On March 23, 2020, the U.S. Department of Health and Human Services Office of Inspector General (“HHS-OIG”) issued an alert to the public about fraud schemes related to the novel coronavirus (COVID-19)....more
Seyfarth Synopsis: Reversing course and overruling previous precedent, the Court of Appeals for the Ninth Circuit now holds that ERISA plan mandatory arbitration and class action waiver provisions are enforceable, and can...more
10/16/2019
/ 401k ,
Arbitration ,
Arbitration Agreements ,
Breach of Duty ,
Charles Schwab ,
Class Action Arbitration Waivers ,
Contract Terms ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Fiduciary Duty ,
Putative Class Actions ,
Retirement Plan
Seyfarth Synopsis: In an unpublished yet fascinating decision, the California Court of Appeal held that ERISA § 514 preempts state law causes of action premised on wrongful disclosure of protected private health information....more
SEYFARTH SYNOPSIS: The Ninth Circuit recently dealt another major blow to healthcare providers that attempt to bring suits as assignees of their individual patients, holding that an ERISA plan’s anti-assignment provision bars...more
Seyfarth Synopsis: In a major victory for ERISA plans and other payors, the Fifth Circuit recently overturned a district court’s notorious decision in favor of a healthcare provider and reinstated a plan administrator’s...more
2/13/2018
/ Appeals ,
Breach of Duty ,
CIGNA ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Fiduciary Duty ,
Health and Welfare Plans ,
Healthcare Facilities ,
Healthcare Fraud ,
Medical Reimbursement ,
Plan Administrators ,
Reversal ,
Underpayment
Seyfarth Synopsis: The Fourth Circuit found that the medical necessity of a given service constitutes a material element of representations regarding submissions for payment, potentially providing payors with another legal...more
11/16/2017
/ Clinical Laboratories ,
Criminal Convictions ,
Drug & Alcohol Abuse ,
Drug Testing ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
False Billing ,
Health Clinics ,
Health Insurance ,
Healthcare Fraud ,
Material Misrepresentation ,
Medical Necessity
Seyfarth Synopsis: The Ninth Circuit Court of Appeals recently confirmed that ERISA preempts state insurance law bans on discretionary clauses for self-funded ERISA plans....more
9/11/2017
/ Aetna ,
Denial of Benefits ,
Disability Benefits ,
Discretionary Clauses ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Health Insurance ,
Insurance Industry ,
Popular ,
Preemption ,
Self-Funded Health Plans
Seyfarth Synopsis:
In Universal Health Services Inc. v. U.S. et al. ex rel. Escobar et al., the United States Supreme Court found a healthcare provider liable under the False Claims Act (“FCA”) for material omissions on...more
A district court in Tennessee recently rejected ERISA claims by healthcare providers against a plan insurer, holding that the providers lacked standing to sue under ERISA as their patients’ assignees. Brown v. Blue Cross...more
In a recent decision, the Ninth Circuit Court of Appeals rejected a Plan participant’s attempt to extend California insurance law’s notice-prejudice rule to self-insured ERISA plans. Zagon v. Am. Airlines, Inc., 2015 BL...more