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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 | 
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 30, 2024 | 
jdsupra.com | Pascal Naples |D. Jacques Smith |Hillary Stemple
Previously, we discussed how the US Supreme Court’s opinion in Loper Bright Enterprises v. Raimondo and Relentless, Inc. v. Department of Commerce could create opportunities for private litigants to challenge health care-related agency actions, particularly with respect to the Stark Law (42 U.S.C. § 1395nn(a)(1)). Read our prior discussion here.
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Jul 29, 2024 | 
afslaw.com | D. Jacques Smith |Hillary Stemple |Pascal Naples
On Read our prior discussion here. To recap, the Court’s opinion in Loper Bright requires courts to exercise “independent judgment” when reviewing an agency’s interpretation of a statute rather than deferring to that agency’s interpretation under Chevron.
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Jul 24, 2024 | 
jdsupra.com | Pascal Naples |D. Jacques Smith |Hillary Stemple
The US Supreme Court recently overturned its ruling in Chevron USA, Inc. v. Natural Resources Defense Council, Inc., changing the landscape for federal agency rulemaking and actions, particularly in the health care industry. Read our previous discussion here. To recap, the Court’s opinion in Loper Bright Enterprises v. Raimondo and Relentless, Inc. v.
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Jul 23, 2024 | 
afslaw.com | D. Jacques Smith |Hillary Stemple |Pascal Naples
On Read our previous discussion here. To recap, the Court’s opinion in Loper Bright Enterprises v. Raimondo and Relentless, Inc. v. Department of Commerce requires courts to exercise “independent judgment” when reviewing an agency’s interpretation of a statute rather than deferring to that agency’s interpretation. In effect, this provides new opportunity for private litigants to challenge agency actions.
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Jul 12, 2024 | 
afslaw.com | Douglas Grimm |Lowell Brown |David Greenberg |Pascal Naples
On Chevron reflected the view that a federal agency’s subject matter experts are best positioned to interpret and set policy when the language of a statute is silent or ambiguous regarding a specific issue, as opposed to a judge with little experience in the subject matter area. As discussed in our prior alert, the consolidated opinion in Loper Bright Enterprises v. Raimondo and Relentless, Inc. v.
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Aug 31, 2023 | 
afslaw.com | Caroline English |Alison Andersen |Jack Bierig |Pascal Naples
Last week, the US Court of Appeals for the Ninth Circuit, in its third opinion in the case, reversed a lower court’s decision allowing patients challenging United Behavioral Health’s (UBH) internal mental health coverage guidelines to seek reprocessing of their benefits claims as three certified classes.
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Aug 15, 2023 | 
afslaw.com | Caroline English |Pascal Naples
Off The nearly 400-page proposed rule, if adopted, would prohibit health plans and issuers from using nonquantitative treatment limitations (NQTLs) to place greater limits on access to mental health and substance use disorder benefits than on medical and surgical benefits. A link to the proposed rule is here. NQTLs refer to the nonnumerical tools that plans use to limit access to mental health and substance use disorder treatments.
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May 10, 2023 | 
jdsupra.com | Linda Jackson |Pascal Naples
In a case involving government contracts, the Fourth Circuit held that a company could proceed with its claims against three former employees for actions they took as employees – through their newly formed company - to pursue the same contract the company was pursuing. A link to the decision can be found here. BackgroundThe factual background is a well-worn territory in the government contracting industry. The plaintiff-appellant, Adnet, Inc., had an existing contract with the Army.
