News & Analysis as of

Health Insurance › Arbitrary and Capricious

Rivkin Radler LLP

Pharma Coalition Files Suit Against HHS over OIG Advisory Opinion

Rivkin Radler LLP on

On November 9, the Pharmaceutical Coalition for Patient Access (PCPA) filed an action against the U.S. Department of Health and Human Services (HHS) after HHS’s Office of Inspector General (OIG) determined that a proposed...more

K&L Gates LLP

K&L Gates Triage: Michael P. V. BCBS Of Texas

K&L Gates LLP on

In this week’s episode, Gary Qualls discusses a recent case decided in the Western District of Louisiana, which highlights how the application of the arbitrary and capricious standard as applied to payor coverage...more

King & Spalding

Federal Appeals Court Strikes Down Arkansas Medicaid Work Requirements

King & Spalding on

On February 14, 2020, the United States Court of Appeals for the District of Columbia Circuit issued its decision in Gresham et al. v. Azar et al., Case No. 19-5094, a case challenging HHS’s Medicaid waiver that allowed...more

Bradley Arant Boult Cummings LLP

Could Possible Predictability Be Coming to Wilderness Therapy Coverage Disputes?

Bradley Arant Boult Cummings LLP on

Current trends in litigation regarding wilderness therapy coverage center on motion practice. Courts have been unpredictable with granting or denying defendants’ motions to dismiss and motions for summary judgment, and recent...more

Sheppard Mullin Richter & Hampton LLP

Arkansas and Kentucky Halt Medicaid Work Requirements

Sheppard Mullin Richter & Hampton LLP on

On April 10, 2019, the Department of Justice filed notices appealing two District Court rulings that struck down Medicaid work requirements in both Kentucky and Arkansas to the U.S. Court of Appeals for the District of...more

Mintz - Health Care Viewpoints

New Mexico Court Affirms Ruling in ACA Risk Corridor Case

Mintz - Health Care Viewpoints on

On October 19, 2018, a New Mexico district judge rejected a request from HHS to reconsider a February decision that had briefly led to the suspension of the ACA’s risk adjustment program. In February, District Judge James...more

Mintz - Health Care Viewpoints

CMS, In a Reversal, Announces Plans to Continue Funding Risk Adjustment Payments

Mintz - Health Care Viewpoints on

On Wednesday, August 8, CMS filed a proposed rule clearing the way for the federal government to continue making payments under the ACA’s risk adjustment program for the benefit year 2018. The 2018 proposed rule is...more

Robinson+Cole ERISA Claim Defense Blog

Fifth Circuit Joins Sister Circuits by Overruling Default Deferential Standard of Review

Robinson+Cole ERISA Claim Defense Blog on

In Ariana M. v. Humana Health Plan of Tex., 2018 U.S. App. LEXIS 5227, *5, 2018 WL 1096980 (March 1, 2018) (“Ariana M. II”), a majority of judges of the U.S. Court of Appeals for the Fifth Circuit, in an en banc decision,...more

Proskauer Rose LLP

The ERISA Litigation Newsletter - October 2016

Proskauer Rose LLP on

Editor's Overview - This month, we look at the implications of the two federal district court cases from California that applied the ban on discretionary clauses typically found in ERISA plans to self-insured plans. The...more

McDermott Will & Emery

Seventh Circuit Finds that State Insurance Law Applies, Resulting in De Novo Review of Benefit Claim

McDermott Will & Emery on

On September 4, 2015, the U.S. Court of Appeals for the Seventh Circuit ruled in Fontaine v. Metropolitan Life Insurance Company that the Employee Retirement Income Security Act of 1974, as amended (ERISA), does not preempt...more

10 Results
 / 
View per page
Page: of 1

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
Sign up Log in
*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
- hide
- hide