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Aug 8, 2024 | 
jdsupra.com | Alison Andersen |Jack Bierig |Caroline English
On August 2, health care providers scored yet another significant victory when the US Court of Appeals for the Fifth Circuit affirmed the vacatur of various federal regulations regarding the arbitration procedures used to resolve billing disputes between providers and insurers under the federal No Surprises Act (NSA).
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Aug 7, 2024 | 
afslaw.com | Aphrodite Kokolis |Caroline English |Alison Andersen |David Greenberg
On In this case, commonly referred to as TMA II, the Fifth Circuit held that the regulations improperly restricted the arbitrators’ authority to consider the various factors specified in the NSA when deciding on reimbursement amounts for out-of-network providers’ services.
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Aug 2, 2024 | 
jdsupra.com | Caroline English |Pascal Naples
On July 19, the US District Court for the Northern District of Texas denied a motion to dismiss Blue Cross Blue Shield of Texas (BCBSTX), which claimed sovereign immunity in a suit brought by a group of providers. In so doing, the court aptly explained the limits on sovereign immunity for administrators contracting with state health plans.
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Aug 1, 2024 | 
natlawreview.com | Caroline English
On July 19, the US District Court for the Northern District of Texas denied a motion to dismiss Blue Cross Blue Shield of Texas (BCBSTX), which claimed sovereign immunity in a suit brought by a group of providers. In so doing, the court aptly explained the limits on sovereign immunity for administrators contracting with state health plans.
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Aug 1, 2024 | 
afslaw.com | Caroline English |Pascal Naples
On The 11th Amendment of the US Constitution bars private parties from suing a state agent acting in an official capacity unless US Congress or the state waives the immunity. As a result, administrators contracting with state health plans often claim that the 11th Amendment affords them immunity from suits arising out of the services they provide to such plans.
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Jul 31, 2024 | 
jdsupra.com | Caroline English |David Greenberg
In a recent opinion, Smith et al. v. UnitedHealth Group Inc. et al., the US Court of Appeals for the Eighth Circuit affirmed the dismissal of an Employee Retirement Income Security Act (ERISA) class action suit brought by health plan participants. The court determined that the plaintiffs could not assert a breach of ERISA by merely arguing a plan’s terms were inconsistent with federal benefits law. Rather, plaintiffs must also show a concrete injury. A link to the opinion is here.
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Jul 30, 2024 | 
natlawreview.com | Caroline English
In a recent opinion, Smith et al. v. UnitedHealth Group Inc. et al., the US Court of Appeals for the Eighth Circuit affirmed the dismissal of an Employee Retirement Income Security Act (ERISA) class action suit brought by health plan participants. The court determined that the plaintiffs could not assert a breach of ERISA by merely arguing a plan’s terms were inconsistent with federal benefits law. Rather, plaintiffs must also show a concrete injury. A link to the opinion is here.
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Jul 30, 2024 | 
afslaw.com | Caroline English |David Greenberg |Oluwaseun Wells
On A link to the opinion is here. The Controversial Practice of Cross-Plan OffsettingCross-plan offsetting is a practice by which an administrator of multiple health plans reduces, or even pays nothing, on a benefit due to a provider for a particular patient covered under one plan in order to recover (offset) an amount believed to have been overpaid to the provider with respect to services rendered to another patient covered by another plan.
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Jun 17, 2024 | 
afslaw.com | Brian Waldman |Caroline English
ArentFox Schiff is pleased to announce that Firmwide Managing Partner Brian Waldman and Partner Caroline Turner English have been named to the BTI Client Service All-Stars 2024, independently researched, client-driven ranking of attorney client service. The BTI Client Service All-Stars are determined by top legal decision makers who single out the attorneys delivering the absolute best in client service.
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May 15, 2024 | 
thepointsguy.com | Caroline English
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