News & Analysis as of

Reversal Reimbursements

Bass, Berry & Sims PLC

CMS Reverses 340B Payment Cuts for 2023 but Does Not Address Remedy for Prior Years

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On November 3, the Centers for Medicare & Medicaid Services (CMS) issued an update to its Medicare Part B drug payment policy for hospitals participating in the 340B drug pricing program and reversed payment cuts in place...more

McDermott Will & Emery

Recent Litigation Shines Spotlight on Hospital and Physician Group Transactions

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The US Department of Justice recently intervened in an qui tam alleging false and fraudulent claims involving the acquisition of physician practice locations by a health system and subsequent management of the health system’s...more

Morgan Lewis

High Court Checks Government in Risk Corridors Case

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In Maine Community, the US Supreme Court found on April 27, 2020, that the Risk Corridors program created by Congress was a “money-mandating obligation” requiring the federal government to make payments under Section 1342 of...more

Ballard Spahr LLP

Health Insurance Exchanges: A $12B Judgment

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The U.S. Supreme Court has determined that the federal government must pay over $12 billion to certain health insurers that participated in health insurance exchanges in the first three years that those exchanges were in...more

Akerman LLP - Health Law Rx

SCOTUS Rules Government Must Pay $12 Billion to Unprofitable ACA Insurers

Despite Congress’ efforts to use riders to neutralize a provision of the Affordable Care Act (ACA or Act), the Federal government (Government) owes certain insurers $12 billion....more

Troutman Pepper

Supreme Court Finds Insurers Entitled To Millions In ACA Payments

Troutman Pepper on

On April 27, the U.S. Supreme Court held that the federal government is on the hook for $12 billion it failed to pay insurers under the Affordable Care Act (ACA) risk-mitigation program known as the Risk Corridors Program. ...more

Sheppard Mullin Richter & Hampton LLP

Supreme Court Issues Long Awaited Ruling on Affordable Care Act Risk Corridors Program

The Supreme Court issued a long-awaited ruling on April 27, 2020, directed at a more than $12 billion challenge related to the temporary risk corridors program established by the Affordable Care Act (the “ACA”). Challenges...more

Faegre Drinker Biddle & Reath LLP

Supreme Court Decides Moda Health Plan, Inc. v. United States

On April 27, 2020, the U.S. Supreme Court decided Moda Health Plan, Inc. v. United States, holding that the Affordable Care Act requires the federal government to compensate insurers for significant losses their health plans...more

Seyfarth Shaw LLP

Supreme Court Rules Government Must Pay $12 Billion to Health Insurers Under ACA Risk Corridor Program

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On April 27, 2020, the US Supreme Court ruled by an 8-1 decision that the federal government must pay billions of dollars to health insurers who sold consumer policies on exchanges under the Affordable Care Act’s (“ACA”)...more

Locke Lord LLP

Supreme Court Rules 8-1 That Government Must Pay Health Insurers Under ACA Risk Corridor Program

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In a major win for health insurers, the U.S. Supreme Court ruled in an 8-1 decision that the federal government owes roughly $12.3 billion to health insurers who claimed losses under the risk corridor program of the...more

Payne & Fears

Key California Employment Law Cases: September 2019

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ZB, N.A. v. Super Ct. of San Diego Cty., 8 Cal. 5th 175, 252 Cal. Rptr. 3d 228 (2019) - Summary:  Employee may not recover unpaid wages under Labor Code section 558 through PAGA. Facts:  Plaintiff Lawson worked for...more

Payne & Fears

Key California Employment Law Cases: July 2019

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This month's key California employment law cases involve payment of wages, workplace conditions, public employment issues, and civil procedure....more

Foley & Lardner LLP

California Supreme Court Confirms that PAGA Plaintiffs Are Entitled to Broad Discovery of Other Employees’ Contact Information

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California’s Private Attorneys General Act (PAGA) allows aggrieved employees to recover civil penalties on behalf of themselves, other employees, and the State of California for Labor Code violations. On July 13, 2017, the...more

Pullman & Comley, LLC

Appellate Court Notes

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Supreme Court Advance Release Opinions: SC19516 - Doe v. Boy Scouts of America Corp. SC19516 Concurrence - Doe v. Boy Scouts of America Corp. SC19516 Concurrence - Doe v. Boy Scouts of America Corp. ...more

Cozen O'Connor

California Supreme Court: Insurer Can Directly Sue Independent Counsel for Excess Fees in Limited Circumstances

Cozen O'Connor on

On August 10, 2015, the California Supreme Court issued a unanimous decision that could have broad implications regarding an insurer’s right to seek reimbursement of unreasonable fees and costs directly from so-called Cumis...more

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