On Thursday, June 17, 2021, in a 7-2 opinion, the U.S. Supreme Court upheld the Affordable Care Act (“ACA”) in the case California v. Texas. The Court held that Texas, the other plaintiff states, and the two individual
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Supreme Court to Hold Oral Arguments on Certain Republican States’ Challenge to the ACA on November 10
The U.S. Supreme Court will hear oral arguments on certain red states’ challenge to the Affordable Care Act on November 10, one week after the November 3 presidential election, according to the court’s online docket released on Wednesday, August 19. …
COVID-19 Update: CMS Approves First Section 1135 Waiver
Following President Trump’s declaration of a national emergency on March 13, 2020, CMS approved the first Section 1135 waiver related to Medicaid on Monday. The State of Florida received permission to eliminate the limits on instances of care furnished and…
Allina Update: Supreme Court holds Medicare statute requires notice and comment for DSH payment change
In a decision with potentially far reaching implications for Medicare hospital reimbursement, on June 3 the U.S. Supreme Court ruled 7-1 against the U.S. Department of Health and Human Services (“HHS”) in Azar v. Allina Health Services. The Court…
The Supreme Court resolves circuit split on FCA statute of limitations period
On May 13, the U.S. Supreme Court unanimously affirmed a decision by the U.S. Court of Appeals for the 11th Circuit, holding that the False Claims Act’s (“FCA”) limitations period in 31 U.S.C.(b)(2) applies to “relator-initiated actions” in which…
South Africa: Covering doctors have an immediate legal duty of care to patients
A doctor who covers for a colleague has an immediate legal duty to care for his colleague’s patients whilst on call.
This was recently confirmed by the Supreme Court of Appeal in South Africa in a case where a doctor…
Twenty states file a lawsuit alleging the ACA is unconstitutional without the individual mandate penalty
A group of twenty states has filed a lawsuit against the Trump administration alleging that the Affordable Care Act (ACA) is unconstitutional. Plaintiffs take the position that the elimination of the individual mandate penalty in the Tax Cuts and Jobs …
Court applies Escobar, overturns $350M False Claims Act verdict
In Universal Health Services v. U.S. ex rel Escobar, the United States Supreme Court emphasized the importance of the materiality standard in False Claims Act cases. Since that decision, litigants have anxiously awaited further guidance on how Escobar’s instructions would…
Judge doubles down on finding of materiality in FCA case
Federal courts continue to grapple with applying the “materiality” standard that is needed to cause a Stark Law violation or other underlying compliance matter to trigger False Claims Act liability. Although we have recently begun to gain a clearer view…
SCOTUS applies ERISA exemption to plans established by church-affiliated hospitals
In an 8-0 decision, the Supreme Court unanimously held that ERISA’s exemption of “church plans” from its regulation of employee benefit plans extends to church-affiliated hospitals even if an actual church did not establish the plan.
The Petitioners, Advocate Health…