Reimbursements

ERISA Litigation Alert: Check Your Plan Subrogation and Reimbursement Language to Eliminate “Contractual Gaps”

by Richard Birmingham | Davis Wright Tremaine LLP on 5/21/2013

In U.S. Airways v. McCutchen, the U.S. Supreme Court upheld the ability of U.S. Airways’ health plan to recover medical expenses that it previously paid to the injured party from a third party settlement, but remanded the...more

Fenwick Employment Brief - May 2013: Unreimbursed Expense May Result in Minimum Wage Violation, But Not a Labor Code § 450 Private...

by Daniel J. McCoy, Dan Ko Obuhanych | Fenwick & West LLP on 5/16/2013

In Sanchez v. Aerogroup, the plaintiff alleged that as a condition of her employment she was required to purchase at least eight pairs of shoes from her employer without reimbursement. She asserted violations of both minimum...more

Real World - Spring 2013: Break clauses - tenants should err on the side of caution

by David Gervais | Dechert LLP on 5/16/2013

With the outlook for the UK economy still rather patchy at best, it is not surprising that tenants have in recent times been looking closely at their lease terms and, in particular, any break rights that they may have, with a...more

Monthly Benefits Update - April 2013

by Andrew Malahowski | Franczek Radelet P.C. on 5/1/2013

Health Care Reform: Guidance on Required Future Modifications to SBC, Other Issues - The Internal Revenue Service (IRS), Department of Labor (DOL), and Department of Health and Human Services (HHS) issued new guidance...more

ERISA Legal News - 1st Quarter, 2013 • Volume 4, Number 1

by Kimberly Ruppel | Dickinson Wright on 4/23/2013

In This Issue: - Supreme Court Update: Where Plan Reimbursement Or Recovery Terms Are Ambiguous Or Silent,Equitable Doctrines May Fill The Gaps: US Airways, Inc. v. McCutchen, 569 U.S. ___ (2013). In an...more

Supreme Court Upholds Health Plan’s Right To Recover Money from Third Party

by Edward I. Leeds | Ballard Spahr LLP on 4/23/2013

The U.S. Supreme Court has ruled that the clear terms of an employer's group health plan override an employee's equitable defenses in determining the plan's right to recover amounts from a third party. This decision points...more

Supreme Court Rules on Equitable Defenses to Reimbursement Claim by Employee Health Plan

by Katherine Lange | Womble Carlyle Sandridge & Rice, PLLC on 4/22/2013

Executive Summary: Reimbursement claim brought under ERISA sec. 502(a)(3) was akin to “equitable lien by agreement,” and therefore could not be defeated by equitable defenses that contradicted plan terms. ...more

Supreme Court “Dooms” Equitable Defenses to Plan’s Reimbursement Provisions

by Lori Oliphant | Winstead PC on 4/19/2013

In a prior blog, I discussed the importance of including unambiguous reimbursement rights in health plan documents in order to manage healthcare costs. The enforceability of such rights was confirmed by the United States...more

High Court Rules Equitable Defenses Don’t Override ERISA Plan Terms

by Ogletree, Deakins, Nash, Smoak & Stewart,... on 4/19/2013

On April 16, 2013, the U.S. Supreme Court issued its decision in US Airways, Inc. v. McCutchen (No. 11–1285), deciding the issue of whether equitable defenses, such as the principle of unjust enrichment, can override the...more

U.S. Supreme Court: Equity Cannot Trump ERISA Plan Terms in ERISA Reimbursement Case

by D. Michael Reilly | Lane Powell PC - ERISA Law on 4/18/2013

The U.S. Supreme Court yesterday strengthened the ability of employer health insurance plans to recoup payments for medical expenses paid for an injured plan participant who later sues to recover damages from a third...more

TRANSACTIONAL: Upstream Developments -- Latin America Overview of PEMEX’s 3rd Round Model Service Contract

by King & Spalding on 4/18/2013

On October 18, 2012, Pemex Exploración y Producción (PEP) published a model contract to be used in the bidding for E&P contracts in Chicontepec (the “Model”), an area in the eastern coastal plains of Mexico estimated to...more

U.S. Supreme Court Rules That Plan Terms Trump Equitable Defenses

by Russell Hirschhorn, Myron Rumeld | Proskauer - ERISA Practice Center on 4/17/2013

Today, the U.S. Supreme Court issued its ruling in U.S. Airways, Inc. v. McCutchen in which the Court unanimously ruled that a clearly drafted reimbursement clause will trump all equitable defenses....more

Recent Changes Impact Appeal of Medicare Denials and Reimbursement Strategies

by Womble Carlyle Sandridge & Rice, PLLC on 4/17/2013

Recovery Audit Contractors (“RACs”) and other Centers for Medicare and Medicaid Services (CMS) contractors are charged with identifying overpayments made by Medicare to healthcare providers. However, with the increase in RAC...more

Supreme Court Forbids Rewrite Of ERISA Plan

by Fisher & Phillips LLP on 4/17/2013

The supremacy of a written ERISA -governed plan still reigns as the U.S. Supreme Court reversed the ruling of an appellate court which had held that a court in equity can ignore unambiguous subrogation reimbursement language,...more

Carnival Cruise Class Action Lawsuit

by Lanier Law Group, P.A. on 4/8/2013

The owner of the incapacitated Carnival Triumph is getting hit by lawsuit after lawsuit, including a class action lawsuit seeking for stranding more than 3,000 passengers for five days on a ship without electricity or...more

Supreme Court of Washington Holds that Insurers Are Not Entitled to Reimbursement of Non-Covered Defense Costs

by Eryk Gettell | Sedgwick LLP on 4/5/2013

In a 5-4 decision, the Washington Supreme Court held that an insurer may not recover defense costs incurred under a reservation of rights while the insurer’s duty to defend is undetermined. National Sur. Corp. v. Immunex...more

6th Circuit Rules in Favor of HHS on Dual-Eligible Exhausted Benefit Days Issue

by King & Spalding on 4/2/2013

On March 27, 2013, the 6th Circuit, sitting en banc, issued its decision in Metropolitan Hospital v. U.S. Department of Health and Human Services, Case Nos. 11-2465\2466. At issue in the case was whether the HHS Secretary’s...more

Hospitals: Audits And Compliance

by Michael Volkov on 4/2/2013

Hospitals are under intense scrutiny. The federal government knows that one sure way to reduce healthcare costs is to get hospitals to lower their costs. Hospitals feel the pinch given the need to generate revenue but know...more

Home Health Care by Spouses

by Virginia L. Hunt on 4/1/2013

After a serious Nevada work accident and hospitalization, the injured worker may require a nurse, then unskilled nursing care at home to go to the bathroom, bathe, and make meals. This need for home health care often falls...more

Court Places Limits on Secretary's "No Reopening" Arguments

by Thomas W. Coons | Ober|Kaler on 3/31/2013

CMS has often argued that “base year” determinations cannot be revisited once the three-year reopening period has closed. Now, a recent decision from the U.S. Court of Appeals for the District of Columbia Circuit places those...more

Appellate Notes: Week of March 25

by Edward McCreery III | Pullman & Comley, LLC on 3/28/2013

In This Issue: - SC18915- Misiti, LLC v. Travelers Property Casualty Co. of America - SC18840- New England Road, Inc. v. Planning & Zoning Commission - SC18804- Cordero v. University of Connecticut...more

Water and Wastewater Projects: Financing with Tax-Exempt Bonds

by Devin Brennan, Stephen Spitz | Orrick, Herrington & Sutcliffe LLP on 3/27/2013

Introduction - Managers of water and wastewater utilities face complex financial challenges. The purpose of this guidebook is to provide an overview of issues relating to the financing of water and wastewater projects...more

Provider Reimbursement Review Board Issues Alert 9 and Revised Rules

by Jeffrey Bates, R. Michael Scarano Jr., Judith A. Waltz | Foley & Lardner LLP on 3/27/2013

On March 1, 2013, the Provider Reimbursement Review Board (PRRB or the Board) issued Alert 9, which notified interested parties that the PRRB has made revisions to its Rules and updated its Model Forms. Medicare providers...more

Subrogation Claims are “Equitable Relief” Governed by ERISA

by D. Michael Reilly | Lane Powell PC - ERISA Law on 3/26/2013

That subrogation claim you have might be governed by ERISA, at least in some circuits… Here’s the case of Thurber v. Aetna Life Insurance Company, __F.3d__ (2nd Cir. March 13, 2013) (Insurer’s counterclaim for return...more

SCOTUS Holds Federal Medicaid Anti-Lien Statute Pre-empts State Law on Recovery of Medical Expenses

by King & Spalding on 3/26/2013

Federal Medicaid law requires states, in administering their Medicaid programs, to seek reimbursement for Medicaid covered medical expenses when beneficiaries later recover amounts for medical care from third-party...more

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