Alto, CA

Please join us for Sheppard Mullin's bi-annual Labor & Employment Law Update & Happy Hour. There have been significant developments in California labor and employment law this year. We will explain how these new developments...more

Compensation to Human Clinical Study Participants: A (Very) Informal Survey

At least once a month, life science clients reach out to us to ask us about best practices on a particular topic or to benchmark a proposed activity against what others in the industry might be doing. One such request,...more

Litigating California Wage & Hour and Labor Code Class Actions

We are excited to announce the 15th edition of Seyfarth Shaw’s publication Litigating California Wage & Hour and Labor Code Class Actions. As in previous editions, the publication discusses and analyzes the most commonly...more

California Federal District Court Certifies Class of 160,000 Uber Drivers

In O’Connor v. Uber Technologies, Inc. (Filed 09/01/2015, No. C-13-3826 EMC), the United States District Court, Northern District of California, certified a class of approximately 160,000 current and former drivers of Uber in...more

Lands’ End Requests Dismissal of “Made in U.S.A.” Class Action After Reimbursing Plaintiff

Last week, Lands’ End tried a second time to dismiss a “Made in U.S.A.” class action with the novel argument that, because the company had already reimbursed the plaintiff for the necktie she purchased, she is not injured and...more

California Court Considers Reimbursement of Legal Fees Under D&O Policy

In its recent decision in Clark v. Travelers Cas. Ins. Co. of America, 2015 U.S. Dist. LEXIS 114877 (C.D. Cal. Aug. 28, 2015), the United States District Court for the Central District of California had occasion to consider...more

Telehealth Commercial Coverage and Parity Laws: Trends, Challenges and Opportunities

There will always be differences among state laws on telehealth coverage, but what is remarkable is the rapidly increasing pace at which states have been adopting coverage statutes in the last few years, with currently 29...more

California Supreme Court Upholds Limited Right of Carrier to Seek Recovery of Unreasonable Fees Directly from Insured’s...

On August 10, 2015, in Hartford Casualty Insurance Company v. J.R. Marketing, LLC, et al., the California Supreme Court held that in some circumstances insurers may seek reimbursement of payments made to the insured's...more

AmerisourceBergen Guest Post: Solutions to Overcome Reimbursement Challenges in Personalized Medicine

The continued development and refinement of personalized medicine (PM) has offered an opportunity to revolutionize medical practice and improve outcomes by providing treatments for patients with the notion that “this drug is...more

The ERISA Litigation Newsletter - August 2015

Editor's Overview - As the summer draws to a close, this month's Newsletter previews three cases that the U.S. Supreme Court already has agreed to hear that ought to be of particular interest to ERISA plan sponsors and...more

Independent “Cumis” Counsel Now Face Direct Claims for Reimbursement From Insurers

On April 30, 2015, we blogged about Hartford Casualty Insurance Company v. J.R. Marketing, LLC, Case No. S211645, then set for oral argument in the California Supreme Court. [see the prior post: California’s “Independent”...more

California Supreme Court: Insurer Can Directly Sue Independent Counsel for Excess Fees in Limited Circumstances

On August 10, 2015, the California Supreme Court issued a unanimous decision that could have broad implications regarding an insurer’s right to seek reimbursement of unreasonable fees and costs directly from so-called Cumis...more

5 Ways to Pay for College

Here in Arizona it seems that school starts earlier each year. With the new school year right around the corner it is a good time for soon- to – be seniors and current college students to put some time into planning out how...more

Congress Wows With Medicare Telehealth Parity Act of 2015, But Will It Succeed?

Rep. Mike Thompson (D-CA) and co-sponsors Rep. Gregg Harper (R-MS), Rep. Diane Black (R-TN), and Rep. Peter Welch (D-VT) announced, on July 7, 2015, the introduction of the Medicare Telehealth Parity Act of 2015,...more

That is SO last week - July 2015 #2

Last week, The New York Times’ The Upshot blog covered a topic that has been one of our top concerns for a while: how big data can discriminate. The post followed a Carnegie Mellon University study that reported, among many...more

Employment Law - July 2015

The Impact of National Same-Sex Marriage for Employers - Why it matters: How will employers feel the impact of the U.S. Supreme Court’s decision in Obergefell v. Hodges? The landmark ruling that the Fourteenth...more

GAO Report Examines Hospital Financial Incentives to Prescribe 340B Drugs to Medicare Beneficiaries

The Government Accountability Office (GAO) has issued a report examining financial and other characteristics of hospitals that participate in the 340B Drug Pricing Program, focusing on disproportionate share hospitals (DSH)...more

“Uber” Ruling Jars “Sharing Economy”

On June 3, 2015, Barbara Ann Berwick received a favorable ruling from a hearing officer for the California Labor Commissioner (the “CLC”) that the “ride sharing” company Uber must reimburse her for certain expenses...more

Labor Commissioner Finds Uber Driver To Be Employee, Not Independent Contractor

On June 3, 2015, the California Labor Commissioner determined that an Uber driver, Barbara Ann Berwick, was considered an employee of Uber, not an independent contractor. As such, she was entitled to reimbursement in the...more

Uber Driver—Independent Contractor or Employee? One Labor Commissioner Hearing Officer's Opinion

A hearing officer for the Labor Commissioner’s local office in San Francisco concluded earlier this month that an Uber driver was an employee of Uber, not an independent contractor. As a result, the hearing officer awarded...more

Former Uber Driver Gets a Lyft from the Labor Commissioner

A California Labor Commissioner has ruled that one of San Francisco-based Uber’s drivers, Barbara Ann Berwick, is an employee, not an independent contractor. The Labor Commissioner awarded Berwick just over $4,000 for...more

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