Newsletters

06.20.18

ERISA Reprocessing Class Actions: Circuit Courts Should Address Flaws

In an increasing number of cases, courts have used Federal Rule of Civil Procedure 23(b)(2) to certify classes seeking injunctive and declaratory relief that includes, among other things, an injunction ordering the defendant to “reprocess” past claims for healthcare benefits.


05.22.18

Healthcare Litigation 2018: Conscience Rights and Civil Rights

The free exercise clause is found in the First Amendment of the Bill of Rights and provides that “Congress shall make no law respecting an establishment of religion or prohibiting the free exercise thereof.”


05.22.18

Empowering States to Regulate Their Insurance Markets

On April 9, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a Health & Human Services (HHS) Notice of Benefit and Payment Parameters for 2019 (final rule).


04.23.18

Mental Health and Minors: Proceed With Caution!

Imagine representing a party in a lawsuit concerning coverage for mental health services. The lawsuit was brought by the parents of a minor child.


02.21.18

Applying Escobar’s Heightened Materiality Standard: Limiting FCA Liability

In United States ex rel. Petratos v. Genentech, Inc., 855 F.3d 481 (3d Cir. 2017), the Third Circuit affirmed the district court’s order dismissing an FCA complaint on the grounds that the relator could not establish materiality based on the guidance set forth in Escobar.


12.18.17

CMS Final Rule Reduces Reimbursement Rates for 340B-Eligible Hospitals

On November 1, 2017, the Centers for Medicare & Medicaid Services (CMS) issued the final rule with comment period revising the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for 2018.


11.21.17

The Legality of Cost-Sharing Reduction Payments Under the ACA

Health insurers may have experienced uncertainty in 2017 when they were setting 2018 rates for individual plans sold on federal and state exchanges pursuant to the Affordable Care Act (ACA).


10.24.17

Justice Department Abandons Medicare Advantage FCA Suit Against UnitedHealth

On October 13, 2017, the U.S. Department of Justice (DOJ) decided to abandon its lawsuit accusing UnitedHealth Group and affiliated health plans1 (UnitedHealth) of exaggerating how sick its patients were to procure millions of dollars in inflated Medicare Advantage payments.


08.23.17

Using Statistical Sampling in False Claims Act Cases

The False Claims Act (FCA) is silent about whether statistical sampling may be used to prove a violation of the Act and, since the case law is varied, there are no clear rules about when or how statistical sampling evidence may be introduced.


07.24.17

ERISA Procedural Rights Violations Can Still State Federal Claims

Last year, the United States Supreme Court decided Spokeo v. Robins, holding that a procedural violation of a statute is insufficient to create a “concrete” injury and confer standing if the plaintiff suffered no real harm.