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Arthur N. Lerner Document Search Results (33) Show: results per page Sort by:  | The Oak Brook Surgical Center v. Aetna Health, Inc.
Justin Gundlach, Arthur N. Lerner; Crowell & Moring LLP;
Legal Alert/Article April 9, 2012, previously published on April 6, 2012 The Oak Brook Surgical Center ("Plaintiff") brought claims against Aetna, alleging that Aetna had pre-approved treatments then declined to provide coverage for them. Aetna removed the case to federal court after Plaintiff amended its complaint, narrowing the causes of action to promissory...
| | HHS Rate Review of Trustmark Life Insurance Company
Justin Gundlach, Arthur N. Lerner; Crowell & Moring LLP;
Legal Alert/Article April 9, 2012, previously published on April 6, 2012 The Affordable Care Act added a new section to the Public Health Service Act directing HHS, in conjunction with the states, to establish a process for the annual review of "unreasonable increases in premiums for health insurance coverage." This statutory addition requires health insurance...
| | John B. v. Emkes
Justin Gundlach, Arthur N. Lerner; Crowell & Moring LLP;
Legal Alert/Article April 9, 2012, previously published on April 6, 2012 The U.S. District Court for the Middle District of Tennessee vacated a longstanding consent decree on provision of EPSDT services to children in Tennessee. In so deciding, the court looked to the consent decree's terms permitting expiration upon the state's achievement of prescribed screening rates...
| | Messner v. Northshore University Healthsystem
Justin Gundlach, Arthur N. Lerner; Crowell & Moring LLP;
Legal Alert/Article April 9, 2012, previously published on April 6, 2012 Northshore University Healthsystem and other Chicago-area hospitals ("Defendants") merged in 2000, but the FTC successfully challenged their merger under § 7 of the Clayton Act and only permitted the merger to survive on the condition that the various entities continue to negotiate...
| | In the matter of ProMedica Health System, Inc.
Justin Gundlach, Arthur N. Lerner; Crowell & Moring LLP;
Legal Alert/Article April 9, 2012, previously published on April 6, 2012 The Federal Trade Commission (FTC) and Ohio Attorney General ("AG") challenged ProMedica Health System, Inc.'s ("ProMedica") acquisition of St. Luke's, a non-profit hospital in northwest Ohio. The FTC and Ohio AG persuaded the District Court for the Northern District of Ohio to...
| | Sw. Pharmacy Solutions, Inc. v. CMS
Justin Gundlach, Arthur N. Lerner; Crowell & Moring LLP;
Legal Alert/Article April 9, 2012, previously published on April 6, 2012 Plaintiffs, a for-profit member-owned independent pharmacy cooperative, challenged implementation of the "preferred pharmacy" rule by the administrators of the Medicare Part D prescription drug program. Plaintiffs allege that the rule, which, the plaintiffs said, permits a Part D plan to...
| | Kaiser Foundation Health Plan, Inc. v. Superior Court
Justin Gundlach, Arthur N. Lerner; Crowell & Moring LLP;
Legal Alert/Article April 9, 2012, previously published on April 6, 2012 Plaintiffs, Anna Rahm (a cancer patient) and her parents, filed a complaint against Kaiser Foundation Health Plan and two Kaiser health care providers ("Defendants") alleging that Defendants operated "a system of withholding benefits from insureds." Plaintiffs alleged that this...
| | Anthem Health Plans of Maine, Inc. v. Superintendent of Insurance
Justin Gundlach, Arthur N. Lerner; Crowell & Moring LLP;
Legal Alert/Article April 9, 2012, previously published on April 6, 2012 Maine law requires the review of individual health coverage premium increases by the Superintendent of Insurance, though not of group coverage premium increases. Last year, the Maine Supreme Court dismissed as moot a challenge from insurers who sought rate increases on premiums for individual...
| | New MLR Final Rule for Community Rated Plans Under FEHBP
Arthur N. Lerner, Dawn Miller; Crowell & Moring LLP;
Legal Alert/Article April 4, 2012, previously published on April 3, 2012 On Monday, April 2, 2012, the U.S. Office of Personnel Management ("OMB") published in the Federal Register final regulations which amend existing Federal Employees Health Benefits ("FEHB") and the Federal Employees Health Benefits Acquisition Regulation ("FEHBAR")...
| | DOL Issues Long-Awaited Final Rules For Service-Provider Compensation Disclosures Under ERISA
Arthur N. Lerner, Joel D. Wood; Crowell & Moring LLP;
Legal Alert/Article February 8, 2012, previously published on February 7, 2012 On February 3, the Department of Labor issued its long-awaited (and much delayed) final rules for service-provider compensation disclosures under ERISA Section 408(b)(2). Although these rules do not, by their terms, apply to health and welfare plans, the Department has, as discussed below,...
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