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Cadwalader: Federal Court Upholds Provider Mandate to Report and Return Medicare and Medicaid Overpayments in 60 Days

Introduction | The Patient Protection and Affordable Care Act (“PPACA”), signed into law on March 23, 2010, included a provision (the “Report and Refund Mandate”), broadly requiring health care providers, suppliers, Part D plans and managed care organizations that were overpaid...

DLA Piper LLP Health Systems Alert: CON Laws, COPAs And The FTC: 7 Antitrust Points For The Health Care Sector

By Lesli C. Esposito and Steven Levitsky The Federal Trade Commission is on a roll in its attack on what it considers anti-competitive effects in the healthcare industry. And that roll has consistently involved challenging activity that once appeared to be protected by state laws. Now, the FTC...

Mealey's Health Law - Multiemployer Health Fund's Reimbursement Suit Seeks Legal Relief, 8th Circuit Says

ST. LOUIS - A multiemployer health fund is not entitled to equitable relief in the amount it paid in medical benefits to students who were also covered by student accidental medical insurance under the fund's coordination-of-benefits provision pursuant to the Employee Retirement Income Security Act...

Barnes & Thornburg: DOJ Secures Big Win in First Court Interpretation of FCA’s 60-Day Overpayment Rule

By Jessica Talati On August 3, Judge Edgardo Ramos of the Southern District of New York denied hospital defendants’ motions to dismiss in United States ex rel. Kane v. Healthfirst, Inc., et al . , No. 11 CIV 2325 (S.D.N.Y. Aug. 3, 2015), keeping alive a much-followed whistleblower case accusing...

Williams Mullen: The Definition of Identify: The 60-Day Rule

By Ruth Levy & Patrick C. Devine, Jr. | The Patient Protection and Affordable Care Act (“PPACA”) established that any person who receives an overpayment from the Medicare or Medicaid programs and who does not report and return the overpayment within 60 days after it is identified will...

Ballard Spahr LLP: EPA Proposes New Rules for Pharmaceutical Hazardous Waste Management and for Other Hazardous Waste Generators

The U.S. Environmental Protection Agency (EPA) has announced two new proposed hazardous waste rules that EPA believes would clarify and simplify requirements for health care facilities and retail pharmacies to manage their unused pharmaceuticals that meet hazardous waste criteria, and would offer flexibility...

Pennsylvania Jury Awards Nearly $ 2.8 Million In Medical Malpractice Action Brought By Patient Who Required Permanent Tracheostomy Following Surgery

On March 24, 2011, Bonnie Semple filed a medical malpractice action in the Pennsylvania Court of Common Pleas for Delaware County. Through the complaint, she asserted professional negligence claims against a number of defendants, including Mohammed Budeir, M.D.; Riad Cahecho, M.D.; Janice Silva Sicat...

Barnes & Thornburg LLP: Recent Rulings May Spell Trouble for the ACA

By Anne Compton-Brown | President Obama’s signature healthcare legislation will likely force two more significant legal hurdles after decisions this month that attack peripheral but important portions of the Affordable Care Act (ACA). On Sept. 17, 2015, the United States Court of Appeals...

Mealey's Health Law - Medicare, Not Employer, Was Primary Provider, South Carolina Federal Judge Says

GREENVILLE, S.C. - A health insurer was not the primary payer for an employee's medical claims because the plan at issue clearly stated that Medicare was the primary payer if an insured received Medicare benefits, a South Carolina federal judge said Sept. 30 (Jennifer Perkins v. US Airways Inc.,...

McNees Wallace & Nurick: Health Care Consolidations: Complex Maneuvers In A High-Stakes Environment

By John W. Greenleaf III In today’s shifting health care landscape, providers are consolidating and forming strategic partnerships that position them to offer comprehensive, high-quality services at reasonable costs. Motivations vary, but in any merger, all parties want the same outcome –...

Mealey's Health Law - Medical Providers Are Not Beneficiaries, 7th Circuit Determines

CHICAGO - Because a number of medical providers alleging that an insurer wrongfully reduced payments on health claims are not beneficiaries to an insurance contract, they are not entitled to allege claims under the Employee Retirement Income Security Act of 1974, the Seventh Circuit U.S. Court of Appeals...

Mealey's Health Law - Health Insurer's Denial Supported By The Record, 2nd Circuit Panel Says

NEW YORK - The Second Circuit U.S. Court of Appeals on Oct. 15 determined that a health benefits insurer did not wrongfully deny a claim for residential treatment because four physicians noted in the administrative record that residential treatment was not necessary (Neil Tansey, et al. v. Anthem Health...

Bullivant Houser Bailey PC: Interplay of the Washington Industrial Insurance Act and Asbestos Exposure Claims

By Melissa Tarab Although the Washington Industrial Insurance Act (WIIA) often provides the exclusive remedy for employees' tort claims against employers, there are exceptions. Attorneys filing asbestos personal injury claims have found creative ways to try to use those exceptions to their clients'...

DLA Piper Health Care Alert: DOJ Pursues Individual Liability For Corporate Misconduct – Yates Memo Signals Policy Shift

By Frank E. Sheeder The US Department of Justice has made it a priority to hold individuals accountable for organizational misdeeds – both civil and criminal. Through the recent Yates Memo, the DOJ is sending a message of deterrence to corporate leaders and their governing bodies. The Memo details...

Mealey's Health Law - Vermont, Insurer Square Off Before Top Court Over Preemption Of Reporting Rules

WASHINGTON, D.C. - The State of Vermont and an insurer squared off before the U.S. Supreme Court Dec. 2 in oral arguments over whether the Employee Retirement Income Security Act, as amended by the Patient Protection and Affordable Care Act (ACA), preempts state level collection of health insurance data...

Steptoe & Johnson PLLC: Make Sure Your Peer Review Program Is Ready Before You Need It

A 2015 decision by the West Virginia Supreme Court of Appeals highlights the importance of following procedural formalities by making it clear that a failure to apply and maintain clear distinctions in what health care providers intend to classify as “peer review,” both before and during...

Barnes & Thornburg: Another State (N.Y.) Enforces HIPAA –Settles Case With Health Center

By Stacy L. Cook The New York attorney general recently entered into a settlement agreement with the University of Rochester Medical Center (URMC) for HIPAA violations. The enforcement action by New York comes on the heels of a HIPAA enforcement action by the Connecticut attorney general in early...

Mealey's Health Law - West Virginia Federal Judge Dismisses Counterclaim In ERISA Preemption Case

WHEELING, W.Va. - A breach of contract counterclaim brought in response to an action seeking a declaration that the Employee Retirement Income Security Act preempts a request for indemnification was dismissed Dec. 10 by a West Virginia federal judge (Ohio Valley Health Services & Education Corporation...

Mealey's Health Law - Insurer Must Provide Hospital Ranking Method In Suit Over New Health Plan

HACKENSACK, N.J. - A New Jersey judge on Dec. 17 granted a motion for expedited discovery brought by a group of hospitals, finding that their requests for documents related to certain hospital-ranking methodology and resulting scores of hospitals that are not parties to the suit are relevant to their...

Mealey's Health Law - ERISA Fiduciary Duty Claims Related To Denial Of Autism Treatment Continue

PORTLAND, Ore - A federal judge in Oregon on Jan. 7 denied a health insurers' motion to dismiss claims alleging that it breached its fiduciary duties under the Employee Retirement Income Security Act by denying coverage for applied behavioral analysis (ABA) therapy for the treatment of autism-related...

Mealey's Health Law - 8th Circuit: Injunctive Relief Not Available In Pharmacies' Suit Against PBM

ST. LOUIS - Compounding pharmacies are not entitled to injunctive relief against a pharmacy benefits manager for denial of claims in violation of the Employee Retirement Income Security Act's claims regulation, the Eighth Circuit U.S. Court of Appeals affirmed Jan. 11 (Grasso Enterprises, LLC, et...

Mealey's Health Law - High Court: Enforcement Of Equitable Lien Against General Assets Is Not Equitable Remedy

WASHINGTON, D.C. - The U.S. Supreme Court ruled 8-1 on Jan. 20 that an employee welfare plan fiduciary may not bring a suit under Employee Retirement Income Security Act Section 502(a)(3) to attach a participant's separate assets when the participant wholly dissipated a third-party settlement on...

Mealey's Health Law - DOJ: California Hospital To Pay $3.2M To Settle Claims Over Illegal Referrals

WASHINGTON, D.C. - The U.S Department of Justice (DOJ) announced Jan. 15 that a California hospital has agreed to pay $3.2 million to resolve allegations that it violated the Stark Law and False Claims Act by maintaining financial arrangements with referring physicians.

Mealey's Health Law - Anthem, Insureds Argue Whether Data Breach Suit Should Be Dismissed

SAN JOSE, Calif. - In respective reply briefs filed Jan. 19, Anthem Inc. and related insurers argued in support of their motions to dismiss a putative class action over a January 2015 breach of Anthem's network, asserting that the plaintiffs did not adequately specify the allegedly breached contractual...

Mealey's Health Law - Aetna Prevails In 1 Wisconsin ERISA Case; Dismissal Denied in Another

MADISON, Wis. - A challenge by the University of Wisconsin Hospitals and Clinics Authority (UWHCA) of an insurer's denial of payment was rejected on summary judgment Jan. 25 by a Wisconsin federal judge in light of an anti-assignment provision in the parties' contract; the same day, UWHCA's...