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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...
The use of artificial intelligence (AI) in health care, and specifically, as the utilization of software in medical devices continues to increase. Machine learning (ML) is a branch of AI in which computer systems automatically adapt, improve, and make predictions by applying algorithms to analyze...
On December 2, 2022, the Office for Civil Rights (“ OCR”) and the Substance Abuse and Mental Health Services Administration (“ SAMHSA”) within the U.S. Department of Health and Human Services (“ HHS”) issued a Notice of Proposed Rulemaking (“ NPRM”) to revise the Confidentiality of Substance Use...
Neither shots nor pills will immunize smaller medical, dental, chiropractic, and physical therapy practices, surgery centers, and other healthcare concerns from compliance with the looming (and burdensome) reporting obligations imposed on them if they are “reporting companies” under the federal...
This month’s Friday Five explores recent decisions that illustrate the importance of the administrative record built by a claims administrator, and the impact that the depth and thoroughness of the record will have on litigation over claims decisions. Whether reviewing claims under the de novo...
Effective November 16, 2022, New Jersey will impose additional requirements when a ‘health care entity’ is sold or undergoes a change in control. The changes are the result of the enactment of S-315, on August 18, 2021. What You Need to Know: New Jersey enacted a statute that will impose additional...
The No Surprises Act (“NSA”) is a federal law that went into effect January 1, 2022. The NSA statute was enacted as part of the Consolidated Appropriations Act, 2021 and has been implemented by three interim rule s jointly announced by the Office of Personnel Management within the Department of the...
October was National Cybersecurity Month. As part of its ongoing focus on HIPAA Security Rule awareness and compliance, the Office for Civil Rights (“OCR”) within the Department of Health and Human Services (“HHS”), published its HIPAA Security Rule Incident Procedures newsletter (the “Newsletter”)...
This month’s Friday Five covers cases relating to augmentation of the administrative record following new rationales, attempted alternative ERISA causes of action, untimely ERISA claims, plans governed by ERISA even in the absence of a written plan document, and the limited weight given to residual...
This month’s Friday Five covers cases relating to the interpretation of time periods for claims under life insurance and disability plans, a situation where three separate administrators handled a disability benefits claim (but came to different decisions), the Eleventh Circuit’s parsing of...
Property insurers faced with COVID-19 related claims for business income losses can take comfort in the recent trend of most appellate courts to find in favor of insurers that have denied coverage based on policy language requiring direct physical loss or damage. What You Need to Know: Many...
This month’s Friday Five covers cases relating to interpretation of ambiguous policy terms, evaluation of claimant’s expert witness, inclusion of law firms as appropriate parties from whom plan administrators may seek equitable relief, transfer of cases from the claimant’s choice of venue, and...
On August 23, 2022, the Office for Civil Rights (OCR) within the U.S. Department of Health and Human Services (HHS) announced a $300,640 settlement and a Corrective Action Plan ("CAP") with New England Dermatology P.C., d/b/a New England Dermatology and Laser Center ("NEDLC") to resolve allegations...
On July 15, 2022, the Office for Civil Rights (OCR) within the U.S. Department of Health and Human Services (HHS) announced the resolution of eleven investigations as part of its Health Insurance Portability and Accountability Act (HIPAA) Right of Access Initiative (the "Initiative"). OCR created...
This month’s Friday Five addresses cases considering: (1) whether monetary relief in the amount of lost benefits is an available remedy for breach of fiduciary duty; (2) the validity of an ex-spouse’s beneficiary designation that contradicts a subsequent divorce decree; (3) if waiver of a pre...
On June 29, 2022, the U.S. Department of Health and Human Services Office for Civil Rights released two guidance documents addressing (1) disclosures under the HIPAA Privacy Rule relating to reproductive health care (“Disclosure Guidance”), and (2) the privacy and security of reproductive health...
As we have just passed the half-way point of 2022, many health systems are thinking about acquisitions they would like to complete before the end of the calendar year. In addition to the necessary due diligence, contracting considerations and licensure and regulatory issues, acquiring and selling...
This month’s Friday Five covers cases relating to interpretation of regulatory deadlines, the enforceability of discretionary clauses, circuit courts going both ways on appeals from summary judgment rulings in favor of plans, and a benefits award for a former professional football player where the...
On June 13, 2022, the U.S. Department of Health and Human Services Office for Civil Rights issued guidance (the “Guidance”) for covered health care providers and health plans relating to the use of remote communication technologies to provide audio-only telehealth services in a manner that is...
This month’s Friday Five covers cases relating to an award of attorney’s fees (but not) costs, class certification in an ERISA benefits case, a court finding that a physician claimant was disabled from his own occupation, a claimant paying into insurance he thinks he has, and an insurance company...