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296 results found

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Hall Benefits Law | USA | 25 Jul 2019

Recent Court Decision Highlights Importance of Clear Anti-Assignment Language in Health Plan Documents

A recent, comprehensive court ruling in the Southern District of New York upheld an anti-assignment clause in a health plan. The court made a point…
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Proskauer Rose LLP | USA | 24 Jan 2019

Eighth Circuit decision on“cross-plan offsetting” illustrates importance of careful plan drafting

The U.S. Court of Appeals for the Eighth Circuit recently weighed in on a practice for recovering health plan overpayments known as “cross-plan…
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Arent Fox LLP | USA | 22 Jan 2019

Eighth Circuit Strikes Down Cross-Plan Offsetting

In a long-awaited opinion, the Eighth Circuit Court of Appeals struck a blow to UnitedHealth Group. Inc.’s (“United”) sweeping overpayment recovery…
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Bass, Berry & Sims PLC | USA | 17 Jan 2019

DOJ Intervenes in Another Medicare Advantage Risk Adjustment FCA Suit

On December 11, 2018, the United States announced that it has elected to intervene in a False Claims Act (FCA) lawsuit filed against Sutter Health and…
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Quarles & Brady LLP | USA | 16 Jan 2019

Long-Awaited “Cross-Plan Offsetting” Case Increases Risk for Employers, Insurers

On January 15, 2019 the Eighth Circuit Court of Appeals issued a long-awaited decision relating to a relatively obscure -- but important -- concept…
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Haynes and Boone LLP | USA | 31 Dec 2018

FCA Implications for Recent UnitedHealth Overpayment Ruling

UnitedHealthcare Insurance Co. recently secured a significant victory with potentially far-reaching consequences when the United States District…
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Sidley Austin LLP | USA | 14 Dec 2018

DOJ Intervenes in Medicare Advantage FCA Case Against Provider

On December 11, 2018, the Department of Justice announced that it has intervened in a False Claims Act suit against Sutter Health and its affiliate…
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Arent Fox LLP | USA | 7 Nov 2018

The Commonality Challenge: Recent Rulings Show Path to Class Certification in ERISA Cases

As class action practitioners know, class certification can be difficult to achieve, particularly in the years since the Supreme Court’s decision in…
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Sidley Austin LLP | USA | 7 Sep 2018

District Court Vacates 2014 Medicare Advantage Overpayment Rule and Curtails Potential Avenues for DOJ to Pursue False Claims Act Damages

On September 7, 2018, the United States District Court for the District of Columbia vacated CMS’s 2014 Final Overpayment Rule, applicable to the…
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McDermott Will & Emery | USA | 19 Apr 2018

DOJ Continues Action against Medicare Advantage Plans, Showing Increased Focus on Intersection of the FCA and Managed Care

Last year, DOJ intervened in United States ex rel. Poehling v. UnitedHealth Group., Inc. (C.D. Cal.). In this case, DOJ alleged FCA violations…
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