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California Federal District Court Rules That AGG Clients’ Case Against Cigna for Institutional Practice of Under-Reimbursing...

U.S. District Court Judge David O. Carter ruled in favor of AGG’s clients on March 18, 2024, in a case involving “matters of widescale public concern” and a strong “public interest in access” to some of Cigna’s most coveted...more

Ninth Circuit Publishes New Opinion Regarding Healthcare Provider Assignments and Reinforcing Broad Standing to Bring Suit Against...

On January 10, 2024, the United States Court of Appeals for the Ninth Circuit published an opinion in the matter of South Coast Specialty Surgery Center, Inc., v. Blue Cross of California, which resolidified the Ninth...more

Government Investigations Team Insights - September 2023

AGG’s Government Investigations Team Insights provides periodic updates covering legal and regulatory topics. Our team, which includes former federal prosecutors, SEC enforcement attorneys, and federal agency attorneys, has...more

Senate Introduces Bill Amending False Claims Act Materiality Element and Anti-Retaliation Provision Expanding Liability

On July 25, 2023, Sens. Chuck Grassley (R-IA), Dick Durbin (D-IL), John Kennedy (R-LA), and Roger Wicker (R-MS) introduced the False Claims Amendments Act of 2023. The proposed amendment to the False Claims Act does not...more

Preemption and Exhaustion Requirements Thwart Medicare Advantage Plan Members’ Ability to Hold Health Insurers Accountable

Most states have statutes or common law that allow an insurance policyholder to bring a civil action and seek more than just compensatory damages (e.g., punitive damages) when her insurance company denies coverage in bad...more

Blue Cross Found to Be Behind the Times: Fifth Circuit Finds Blue Cross’ Proton Beam Treatment Guidelines Are Outdated, Superseded...

Background - Revisiting the topic from an article published earlier this year, another plaintiff has successfully challenged a commercial insurer’s internal Proton Beam Radiation Treatment (“PBT”) policy. PBT is a proven...more

Home Health & Hospice Quarterly - Q1

AGG’s Home Health & Hospice team publishes a quarterly newsletter covering legal and regulatory topics specific to the home and community-based healthcare industry. The fields of end-of-life and home healthcare present...more

Curbs on ERISA Class Action Litigation Could Impact Provider Reimbursements

Under the Employee Retirement Income Security Act of 1974 (“ERISA”), a health benefit plan participant who believes her insurer wrongfully denied coverage for services or benefits may bring a Section 502(a)(1)(B) claim to...more

The Cost of Not Covering Proton Radiation Therapy

In 2018, an Oklahoma jury awarded $25.5 million to the family of a cancer patient denied coverage for proton radiation therapy by Aetna. The case involved the denial of coverage for Orrana Cunningham, who had stage 4...more

GAO Report Recommends That CMS Expand Hospice Abuse Reporting Requirements

The US Government Accountability Office (“GAO”) issued a report on December 12, 2022, recommending that the Centers for Medicare and Medicaid Services (“CMS”) expand hospice fraud and abuse reporting requirements to make them...more

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