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Summary Judgment Health Insurance

Arnall Golden Gregory LLP

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

Troutman Pepper

California Court of Appeal Affirms Grant of Summary Judgment Against Health Care Provider in Win for Managed Care Payors and...

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The California Court of Appeal, in a major win for managed care payors and claims administrators, affirmed a lower court decision granting summary judgment in favor of United Healthcare (United), finding that United did not...more

ArentFox Schiff

Court Holds NC State Health Plan Constitutes “Health Program or Activity,” Granting Summary Judgment for Transgender Plaintiffs...

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On December 5, 2022, the US District Court for the Middle District of North Carolina held that the North Carolina State Health Plan (NCSHP) constitutes a “Health Program or Activity” under the Affordable Care Act (ACA). In so...more

Sheppard Mullin Richter & Hampton LLP

Fifth Circuit Upholds ACA Risk Adjustment Program

Various smaller health insurance issuers have challenged the risk-adjustment program under the Patient Protection and Affordable Care Act (ACA), alleging, among other things, that its underlying methodology favors larger...more

Fox Rothschild LLP

Fascinating Recusal Issue Facing Supreme Court Of North Carolina

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Last month I blogged about a Fourth Circuit case that saw an eleventh-hour judge recusal. The Supreme Court of North Carolina is now facing a similar issue, times five. The case involves a class action challenging a law...more

Hinshaw & Culbertson - The LHD/ERISA Advisor

The LHD/ERISA Advisor - October 2020: Summary Judgment in Favor of Insurer Reversed by California Appellate Court in Application...

Under the "genuine dispute" doctrine, an insurer is not liable for bad faith if its denial of a claim was reasonable. In Ghazarian v. Magellan Health, Inc., 53 Cal. App. 5th 171 (2020), a California appellate court reversed a...more

Haight Brown & Bonesteel LLP

Unreasonableness of Insurer’s “Medical Necessity” Criteria and Inconsistent Expert Testimony Mandate Reversal of Genuine Dispute...

In Ghazarian v. Magellan Health (No. G057113, filed 8/7/20), a California appeals court reversed summary judgment that had been granted for a health plan insurer in a bad faith and unfair business practices lawsuit on the...more

Robinson+Cole ERISA Claim Defense Blog

Remand Directing Change in Standard of Judicial Review Is Not Sufficient Success on the Merits to Support Attorneys’ Fee Award

In Ariana M. v. Humana Health Plan of Texas, Inc., No. 18-20700, 2019 WL 5866677 (5th Cir. Nov. 8, 2019), the Fifth Circuit Court of Appeals rejected a plaintiff’s petition for attorneys’ fees under 29 U.S.C. § 1132(g).  This...more

Seyfarth Shaw LLP

A Small Administrative Health Care Fix Gets Court Approval (So Far)

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The hyper-partisan political warfare in the American health care industry is far from over. But another small battle in a federal district court was just resolved in favor of the Trump Administration....more

Bradley Arant Boult Cummings LLP

Could Possible Predictability Be Coming to Wilderness Therapy Coverage Disputes?

Current trends in litigation regarding wilderness therapy coverage center on motion practice. Courts have been unpredictable with granting or denying defendants’ motions to dismiss and motions for summary judgment, and recent...more

Carlton Fields

Six Degrees Of Separation: Eleventh Circuit Upholds a Broad ‘Related Claims’ Provision

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“Related Claims” provisions in directors and officers (D&O) and errors and omissions (E&O) policies, while common, can spawn disagreement as to scope and application. ...more

Sheppard Mullin Richter & Hampton LLP

Are You a “Hybrid Entity” under the Health Insurance Portability and Accountability Act of 1996? The $4,348,000 Question

A single, multidisciplinary entity, like a university, may include certain departments that use PHI, and other departments that do not. Such institutions are eligible to (and should) self-identify as “hybrid entities” to...more

Mintz

Seventh Circuit OKs Exclusive Network Agreements Between “Must-Have” Hospital and Health Insurers

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In an opinion written by Judge Posner, the Seventh Circuit on Friday gave its stamp of approval to a “must-have” hospital’s bargaining to exclude competitors from certain narrow-network payor contracts in and around Peoria,...more

Cozen O'Connor

Minnesota Federal Court Says Cross-Plan Offsets Are Unlawful; Certifies Case for Immediate Appeal

Cozen O'Connor on

The U.S. District of Minnesota has ruled in Peterson v. Unitedhealth Grp. Inc., No. 14-CV-2101 (PJS/BRT), 2017 WL 991043 (D. Minn. Mar. 14, 2017) that ERISA does not permit United Healthcare (“United”) to claw back alleged...more

Sheppard Mullin Richter & Hampton LLP

Do Routine Calls by Health Plans to Patients and Health Plan Members Constitute “Telemarketing” Under the Telephone Consumer...

Covered entities have a long list of laws and regulations governing their conduct, including their communications with patients, customers, and members. Specifically, the Health Insurance Portability and Accountability Act...more

Mintz

Big Summary Judgment Win for Hospital Defending $300M Exclusive Dealing Antitrust Suit

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After fending off a motion for judgment on the pleadings in March 2015, a small hospital in Peoria, Illinois lost on summary judgment in its $300 million antitrust suit alleging illegal exclusive dealing and attempted...more

Littler

Half a Loaf: Court Rejects ADA "Safe Harbor" But Approves Pre-Regulations Wellness Program as "Voluntary"

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The EEOC’s attack on employee wellness programs as unlawful under the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA) that began in 2014 with three lawsuits, and continued with...more

Faegre Drinker Biddle & Reath LLP

Supreme Court Decides Gobeille v. Liberty Mutual Insurance Company

On March 1, 2016, the Supreme Court decided Gobeille v. Liberty Mutual Insurance Company, No. 14-181, holding that the Employee Retirement Income Security Act of 1974 (ERISA) pre-empts Vermont’s regulatory scheme requiring...more

Williams Mullen

Plaintiffs’ Misdirected Demand for Documents Fails, and Their Claim for ERISA Civil Penalties Is Dismissed: Boyd v. Sysco...

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A federal court dismissed the plaintiffs’ claim to recover civil penalties for failure to provide plan documents requested by the plaintiffs. Boyd v. Sysco Corporation, No. 4:13-cv-00599 (D. S. C. September 3, 2015), provides...more

Seyfarth Shaw LLP

Inevitable Disclosure Doctrine Held Inapplicable To Failed Business Transaction

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An Illinois appellate court recently rejected applying the inevitable disclosure doctrine in a trade secret misappropriation spat arising out of a failed business transaction....more

Faegre Drinker Biddle & Reath LLP

When Is a Hospital Not a Hospital?

Rebecca was a nurse at North Cypress Medical Center, in Texas. Back in 2011 she was treated for an eating disorder at Timberline Knolls Residential Treatment Center, in Illinois. When she sought reimbursement under the...more

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