05.23.16
On March 1, 2016, the United States Supreme Court, in Gobeille v. Liberty Mutual Insurance Company, No. 14-181, reaffirmed the broad preemptive effect of the Employee Retirement Income Security Act of 1974, 29 U.S.C. §§ 1001, et seq. (ERISA).
04.25.16
If a healthcare plan and provider agree to arbitrate disputes under a provider contract, can the provider compel arbitration against third-party payers that access those same contract rates?
03.22.16
Reducing an employee's hours simply to avoid the requirements set by the Affordable Care Act (ACA) may constitute a violation of the Employee Retirement Income Security Act (ERISA), a New York federal court judge has ruled, refusing to dismiss a class action suit against Dave & Buster's.
01.20.16
Litigation involving out-of-network providers, meaning providers who do not have a negotiated rate agreement with the respective payer, continues to be rampant. Certain issues arise frequently in these lawsuits over whether the payers had properly paid claims. This article discusses several ...
12.17.15
Last month, on November 6, 2015, the United States Supreme Court granted certiorari and consolidated seven cases brought by religious nonprofit organizations challenging the "opt out" provision of the Affordable Care Act's (ACA's) contraception mandate, claiming it violates their ...
11.20.15
When a physician resigns his or her clinical privileges during the course of a healthcare entity's1 investigation into the physician's competence or professional conduct, the Healthcare Quality Improvement Act (HCQIA) requires the entity to report the resignation to the National ...
10.21.15
Regulators in many states are requiring greater standardization of reporting and transparency of data concerning provider networks and access to care. The increased standardization and transparency means more meaningful plan-to-plan comparisons, including between Affordable Care Act (ACA) and ...
09.24.15
As the legal landscape in healthcare becomes increasingly complex, healthcare companies that receive federal program funds face increasing exposure under the federal False Claims Act (FCA), 31 U.S.C. §§ 3729–3733. Generally, the FCA imposes liability on persons or entities who ...
08.19.15
Last year, in Robins v. Spokeo, Inc., 742 F.3d 409 (9th Cir. 2014), the Ninth Circuit Court of Appeals held that an uninjured plaintiff may have standing to bring suit under Article III of the U.S. Constitution* due to a defendant's technical violation of a statute. In April of this year, the ...
07.21.15
Hospitals typically require patients to sign Conditions of Admission (COA) forms, which constitute a contract between the hospital and the patient. COAs typically outline the patient's obligations with respect to the hospital services they receive, which may include the duty to pay for services ...