On August 6, the Federal Trade Commission (the “FTC”) and the State of Nevada entered into a settlement with Renown Health (“Renown”) regarding Renown’s anticompetitive actions in the Reno cardiology market. The FTC alleged that Renown’s acquisition of two cardiology groups in the area effectively removed all competition from the market. As part of the

On July 6, CMS released its proposed rule (the “Rule”) for Hospital Outpatient Prospective Payment Systems (“HOPS”) and Ambulatory Surgery Center Payment Systems (“ASC Payments”) which was published in the Federal Register on July 30, 2012.  The final rule is expected to be published on November 30, 2012.  The Rule would increase reimbursement for HOPS

The headline could read “ABA drags lawyers, kicking and screaming, into the 21st Century,” but that would not tell the whole story. In reality, for the past decade or more, lawyers have increasingly relied on technology to practice law, but that reliance has grown so incrementally that its potential impact on ethical responsibilities may not

Appellate Court Reinstates Claims Against Homeowner’s Insurer

A homeowner sued his insurer for damage from a burst water pipe. The appellate court affirmed the trial court’s decision to dismiss the homeowner’s claims for intentional and negligent infliction of emotional distress, finding that the insurer’s alleged conduct “did not so transcend the bounds

Robert Mericle, the owner of Mericle Construction, a company that built private juvenile facilities, was sued for his alleged role in a judicial kickback scheme. After he tendered the claims to the insurance company that had issued him a commercial general liability insurance policy, the insurer denied coverage. The insurer then filed a declaratory

The plaintiff in this case worked as an engineer for the Boeing Company. Under Boeing’s long term disability plan, employees who were totally disabled as a result of accidental injury or illness were eligible for long term disability benefits. During the first 24 months of disability, the plan’s “own occupation” definition of disability applied, under

On June 22, 2012, the New York State legislature passed A8869-B Gottfried / S6228-B Hannon, an Act to Amend the Public Health Law, in Relation to Accountable Care Organizations.  The bill now only needs the signature of Governor Andrew Cuomo before becoming law.

The bill seeks to promote the formation of accountable care organizations (ACOs)

Taylor v. Harbour Pointe Homeowners Association, 2012 U.S. App. LEXIS 16216 (2d Cir. Aug. 2, 2012)

While attorneys’ fees are more regularly awarded to prevailing plaintiffs under various federal anti-discrimination statutes, prevailing defendants in such cases are not typically awarded attorneys’ fees unless they can demonstrate that the plaintiff’s claims were “frivolous, unreasonable, or groundless,

Please click the link below to view Foreign Parallel Proceedings From the United States Perspective: Do the Courts Need A Crystal Ball? Adobe Reader is required to view the bulletin. If Adobe Reader is not installed on your PC, click here to download and install.

Foreign Parallel Proceedings From the United States Perspective: Do the

Insurance carriers that provide health care coverage in New York (and in other states) typically have developed comprehensive anti-fraud plans that help them identify and investigate insurance fraud. An important tool in these anti-fraud plans is post-payment reviews of claims submitted by health care providers. When insurance carriers detect fraud, and when they are unable

Corning sought coverage for thousands of claims arising from the distribution and/or manufacture of two asbestos-containing products. The court said the insurers failed to make out a prima facie case that each of the thousands of claims constituted a separate occurrence. The court reasoned that claims arising from exposure to an asbestos condition at

Valero Refining Company contracted with Encompass Power Services to design, engineer, and construct a co-generation facility. After a fire caused significant damage, Valero sought over $40 million in damages from Encompass.

A federal district court held that Encompass’ three primary insurers had to split the costs initially spent by one of them defending Encompass

The worker’s compensation claimant in this case worked as a collision shop technician in New York, repairing automobiles. In 2005, he suffered three injuries on the job. On February 21, he slipped on ice, injuring his hip and back. On March 18, he suffered a lower back sprain. He left his job on June 27

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A Landscape View of Privacy Issues

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In recent years, there has been uncertainty as to the standards to be applied when automobile repair shops challenge the conduct of automobile insurers in regard to the negotiation and payment of collision repair costs.  In Nadel v. Allstate Insurance Company, 2012 N.Y. Misc. LEXIS 1527 (N.Y. App. Term 2d Dep’t 2012), the Appellate