Newsletters

03.23.17

Third-Party Payment of Premiums: Controversy and HHS Guidance

Since the passage of the Affordable Care Act (ACA), the payment of healthcare premiums by third parties has been the subject of controversy.


03.23.17

Escobar's Impact: Recent Application of "Materiality" in Ninth Circuit

Last year, a unanimous U.S. Supreme Court decided Universal Health Services, Inc. v. United States ex rel. Escobar (Escobar), 136 S.Ct. 1989 (2016), creating important implications for Federal False Claims Act (FCA) cases and, in particular, their viability.


02.22.17

HCQIA Preemption of State Physician Whistleblower Statutes

Medical professionals who are subject to adverse actions following peer review often seek to sue the peer review participants (including the individual peer-reviewing physicians, medical staff leadership and the hospital), casting themselves as quality-of-care advocates that have been mistreated or ...


12.19.16

California Court Expands Roadmap for “Reasonable Value” of Providers’ Services

Health plans generally are obligated to pay out-of-network providers only the “reasonable value” of their services and not their full billed charges, which often are higher.


11.21.16

IRC § 501(r) Developments and the Importance of Compliance Programs

The Internal Revenue Service (IRS) has moved aggressively to ensure that tax-exempt hospitals are complying with financial assistance, billing and collection requirements under the Affordable Care Act (ACA).


10.20.16

How Will AB 72 (and Similar Laws) Impact Provider/Payer Disputes?

Recently, California Governor Jerry Brown signed into law “surprise medical bill legislation,” seeking to curb out-of-network medical bills. This law, designated AB 72, amends California’s Health and Safety Code to limit the ability of out-of-network physicians who provide ...


08.24.16

Difficult Choices for Healthcare Providers as California Legalizes Assisted Suicide

California's "End of Life Option Act" (the Act) went into effect this June—making California the fifth state (behind Oregon, Washington, Vermont and Montana) to allow terminally ill adults with fewer than six months to live to receive drugs that will allow them to end their life.


07.27.16

California Supreme Court Clarifies Constitutional Limits on Punitive Damages

In Brandt v. Superior Court, the California Supreme Court held that when a plaintiff proves that an insurance company withheld policy benefits in bad faith, attorneys' fees reasonably incurred to compel payment of the benefits are recoverable as an element of damages.


07.27.16

Scalia's Death Has Limited Impact on Major Healthcare Cases

Justice Antonin Scalia's death apparently impacted only one of the four major healthcare cases pending before the United States Supreme Court this term.


07.27.16

The FCA: Escobar Means More Than You Think

On June 6, 2016, the Supreme Court issued a unanimous decision in the Medicaid case of Universal Health Services, Inc. v. United States ex rel. Escobar, adopting a form of the "implied certification" theory of knowingly fraudulent representations under the False Claims Act (FCA).