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Healthcare Fraud › Employee Retirement Income Security Act (ERISA)

Fennemore

Lessons Learned from ERISA Health Plan Representation and Recommendations for Plan Design and Oversight

Fennemore on

ERISA Health Plan clients are engaged in nearly every industry in the United States. There are nearly 139 million Americans covered by ERISA Health Plans and 2.5 million Health Plans. Yet, operating a health plan has become...more

Cozen O'Connor

The State AG Report – 3.23.2023

Cozen O'Connor on

Here are curated AG and federal regulatory news stories highlighting key areas in which state and federal regulators’ decisions are having an impact across the US: •Kia and Hyundai Urged by Bipartisan Coalition of AGs to...more

Robinson+Cole ERISA Claim Defense Blog

Second Circuit Addresses Limitations Periods Governing Fraudulent Billing Claims Against Non-Participating Labs

Robinson+Cole ERISA Claim Defense Blog on

In Connecticut General Life Ins. Co. v. BioHealth Labs., Inc., No. 20-2312-CV, — F.3d –, 2021 WL 476111 (2d Cir. Feb. 10, 2021), Cigna, as administrator of employee health plans, sued six out-of-network lab companies for...more

White and Williams LLP

Recent Healthcare Fraud Suit Puts Private Equity Industry on Notice as to Potential Liability for Portfolio Company Conduct

White and Williams LLP on

In February, the Department of Justice (DOJ) intervened in a False Claims Act case alleging healthcare fraud, a common enough event. The case in question, originally began in 2015 as a whistleblower case brought by two...more

Seyfarth Shaw LLP

Vindication! Fifth Circuit Reverses Notorious District Court Health Care Fraud Decision

Seyfarth Shaw LLP on

Seyfarth Synopsis: In a major victory for ERISA plans and other payors, the Fifth Circuit recently overturned a district court’s notorious decision in favor of a healthcare provider and reinstated a plan administrator’s...more

Seyfarth Shaw LLP

Fourth Circuit Affirms Health Care Fraud Convictions for Billing Insurers for Medically Unnecessary Services

Seyfarth Shaw LLP on

Seyfarth Synopsis: The Fourth Circuit found that the medical necessity of a given service constitutes a material element of representations regarding submissions for payment, potentially providing payors with another legal...more

Poyner Spruill LLP

Fiduciary Responsibility . . . You Mean that Stuff Applies to the Health Plan I Sponsor, Too?

Poyner Spruill LLP on

In the summer of 2016, over 100 of CIGNA’s self-insured health plan clients were sued with the complaint alleging breach of the defendants’ fiduciary duties under ERISA for engaging in widespread fraudulent behavior involving...more

BakerHostetler

Texas Hospital Strikes Back at Aetna

BakerHostetler on

On February 23, 2015, Aetna filed suit in Texas federal court against Robert A. Behar, M.D. and North Cypress Medical Center (North Cypress), alleging that Dr. Behar, the CEO of North Cypress, offered impermissible ownership...more

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