News & Analysis as of

Reimbursements Appeals

Robinson+Cole Health Law Diagnosis

U.S. Supreme Court Denies DSH Hospitals’ Attempts to Seek Higher Medicare Payments

On April 29, 2025, the U.S. Supreme Court issued an opinion upholding the formula the U.S. Department of Health and Human Services (HHS) utilized to calculate Medicare hospitals’ disproportionate share hospital (DSH) payment...more

Epstein Becker & Green

A Common Denominator Governs the Medicare Fraction - SCOTUS Today

Epstein Becker & Green on

In its 2022 decision in Becerra v. Empire Health Foundation, for Valley Hospital Medical Center, the U.S. Supreme Court held that the phrase “entitled to [Medicare Part A] benefits” applied to “all those qualifying for the...more

McDermott Will & Emery

CMS Poised for Medicare, Medicaid Integrity Enforcement Actions

McDermott Will & Emery on

The Trump administration and 119th Congress are preparing to reduce federal expenditures by targeting Medicare and Medicaid fraud, waste, and abuse. Medicare enrollment revocations, Medicaid enrollment terminations, and...more

Marshall Dennehey

Reimbursement of Pennsylvania Department of Human Services Lien Is Found Not Automatic by Pennsylvania Commonwealth Court

Marshall Dennehey on

Key Points: No formal liability for payment of work-related medical expenses is triggered on the part of the employer/insurer until such expenses are properly submitted in accordance with the terms and provisions of the...more

Laughlin, Falbo, Levy & Moresi LLP

Who Pays What: The Pitfalls of Contribution and Reimbursement Among Co-Defendants in Workers’ Compensation

The recent Barahona v. ABM Janitorial Services (2024) 53 CWCR 4, decision sheds light on a common but often misunderstood issue in California workers’ compensation: how liability is shared among multiple employers and...more

Buchalter

Actual Loss Under A Title Insurance Policy Is Calculated Based On The “Highest And Best Use” Of The Insured Real Property

Buchalter on

In a victory for all insureds who have title insurance policies, and possibly a victory for insureds under other real property related insurance policies, the California Court of Appeal in Tait v. Commonwealth Land Title...more

Proskauer - Health Care Law Brief

Recent Circuit Litigation Continues to Highlight “But-For” Causation Requirement for the Government to Demonstrate an FCA...

In recent years, a circuit split among the United States Courts of Appeals has emerged over how courts have interpreted the False Claims Act’s (“FCA”) causation element in cases where a violation of the Anti-Kickback Statute...more

Kaufman & Canoles

Court of Appeals of Virginia Holds Plaintiff Who Did Not Seek Reimbursement in its Partition Complaint

Kaufman & Canoles on

On Tuesday, in Lehmann v. WFV Holdings, LLC, Record No. 0201-23-2 (Ct. App. Va. May 14, 2024), available here, the Court of Appeals of Virginia reversed a decision from the Circuit Court of Amelia County, holding that because...more

Mitchell, Williams, Selig, Gates & Woodyard,...

Storage Tank Enforcement: Tennessee Department of Environment and Conservation Proposed Order/Assessment Addressing Robertson...

The Tennessee Department of Environment and Conservation (“TDEC”) issued a February 7th Proposed Order and Assessment (“Order”) to Murphy Oil USA, Inc. (“Murphy”). The Order provides that Murphy is the registered owner of...more

White and Williams LLP

First Circuit Limits Insurers’ Right to Recoup Defense Costs, Settlement Payments

White and Williams LLP on

Weighing in on an issue that has divided courts nationwide, the U.S. Court of Appeals for the First Circuit has ruled that an insurer under Massachusetts law has no right to recoup defense costs, or amounts the insurer pays...more

WilmerHale

The Interplay: Key Decisions at the Intersection of Antitrust & Life Sciences - January 2024

WilmerHale on

Illumina Agrees to Unwind Acquisition of Grail Following Fifth Circuit Decision.  On December 15, 2023, the Fifth Circuit vacated the FTC’s order that Illumina unwind its acquisition of Grail—a developer of a multi-cancer...more

ArentFox Schiff

Five Key Legislative Updates Affecting California Employers in 2024

ArentFox Schiff on

California Governor Gavin Newsom signed a flurry of new bills at the end of the legislative session, including numerous bills that will impact employers across various industries across the state. Some of the key changes...more

King & Spalding

Fifth Circuit Affirms Approval of Bid Protections for Debtor’s Prior Lender Over Unsecured Creditors’ Objection

King & Spalding on

On July 25, 2023, the U.S. Court of Appeals for the Fifth Circuit affirmed a bankruptcy court’s approval of a break-up fee and expense reimbursement owed to a debtor’s prior lender, after the lender was not the winning bidder...more

Mintz - Technology, Communications & Media...

What’s New in Wireless - August 2023

The wireless industry has revolutionized the way we connect, from facilitating teleworking, distance learning, and telemedicine to allowing the American public to interact virtually in almost all other aspects of their daily...more

Davis Wright Tremaine LLP

Reimbursing California Remote Employees' Expenses: Obligation Confirmed

Reimbursing employees for job-related expenses has become a hot-button issue with so many employees working remotely and even on-site employees communicating with their employers by way of their personal cell phones. The...more

Proskauer - California Employment Law

Court of Appeal Clarifies Employers’ Expense Reimbursement Obligations for Pandemic-Related Remote Work

California Labor Code section 2802 (“Section 2802”) requires employers to reimburse employees for “all necessary expenditures or losses” they incur as a “direct consequence of the discharge of … [their] duties, or … [their]...more

Sheppard Mullin Richter & Hampton LLP

California Court of Appeal Clarifies Employer’s Obligation to Reimburse Expenses Depends on Whether They Were a Direct Consequence...

On July 11, 2023, the California Court of Appeal in Thai v. IBM held that whether an employer is obligated to reimburse expenses incurred by an employee working from home turns on whether the expenses were a direct...more

Arnall Golden Gregory LLP

AGG Talks: Home Health & Hospice - Reimbursement Audits and Appeals

In this episode, Jason Bring, AGG Healthcare partner and co-chair of the Post-Acute & Long-Term Care team, and Lanchi Nguyen Bombalier, AGG Healthcare partner and member of the Post-Acute & Long-Term Care, Hospitals & Health...more

ArentFox Schiff

Investigations Newsletter: Supreme Court Again Tightens FCA Intent, But Tricky Questions Linger

ArentFox Schiff on

The US Supreme Court brushed aside novel assertions from two pharmacy retailers on June 1 and ruled unanimously that False Claims Act liability hinges on whether defendants subjectively believed their claims were “false.” In...more

King & Spalding

CMS Reworks the Medicare Cost Report for Hospitals

King & Spalding on

On December 29, 2022, CMS posted on its website Transmittal 18, which implements sweeping changes to the Medicare cost report for hospitals and its accompanying instructions. The revisions affect nearly every facet of...more

Sheppard Mullin Richter & Hampton LLP

Time Is Not Always Money: Ninth Circuit Holds That Pre-Employment Drug Testing Is Not Compensable Under California Law

On June 13, 2022, the Ninth Circuit Court of Appeals held in Johnson v. WinCo Foods Holdings, Inc, et al. that class members who were not yet employed by WinCo were not entitled to compensation for the time required to take a...more

Proskauer - California Employment Law

Employer Need Not Reimburse Travel Expenses for Drug Test

A federal appeals court recently affirmed a summary judgment entered in favor of WinCo Foods in a class action alleging that WinCo should have reimbursed successful job applicants for the time and travel expenses they...more

King & Spalding

D.C. Circuit Rejects Critical Access Hospital’s Appeal for Medicare Payments to On-Call Specialty Physicians

King & Spalding on

On April 15, 2022, the D.C. Circuit affirmed the denial of a California hospital’s request to obtain critical access hospital cost reimbursement from Medicare for the costs incurred to keep non-emergency specialty physicians...more

Harris Beach Murtha PLLC

Federal Judge Invalidates QPA Provisions of No Surprises Act Regulations

On February 23, 2022, Judge Jeremy Konodle of the U.S. District Court for the Eastern District of Texas, issued a decision in Texas Medical Association v. United States Department of Health & Human Services that invalidated...more

Arnall Golden Gregory LLP

Is There a Constitutional Limit to Excessive Fines in False Claims Act Cases? Eleventh Circuit Says a Million Dollar Fine for a...

In late December, the U.S. Circuit Court of Appeals for the Eleventh Circuit issued its decision in Yates v. Pinellas Hematology & Oncology, P.A. The appellate court affirmed the district court’s imposition of damages and...more

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