Newsletters

01.20.16

As Out-of-Network Provider Litigation Continues, 2015 Published Opinions Offer Guidance to Insurers

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

U.S. Supreme Court to Hear Religious Nonprofit Organizations' Challenge to the Affordable Care Act's

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

What Constitutes an "Investigation" Triggering a Peer Review Body's HCQIA Duty to Report a Subsequen

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

Standardizing Health Plan Reporting on Access to Care

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

Latest Healthcare False Claims Act Roundup and Top 3 Best Practices to Reduce Exposure

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

Can Technical Violations of Healthcare Statutes Serve as a Basis for Uninjured Plaintiffs to Sue? T

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

California Courts Clarify Effect of Hospital Conditions of Admission Forms

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 ...


06.22.15

State Licensing Boards Aren’t Immune From Antitrust Claims Unless They Are Actively Supervised by th

Practicing professionals who serve on state licensing boards can be liable for antitrust violations unless the board’s conduct is subject to active supervision by the state, per the U.S. Supreme Court in North Carolina State Board of Dental Examiners v. FTC, 547 U.S. ___, 135 S. Ct. 1101 ...


06.24.11

Supreme Court Strikes Down Vermont Prescriber Data-Restriction Law

On June 23, 2011, the United States Supreme Court struck down Vermont’s law restricting the sale, disclosure, and use of pharmacy records that reveal the prescribing patterns of individual physicians.