News & Analysis as of

Motion to Dismiss Health Insurance

Pillsbury Winthrop Shaw Pittman LLP

Developments in Association Law 2022 – 2024

The following is a review of notable cases and regulatory developments for nonprofit organizations at the federal and state levels during the last two years....more

Polsinelli

Nursing Home Providers Suffer Blow as District Court Denies Motion to Dismiss in “Worthless Services” FCA Action Based on...

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On March 31, 2023, the United States District Court for the Eastern District of Pennsylvania dealt a blow to a trio of nursing home providers by denying their motion to dismiss a False Claims Act (FCA) claim brought by the...more

Farrell Fritz, P.C.

Supreme Court To Decide Standard For Government Dismissal Of False Claims Act Cases

Farrell Fritz, P.C. on

The Supreme Court granted certiorari in a case that will decide two important questions under the False Claims Act (FCA).  In United States ex rel. Polansky v. Executive Health Resources, Inc., the Relator asks the Court to...more

Hinshaw & Culbertson - The LHD/ERISA Advisor

The LHD/ERISA Advisor: District Court Holds that Plan Administrator Was ERISA Fiduciary

In Technibilt Grp. Ins. Plan & Technibilt, Ltd v. Blue Cross & Blue Shield of North Carolina (W.D. N.C., Feb. 3, 2020), a North Carolina district court held that a plan administrator was an ERISA fiduciary for the purpose of...more

Payne & Fears

Technicalities Don't Defeat Provider Claims for Emergency Services

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Last week, the Court of Appeal gave a victory to non-contracted providers of emergency medical services. In San Jose Neurospine v. Aetna Health of California, the court rejected Aetna's position that because the provider "did...more

Seyfarth Shaw LLP

Exclusion for Gender Reassignment Surgery May Violate Title VII and the Equal Protection Clause

Seyfarth Shaw LLP on

Seyfarth Synopsis: On December 23, 2019, District Judge Rosemary Marquez ruled, in connection with a motion to dismiss, that Title VII does protect discrimination based on a person’s transgender status, and that a health...more

Saul Ewing LLP

The Friday Five: Five Current ERISA Litigation Highlights – August 2019

Saul Ewing LLP on

This month's Friday Five discusses cases that probe the issue of what is appropriately considered in litigation regarding LTD benefits. Some cases seem to state the obvious, for example when a court issues an order directing...more

Ogletree, Deakins, Nash, Smoak & Stewart,...

The Battle Lines of Mental Health Parity Litigation: Utah District Court Grants Motion to Dismiss, Finds Conclusory Allegations...

On June 5, 2019, in the matter Kerry W. v. Anthem Blue Cross and Shield, No. 2:19cv67, Judge Dee Benson of the U.S. District Court for the District of Utah granted Anthem Blue Cross and Shield’s motion to dismiss the...more

Bradley Arant Boult Cummings LLP

Could Possible Predictability Be Coming to Wilderness Therapy Coverage Disputes?

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

K&L Gates LLP

K&L Gates Triage: Important Takeaways from Omega Hospital, LLC v. United Healthcare Services, Inc.

K&L Gates LLP on

In this episode, Gary Qualls discusses a recent development in payer litigation which implicates a number of recurring issues often raised in Employee Retirement Income Security Act (ERISA) cases. Specifically, a federal...more

Bradley Arant Boult Cummings LLP

CNA Long-Term Care Class Action — Could It Have Long-Term Consequences?

A long-term care insurance class action filed in May 2018 highlights the importance of clearly defined policy language. At dispute in the lawsuit pending in the United States District Court for the Northern District of...more

Holland & Knight LLP

EMTALA as a Basis for a Qui Tam Case?

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The Emergency Medical Treatment & Labor Act (EMTALA) requires a hospital with an emergency department (ED) to provide "an appropriate medical screening examination" when an individual comes to the ED and a request is made on...more

Bradley Arant Boult Cummings LLP

Long-Term Care and Elder Abuse: Do They Intersect?

In at least one state, California, the answer to the question of “Do issues related to long-term care and elder abuse intersect?” is yes. The California Welfare and Institutions Code defines “financial abuse” of an elder...more

Proskauer - Employee Benefits & Executive...

Clawbacks: Recent Litigation Targeting Insurers and Pharmacy Benefit Managers

While the term “co-pay” might suggest a sharing of costs between patients and their health plans, a recent study by the University of Southern California Schaeffer Center found that almost a quarter of patients are paying...more

Holland & Knight LLP

Connecticut District Court Provides Interpretation of ACA Provision - Decision Allows Insurers to Circumvent Hospitals in...

Holland & Knight LLP on

• The ACA does not prevent insurers from declining to directly reimburse out-of-network hospitals for emergency care, and instead adjudicate and administer claims directly with individual patients, the U.S. District Court for...more

Carlton Fields

Sticking Firmly to Contract Terms, Court Dismisses Premium and COI Overcharge Claims

Carlton Fields on

In July, in Hancock v. Americo Financial Life & Annuity Co., Americo achieved a total victory on its motion to dismiss a putative class action in the Eastern District of North Carolina that challenged its premium and COI...more

Sheppard Mullin Richter & Hampton LLP

Alert: In a Surprise Decision Issued on October 5, 2017, Honorable John Walter, United States District Judge, Dismissed a Medicare...

On October 5, 2017, the Honorable Judge John Walter of the United States District Court, Central District of California, granted the Defendants’ Motion to Dismiss the Medicare Advantage (“MA”) Federal False Claims Act (“FCA”)...more

McDermott Will & Emery

'Right-Sizing' Full-Time Employees to Reduce ACA Obligations May Lead to ERISA Class Action Exposure

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Compliance with the Affordable Care Act (ACA) has resulted in increased health benefit costs for many employers. A recent court decision demonstrates that while programs to reduce the number of full-time employees may lower...more

Dickinson Wright

Insurance Antitrust Legal News: Volume 4, Number 3

Dickinson Wright on

Auto Insurers Again Seek Dismissal of In Re Auto Body Shop Antitrust Litigation - In early March, the auto insurer defendants in the In re Auto Body Shop Antitrust Litigation renewed their motions seeking the dismissal...more

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