The Department of Health and Human Services, Office of Inspector General (“OIG”) has recently released its Work Plan for Fiscal Year 2016 (“Plan”). The Plan summarizes new and ongoing audits, investigations and evaluations that OIG will prioritize in the upcoming year.

While many of the areas of focus addressed in the Plan are similar to

Reports have surfaced that the federal government is preparing to announce settlements under the False Claims Act with hundreds of hospitals as part of a nationwide enforcement initiative into the suspected overuse of implantable cardiac devices, referred to as Implantable Cardioverter Defibrillators (“ICDs”).[1]  There reportedly are more than 500 hospitals under investigation, many if not

One of the hallmarks of a claims-made and reported policy historically has been the two-pronged requirement that (1) the claim against the insured must be first made during the policy period, and (2) the claim had to be reported to the insurer, if not strictly within the policy period, at least no later than a

As this column regularly observes, insurance companies frequently use civil litigation as a tool to fight insurance fraud,1 including fraud involving life insurance policies.2 Insurance fraud, of course, also is a crime,3 and prosecutors often bring criminal actions against those who commit insurance fraud.

Generally speaking, a person convicted of insurance fraud faces a potential

On October 30, 2015 the Centers for Medicare and Medicaid Services (“CMS”) released a final rule that makes significant changes to the Medicare Physician Fee Schedule as well as other payment policies for 2016. Below is a summary of the major policy changes reflected by the rule, specifically provisions regarding the physician self-referral law, payment

Medical, health home, mental health, and other providers licensed by the New York State Department of Health, Office of Mental Health or other governmental agency, and any providers ordering, providing, billing or claiming at least $500,000 from Medicaid in a consecutive twelve month period, are required to have an effective compliance program. Those providers must

In a case closely followed by all advertisers in general and the dietary supplement/natural products industry in particular, United States v. Bayer Corp., the United States District Court for New Jersey rebuffed an attempt by the Federal Trade Commission (FTC) to greatly increase the level of proof required for an advertiser to substantiate health related

An appellate court in Illinois, affirming a trial court’s decision, has ruled that a policy exclusion precluded coverage for claims against an insured for violation of the federal Telephone Consumer Protection Act of 1991 (TCPA), conversion, and violations of the Illinois Consumer Fraud and Deceptive Business Practices Act (the “Illinois Act”).

The Case

Wellington Homes,

The Vermont Supreme Court, affirming a trial court’s decision, has ruled that an insured had breached his insurance policy’s cooperation clause and that, as a result, his insurance carrier had no obligation to defend or indemnify him in connection with an underlying personal injury claim.

The Case

Charles Chandler asserted that his then-girlfriend, now-wife, Faye

The West Virginia Supreme Court of Appeals has ruled that exclusions in a commercial general liability (CGL) insurance policy issued to a contractor precluded coverage of claims brought by two homeowners against the contractor.

The Case

In July 2009, Fred Hlad signed a contract to build a house for Travis and Teresa Nelson. The agreement

The U.S. Court of Appeals for the Third Circuit, affirming a decision by the U.S. District Court for the Eastern District of Pennsylvania, has ruled that a “prior publication” exclusion prevented an insured from obtaining insurance coverage for a continuing course of tortious conduct.

The Case

On February 28, 2012, the Navajo Nation and its

Private Settlements of FLSA Claims Require Court or DOL Approval, Second Circuit Rules

The plaintiff in this case worked at both Freeport Pancake House, Inc., and W.P.S. Industries, Inc. (together, Freeport Pancake House) as a restaurant server and manager over the course of several years. In August 2012, the plaintiff sued Freeport Pancake House, seeking to

Second Circuit Applies “Unfortunate Event Test” To Find That Incidents Amounted To Three Accidents

A dump box attached to a dump truck struck and damaged an overpass owned by the New York State Thruway Authority. After hitting the overpass, the dump box separated from the truck and landed in the right lane of the highway.

In 2014, the United States Department of Labor (“DOL”) issued a new regulation to be effective January 1, 2015 to modify the minimum wage and overtime requirements of home care workers (including companionship and live-in domestic workers).  Prior to the new regulation being effective, a Federal District Court vacated the regulation finding that the DOL

Recently, a federal judge for the District of Columbia sided with several hospitals and health care organizations in ruling that the Centers for Medicare and Medicaid Services (“CMS”) must reconsider a regulation that reduced the provider payment rate for Medicare Part A services. While the decision did not overturn the regulation, it did push the