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This month’s Friday Five explores recent decisions that range from the effect on disability benefits when medical records are not provided after two appeals, to a case that examines how an award of death benefits is determined, to a finding that an insurer’s decision to terminate benefits was not...

On September 11, 2023, the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) announced a settlement with LA Care related to potential violations of Health Insurance Portability and Accountability Act (HIPAA). LA Care is the largest publicly operated health plan in the...

In late August, the HHS Office for Civil Rights ("OCR") announced an $80,000 settlement with United Healthcare Insurance Company ("United") relating to OCR's right of access initiative (the "Initiative") which requires that patients be able to access their health information in a timely manner...

This month’s Friday Five explores decisions regarding the timeliness of appeals, the support necessary to sustain an LTD termination decision, a court’s discretion to credit and discredit expert opinions, the circumstances under which an insured may be required to prove they were prejudiced by the...

The HHS Office of Inspector General issued an 'unfavorable' advisory opinion in August with respect to a proposed joint venture relating to interoperative neuro monitoring. Parties considering joint ventures and those in joint ventures should review the OIG analysis to assess compliance with...

This month’s Friday Five addresses two cases involving disability claims that touch on Covid-19, a Circuit Court ruling for an insurer, a district court ruling that a 20-year-old regulatory settlement precluded an insurer from relying on the opinions of physicians it hired, and a claim for breach of...

This month’s Friday Five covers cases relating to what constitutes a fiduciary function, a finding of disability despite working full-time, an enforcement of suit limitation clause, the circumstances under which reinstatement is an appropriate remedy, and ERISA preemption. The Saul Ewing LLP...

The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) announced a settlement on June 28, 2023 of potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules with iHealth Solutions, LLC (doing business as Advantum...

The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) recently announced two settlements with HIPAA-covered entities – one in Washington State and one in New Jersey with settlements of $240,000 and $30,000, respectively. In the Washington State settlement, hospital...

This month’s Friday Five covers cases relating to a plaintiff’s attempts to seal a complaint seeking disability benefits, an administrator’s uncommunicated decision to discontinue its investigation into certain medical conditions, an administrator’s loss of the deferential standard of review for...

Earlier this month, the U.S. Department of Health and Human Services (“HHS”) Office for Civil Rights (“OCR”) announced two (2) different settlements, one with a HIPAA business associate for $350,000 and one with a HIPAA-covered entity pursuant to the OCR Right of Access Initiative for $15,000...

This month’s Friday Five explores two recent decisions that discuss limitations on benefits when both physical disability and disability arising from mental illness are alleged, whether remand of a claim by the court constitutes a new appeal or a continuation of the previous appeal, whether an order...

On April 12, 2023, the Office for Civil Rights (OCR) within the U.S. Department of Health and Human Services (HHS) issued a Notice of Proposed Rulemaking (the “ Notice ”) to solicit comments on its proposal to modify the HIPAA Privacy Rule. Specifically, the Privacy Rule modifications described in...

This month’s Friday Five explores recent decisions that reflect the precise nature of rules and definitions in the context of ERISA claims. For example, effective dates of CFR code provisions and contractually defined limitation periods can draw specific points on the timeline of a case. Similarly...

In February, 2023, the Antitrust Division of the Department of Justice (“DOJ”) announced they are withdrawing three (3) antitrust policy statements – two of which date from the 1990s – which have been relied upon by healthcare providers and their counsel guiding them through their merger and...

On February 10, 2023, the Pennsylvania Commonwealth Court issued four separate but related opinions denying property tax exemptions for four hospitals that had been purchased by the Tower Health system. [1] In each case, the court determined that the owner of the hospital did not qualify as an...

The 2021 calendar year reports from HHS OCR describe OCR’s efforts that calendar year and are instructive tools for all parties who need to comply with HIPAA to understand macro-level trends. What You Need to Know: OCR continues to receive tens of thousands HIPAA complaints each year. “Large”...

See below the Saul Ewing LLP Health Law Practice Group 2023 predictions from various members of our practice group! Our colleagues help interested parties in the health care delivery system with transactional, regulatory, compliance and litigation issues at the Federal and state level. We are...

On November 9, 2022, the New York Department of Financial Services (“NYDFS”) published proposed amendments (the “Proposed Amendments”) to its Cybersecurity Regulations (23 NYCRR 500), commonly referred to as Reg. 500. The comment period for these Proposed Amendments ends on January 9, 2023...

This month’s Friday Five covers cases relating to discovery in ERISA benefits cases, an appellate court strictly interpreting ERISA regulatory deadlines, a district court authorizing an ERISA breach of fiduciary duty claim based on alleged misrepresentations from an employer, another district court...

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