News & Analysis as of

Health Care Providers Insurance Litigation Insurance Industry

Proskauer - Health Care Law Brief

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

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

King & Spalding

Fifth Circuit Finds No Private Right of Action for Providers to Enforce Surprise Billing Awards

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On Thursday, June 12, 2025, a panel of the United States Court of Appeals for the Fifth Circuit issued two rulings construing parts of the No Surprises Act (NSA) to limit judicial review of arbitration awards issued under the...more

ArentFox Schiff

Federal Courts Divided Over Private Enforcement of ‘No Surprises Act’ Arbitration Awards

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Congress enacted the No Surprises Act (NSA) to protect patients from unexpected medical bills. A central pillar of the NSA is its independent dispute resolution (IDR) process, under which payers and providers can submit...more

A&O Shearman

Northern District Of Illinois Denies Motion To Dismiss Antitrust Claims In Healthcare Providers’ Price Fixing Lawsuit

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On June 3, 2025, Judge Matthew F. Kennelly denied motions to dismiss federal and state antitrust claims brought by healthcare providers (“plaintiffs”) against MultiPlan (a healthcare payment management service) and...more

Fennemore

Nursing Impact Litigation – A Tale of Two Matters

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This article highlights legal disputes central to APRNs’ ability to practice independently, the use of professional titles, insurance discrimination, and broader healthcare competition dynamics. Around the country, Advanced...more

Goodwin

Aetna’s “Fraud Scheme” Lawsuit Against Radiology Group Highlights Health Plans’ Resistance to Private-Equity-Backed Providers

Goodwin on

On December 23, 2024, various Aetna affiliates (referred to hereafter as Aetna) filed suit against Radiology Partners, Inc., a national, private-equity-backed radiology group, alleging that Radiology Partners defrauded the...more

Kerr Russell

The Difference Between ‘Non-Covered’ vs. ‘Disallowed’ Services

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Question: I have had several colleagues describe their experience with dental plan audits. All of them have had to pay something back. Sometimes they say this is due to a service being deemed a “noncovered service.” Other...more

Pillsbury - Policyholder Pulse blog

Narrowing the Professional Services Exclusion: Policyholder Lessons “Arising Out of” Practice Fusion v. Freedom Specialty...

A recent decision by a California appellate court in Practice Fusion, Inc. v. Freedom Specialty Insurance Company, denying the policyholder more than $118 million in Directors & Officers liability coverage based on an...more

Marshall Dennehey

Third District Court of Appeals Clarifies the Rules Surrounding Third-Party Intervention

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Accident911 Help Medical Center Corp., et al. v. Direct General Insurance Company, 3rd District, Case No, 3D23-773. L.T. Case No. 22-9836, Aug. 23, 2023 - The Third District Court of Appeal rules that the trial court abused...more

Jackson Walker

Summary of HB 3359: Changes to Preferred Provider Benefit Plans

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HB 3359 amends Chapter 1301 of the Texas Insurance Code. Chapter 1301 sets forth the legal requirements and obligations of a “preferred provider benefit plan”. A “preferred provider benefit plan” is a benefit plan in which an...more

Rumberger | Kirk

The Multiple Issues Surrounding Medicare and Past Damages

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What amount of past medical expenses can a plaintiff present to the jury when he or she is a Medicare recipient? The short answer: only the amount of past medical expenses the plaintiff is obligated to pay, not the gross...more

Steptoe & Johnson PLLC

The West Virginia Medical Professional Liability Act Applies Broadly to Services Encompassing Patient Care – Not Just the Care...

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The Supreme Court of Appeals of West Virginia issued a new opinion that finds that litigants cannot characterize claims as “corporate” or “general” negligence in an attempt to circumvent the West Virginia Medical Professional...more

Cozen O'Connor

Recent Bad Faith Cases Regarding Reasonableness of Medical Treatment

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In two recent cases, the courts showed substantial deference to patients’ treating physicians in determining the reasonableness of medical treatment. This deference appears to reflect a reluctance of courts to decide what...more

Morris James LLP

Superior Court Sets Out Rules For Class Certification

Morris James LLP on

Wilmington Pain & Rehabilitation Center P.A. v. USAA General Indemnity Insurance Co., No. N15C-06-218 JRJ CCLD (October 17, 2017) - This is an important decision became it sets out the most recent rules for determining...more

Faegre Drinker Biddle & Reath LLP

Insurer Liable Though Physician Skips Med Mal Trial

Lancet Indemnity’s $1 M med mal policy had a standard clause requiring the insured, Dr. Ishtiaq Malik, to cooperate and assist Lancet and appointed counsel in investigating and defending claims. But when the family of...more

Faegre Drinker Biddle & Reath LLP

Third Cir. Holds Hospitals May Sue Health Insurers Directly

Before September 11 the Third Circuit Court of Appeals had been out of step with its sister federal circuits when it came to the right of hospitals, physicians and other health providers to sue health insurers that failed to...more

Cozen O'Connor

Eighth Circuit: Repairs May Be Compensable as Extra Expense Even if They Don’t Reduce the Business Income Loss

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“Read the policy, read the policy, read the policy” is a famous piece of advice for coverage counsel everywhere. Last Friday in Midwest Reg’l Allergy, Asthma, Arthritis & Osteoporosis Center v. Cincinnati Ins. Co., 2015 WL...more

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