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Supreme Court upholds the Affordable Care Act’s individual mandate: what it means for employers and plan sponsors
- Proskauer Rose LLP
- -
- USA
- -
- June 28 2012
The Supreme Court of the United States (the "Court") ruled today, in a 5-to-4 landmark decision, that the individual mandate under the Patient Protection and Affordable Care Act ("the Act") is constitutional, although it also held that certain Medicaid expansion provisions are unconstitutional
Third Circuit limits relief available to ERISA welfare plans seeking reimbursement of medical expenses
- Proskauer Rose LLP
- -
- USA
- -
- November 17 2011
In a case of significant importance for plan sponsors and fiduciaries, the U.S. Court of Appeals for the Third Circuit held in US Airways, Inc. v. McCutchen, No. 10-3836 (3d Cir. Nov. 16, 2011), that an employee benefit plan was not entitled to full reimbursement of medical expenses it paid to a participant even though the plan provided that the participant was required to reimburse the plan for all amounts paid "out of any monies recovered from a third party."
Rulings, filings, and settlements of interest
- Proskauer Rose LLP
- -
- USA
- -
- October 5 2011
In Franco v. Connecticut General Life Ins. Co., No. 07-cv-6039, 2011 U.S. Dist. LEXIS 109022 (D.N.J. Sept. 23, 2011), plaintiffs, who were plan subscribers, health care providers, and several associations whose members consisted of out-of-network ("ONET") providers who provided ONET services to patients insured by CIGNA, alleged that CIGNA violated its contractual obligations to pay for ONET services at the "usual, customary and reasonable" ("UCR") rate by relying on the flawed database maintained by Ingenix, which generated artificially low UCRs to underpay ONET benefits to CIGNA plan members
Rulings, filings and settlements of interest
- Proskauer Rose LLP
- -
- USA
- -
- August 6 2010
In Borrero v. United HealthCare of New York, Inc., 2010 WL 2652456 (11th Cir. July 6, 2010), healthcare providers (and their representative organizations) alleged state law claims against United HealthCare for failing to pay them the agreed upon rate contained in the subscriber agreements rate for services
Second Circuit holds Taft-Hartley funds are inherently conflicted, potentially affects outcome and scope of future benefit claims litigation
- Proskauer Rose LLP
- -
- USA
- -
- June 29 2010
On June 24, 2010, the U.S. Court of Appeals for the Second Circuit held, in Durakovic v. Building Service 32 BJ Pension Fund, 2010 WL 2519645 (2d Cir. 2010), that Taft-Hartley funds (administered by boards of trustees consisting of an equal number of union and employer representatives) are inherently conflicted when making benefit determinations, and that this conflict needs to be considered by federal district courts when reviewing plan determinations under an arbitrary and capricious standard of review
Rulings, filings and settlements of interest
- Proskauer Rose LLP
- -
- USA
- -
- June 7 2010
In Golden Gate Restaurant Assoc. v. City and County of San Francisco, No. 08-1515 (U.S.), the U.S. Solicitor General requested that the Supreme Court deny certiorari in light of the recent enactment of the Patient Protection and Affordable Care Act (PPACA
Rulings, filings and settlements of interest
- Proskauer Rose LLP
- -
- USA
- -
- February 3 2010
In Pollitt v. Health Care Serv. Corp., 558 F.3d 615 (7th Cir. Mar. 10, 2009), cert. granted (Oct. 13, 2009), the Seventh Circuit vacated and remanded the district court’s finding that the Federal Employees Health Benefits Act (“FEHBA”) preempted a participant’s claim that Health Cares Services Corporation (“HCSC”) acted in bad faith by terminating her son’s coverage and seeking reimbursement of benefits previously provided
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- Workarea - Litigation
- Workarea - Healthcare
- Author - Howard Shapiro
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