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Supreme Court Holds Benefit Plan Limiting Dialysis Reimbursement Does Not Run Afoul of Medicare Secondary Payer Act

On June 21, 2022, the Supreme Court concluded, in Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita Inc., No. 20-1641, 2022 WL 2203328 (U.S. June 21, 2022), that the terms of a benefit plan limiting...more

Ninth Circuit Reverses Decision Requiring Reprocessing of 67,000 Behavioral Health Claims; Hands United Healthcare a Win 

The Ninth Circuit Court of Appeals recently reversed the Northern District of California’s landmark decision against UnitedHealth Group Inc.’s behavioral health unit, United Behavioral Health (“UBH”), under which UBH had been...more

Texas Court Vacates Arbitration Provisions of Biden Administration Surprise Billing Rule

On February 23, 2022, in what is being heralded as a significant victory for health care providers, a federal court in Texas vacated portions of the Biden Administration’s rules governing the arbitration procedures to resolve...more

As It Mulls Whether To Grant Cert in ERISA Case on PBM Fiduciary Liability, Supreme Court Seeks Government's Input

In December, the Supreme Court requested that U.S. Solicitor General Elizabeth Prelogar file a brief in John Doe 1 v. Express Scripts Inc., weighing in on whether the Court should hear a case about prescription drug costs. If...more

No More Surprise Medical Bills: Second ‘No Surprises Act’ Rule Issued, But More Remains to Be Done

The Departments of Health and Human Services, Labor, and Treasury, and the Office of Personnel Management issued this Fall their second long-awaited interim final rule implementing the federal No Surprises Act (the “Act”),...more

No More Surprise Medical Bills: First ‘No Surprises Act’ Rule Issued

On July 1, 2021, the Departments of Health and Human Services, Labor, and Treasury, and the Office of Personnel Management, released a much-anticipated interim final rule designed to protect Americans from surprise medical...more

Supreme Court Holds Arkansas Statute Regulating PBMs Not Preempted By ERISA

States seeking to regulate pharmacy benefit managers (PBMs) and prescription drug pricing received a win from the Supreme Court, which reversed an Eighth Circuit decision that had invalidated an Arkansas law governing...more

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