Appeals, Statutory Interpretation, Health Care Providers

No Surprises Here! Fifth Circuit Holds NSA Provides No Private Right of Action to Enforce IDR Awards, Deepening Judicial Divide...

Proskauer - Health Care Law Brief on 6/30/2025

In a recently issued opinion, the Fifth Circuit has added yet another chapter to the growing debate over whether providers may seek judicial enforcement of Independent Dispute Resolution (“IDR”) awards issued under the No...more

U.S. Supreme Court Holds Medicaid’s Any-Qualified-Provider Provision Does Not Confer Enforceable Rights

Troutman Pepper Locke on 6/27/2025

The U.S. Supreme Court, in a 6-3 decision, ruled that the Medicaid Act’s any-qualified-provider provision does not confer individual rights enforceable under 42 U.S.C. §1983. This decision reverses the Fourth Circuit’s...more

When Are Hospitals on the Hook? Reconciling Elam and Bichai

Nossaman LLP on 6/18/2025

Din v. Sutter Valley Hospital (June 10, 2025, C099101, unpublished) puts the spotlight on a dividing line in California law: when can a hospital be liable for actions taken by its medical staff? The case sharpens the contrast...more

Peer Review by Licentiates Only: Beware Health Care Service Plans!

Hanson Bridgett on 4/14/2025

On February 19, 2025, the California Court of Appeal published a decision, Lin v. Board of Directors of PrimeCare Medical Network, Inc., 108 Cal.App.5th 1163, emphasizing California Business and Professions Code’s requirement...more

Supreme Court Decides in Favor of 340B Hospitals Regarding Medicare Reimbursement Methodology

Robinson+Cole Health Law Diagnosis on 6/16/2022

On June 15, 2022, the U.S. Supreme Court unanimously ruled in favor of “340B” hospitals in a notable statutory interpretation case concerning how the federal Medicare program reimburses hospitals for prescription drugs. The...more

State Hospital Association Fights Changes to Medicaid DSH Payment Rules

Mitchell, Williams, Selig, Gates & Woodyard,... on 11/19/2019

For hospitals that “serve a disproportionate number of indigent patients” Medicaid allows for supplemental payments to help ensure their financial viability. The calculation of those supplemental payments recently became the...more

ERISA Preemption — The Courts of Appeal Continue to Rule As They Await Further Supreme Court Attempts To Define, Once and for All,...

Seyfarth Shaw LLP on 10/23/2019

Synopsis: Two Courts of Appeal reach opposite results on ERISA preemption, thus continuing the judicial quest for a definitive meaning of ERISA preemption. Stay tuned for more such decisions, and yet more Supreme Court...more

Third Circuit Perpetuates Tuomey’s Controversial Stark Law “Volume or Value” Standard

McDermott Will & Schulte on 10/3/2019

The US Court of Appeals for the Third Circuit endorsed two controversial interpretations of the Stark Law’s “volume or value” standard, known as the correlation theory and the practice “loss” theory in U.S. ex rel. J. William...more

N.Y. Court of Appeals Reinstates Justice Center’s Oversight of Provider Agencies

Farrell Fritz, P.C. on 9/18/2018

Earlier this Summer, the Court of Appeals overturned the Appellate Division Third Department’s (the “Third Department”) unanimous decision in The Matter of Anonymous v. Molik, where it ruled that the New York State Justice...more

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