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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...
If you are the owner or co-owner of a small to medium-size medical practice, dental practice, or other health care concern, you have probably never thought of your practice as the type of vehicle that can be used to launder money—not much revenue in the form of cash, too much regulatory oversight...
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...