In our January 14 blog, we explained that Chief Judge Lance Walker of the U.S. District Court for the District of Maine had entered a nationwide preliminary injunction in American Hospital Association v. Kennedy, blocking the...more
2/12/2026
/ Administrative Procedure Act ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Drug Pricing ,
Federal Pilot Programs ,
Health Care Providers ,
HRSA ,
Preliminary Injunctions ,
Remand ,
Section 340B ,
Vacatur
In an unpublished memorandum decision, the Ninth Circuit in R.R. v. California Physicians’ Service d/b/a Blue Shield of California, affirmed the insurer and administrator’s denial of benefits for a dependent’s residential...more
On January 12, the U.S. Supreme Court denied the petition for writ of certiorari in Guardian Flight, leaving in place the Fifth Circuit’s June 2025 decision that we covered in our prior post. As a result, within the Fifth...more
1/19/2026
/ Appellate Courts ,
Arbitration Awards ,
Denial of Certiorari ,
Dispute Resolution ,
Employee Retirement Income Security Act (ERISA) ,
ERISA Litigation ,
Insurance Litigation ,
No Surprises Act (NSA) ,
Popular ,
Private Right of Action ,
Provider Payments ,
SCOTUS
On January 7, the U.S. Court of Appeals for the First Circuit denied the federal government’s request for a stay of the nationwide preliminary injunction barring implementation of the Health Resources and Services...more
1/15/2026
/ Administrative Procedure Act ,
Appeals ,
Covered Entities ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Drug Pricing ,
Health Care Providers ,
Healthcare ,
Hospitals ,
HRSA ,
Preliminary Injunctions ,
Section 340B
On January 12, the U.S. Supreme Court denied the petition for writ of certiorari in Guardian Flight, leaving in place the Fifth Circuit’s June 2025 decision that we covered in our prior post (available here). As a result,...more
1/15/2026
/ Appellate Courts ,
Arbitration Awards ,
Denial of Certiorari ,
Dispute Resolution ,
Employee Retirement Income Security Act (ERISA) ,
ERISA Litigation ,
Health Care Providers ,
Health Insurance ,
Insurance Claims ,
Insurance Litigation ,
No Surprises Act (NSA) ,
Private Right of Action ,
SCOTUS ,
Standing
On December 29, 2025, Chief Judge Lance Walker of the U.S. District Court for the District of Maine granted the plaintiffs’ motion for a preliminary injunction in American Hospital Association v. Kennedy. The court enjoined...more
On November 24, the Ninth Circuit issued an unpublished memorandum disposition in Dedicato Treatment Center, Inc. v. Aetna Life Insurance Co., affirming dismissal of an out-of-network provider’s state-law claims as preempted...more
12/4/2025
/ Appellate Courts ,
Assignment of Benefits (AOB) ,
Denial of Insurance Coverage ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
ERISA Litigation ,
Federal Rule 12(b)(6) ,
Health Care Providers ,
Health Insurance ,
Insurance Claims ,
Insurance Industry ,
Insurance Litigation ,
Out of Network Provider ,
Preemption
On October 31, CMS finalized the CY 2026 Medicare Physician Fee Schedule (PFS) rule (CMS-1832-F), effective January 1, 2026. While primarily directed at Medicare providers, the rule’s changes have clear downstream effects for...more
11/13/2025
/ Alternative Payment Models (APM) ,
Centers for Medicare & Medicaid Services (CMS) ,
Commercial Insurance Policies ,
Final Rules ,
Health Insurance ,
Insurance Industry ,
Medicare ,
Physician Fee Schedule ,
Provider Payments ,
Reimbursements ,
Telehealth ,
Value-Based Care
On October 15, the California Hospital Association (CHA) filed a petition against the California Office of Health Care Affordability (OHCA) and related entities. The petition challenges the imposition of stringent cost...more
10/23/2025
/ Arbitrary and Capricious ,
California ,
Constitutional Challenges ,
Due Process ,
Health Care Providers ,
Healthcare ,
Healthcare Costs ,
Hospitals ,
New Regulations ,
Regulatory Oversight ,
State and Local Government ,
Takings Clause
On September 17, California Governor Gavin Newsom signed Assembly Bill 144 (AB 144) into law, a move in response to recent changes in immunization recommendations by the U.S. Food and Drug Administration (FDA)....more
9/26/2025
/ California ,
Coronavirus/COVID-19 ,
Department of Insurance ,
Governor Newsom ,
Health Insurance ,
Healthcare Reform ,
Insurance Regulations ,
New Legislation ,
Patient Access ,
Public Health ,
State and Local Government ,
Vaccinations
The U.S. Supreme Court, in a 6-3 decision, ruled that the Medicaid Act’s any-qualified-provider provision does not confer individual rights enforceable under 42 U.S.C. §1983. This decision reverses the Fourth Circuit’s...more
6/27/2025
/ 42 U.S.C. §1983 ,
Appeals ,
Beneficiaries ,
Constitutional Challenges ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Judicial Authority ,
Medicaid ,
Medina v Planned Parenthood South Atlantic ,
Patient Access ,
Planned Parenthood ,
Reproductive Healthcare Issues ,
SCOTUS ,
State and Local Government ,
Statutory Interpretation
On September 27, California Governor Gavin Newsom signed into law two bills that will impact health care service plans and insurers in the state....more
On May 31, the U.S. Court of Appeals for the Ninth Circuit published an opinion in Bristol SL Holdings Inc. v. Cigna Health and Life Insurance Co., which has significant implications for the healthcare industry.
Originally...more
The White House has finalized the new Mental Health Parity rule, which focuses on increasing access to mental health/substance use disorder treatment through nonquantitative treatment limitations (NQTL) data and reporting,...more
In a win for health care providers, on August 2, the Fifth Circuit Court of Appeals affirmed a Texas federal judge’s grant of summary judgment in favor of the Texas Medical Association and LifeNet, an air ambulance company,...more
On May 31, the Ninth Circuit Court of Appeals published an opinion in Bristol SL Holdings, Inc. v. Cigna Health and Life Insurance Company, which has significant implications for the healthcare industry, most notably by...more
The California Court of Appeal, in a major win for managed care payors and claims administrators, affirmed a lower court decision granting summary judgment in favor of United Healthcare (United), finding that United did not...more