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Name Category Published
U.S. ex rel. Hartpence v. Kinetic Concepts
The compliance certification process for Medicare reimbursement of wound therapy pump devices was material under the False Claims Act because it was necessary for payment of a claim. 		Health Care 9th Aug. 10, 2022
Silverado Hospice v. Becerra
Centers for Medicare and Medicaid Services reasonably instituted a sequestration method that was consistent with the text of both the Budget Control Act and the Medicare statute. 		Health Care 9th Aug. 2, 2022
Saini v. Sutter Health
Hospital was not required to further notify a prospective emergency room patient of an emergency medical services fee when it provided signage in the emergency room that its fees are available online. 		Health Care 1DCA/4 Jul. 12, 2022
Magallanes de Valle v. Doctors Medical Center of Modesto
In a medical malpractice suit, hospital was not liable for the alleged negligence of a physician because patient reasonably should have known that physician was not the hospital's agent. 		Health Care 5DCA Jul. 7, 2022
Allied Anesthesia Medical Group v. Inland Empire Health Plan
Health care providers who provided services to Medi-Cal enrollees were not the intended third-party beneficiaries in contract between the health care service plan and the California Department of Health Care Services. 		Health Care 4DCA/2 Jul. 5, 2022
Becerra v. Empire Health Foundation, For Valley Hospital Medical Center
In calculating the Medicare fraction used to adjust rates paid to hospitals with higher percentages of low-income patients, "entitled to benefits" means those qualifying for the program. 		Health Care USSC Jun. 27, 2022
Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita Inc.
Low healthcare plan reimbursements for dialysis services did not violate the Medicare Secondary Payer statute where the plan applied uniformly to all participants. 		Health Care USSC Jun. 22, 2022
American Hospital Assn. v. Becerra
Under the 2003 Medicare Act, the Department of Health and Human Services must conduct a survey of hospitals' acquisition costs before varying drug reimbursement rates among different hospitals. 		Health Care USSC Jun. 16, 2022
Gallardo v. Marstiller
The Medicaid Act permits a state to seek reimbursement from settlement payments allocated for future medical care. 		Health Care USSC Jun. 6, 2022
Daniel C. v. White Memorial Medical Center
The trial court erred in approving a Medi-Cal lien on a settlement without determining what portion of the settlement represented past medical expenses. 		Health Care 2DCA/3 May 31, 2022
Amended Opinion: Aylward v. SelectHealth
Plaintiff's state law claim that health insurance company breached its duty to timely process her deceased husband's appeal of denial of insurance preauthorization was expressly preempted by the Medicare Act. 		Health Care 9th May 31, 2022
Modification: Samantha B. v. Aurora Vista Del Mar, LLC
Medical Injury Compensation Reform Act limits did not apply to plaintiffs' causes of action under the Elder Abuse Act where jury found both professional negligence and reckless neglect. 		Health Care 2DCA/6 Apr. 27, 2022
Aylward v. SelectHealth
Plaintiff's state law claim that health insurance company breached its duty to timely process her deceased husband's appeal of denial of insurance preauthorization was expressly preempted by the Medicare Act. 		Health Care 9th Apr. 14, 2022
Bristol SL Holdings v. Cigna Health and Life Insurance Company
Health center's bankruptcy successor-in-interest has standing to pursue health center's claims under ERISA. 		Health Care 9th Jan. 18, 2022
Riverside County Public Guardian v. Snukst
Federal and state statutes governing trusts and Medi-Cal require that the California Department of Health Services be reimbursed from the trust before any distribution to its beneficiary. 		Health Care 4DCA/2 Jan. 12, 2022
Bichai v. DaVita, Inc.
Medical staff bylaws' burden of proof for peer review hearings must be consistent with Business and Professions Code Section 809.3(b)'s preponderance of the evidence burden. 		Health Care 5DCA Dec. 22, 2021
Samantha B. v. Aurora Vista Del Mar, LLC
Medical Injury Compensation Reform Act limits did not apply to plaintiffs' causes of action under the Elder Abuse Act where jury found both professional negligence and reckless neglect. 		Health Care 2DCA/6 Dec. 21, 2021
Modification: Long Beach Memorial Medical v. Kaiser Foundation Health Plan
The recognition of a new intentional tort of inadequately reimbursing a hospital was at odds with the purposes of the Knox-Keene Act. 		Health Care 2DCA/2 Nov. 29, 2021
Long Beach Memorial Medical v. Kaiser Foundation Health Plan
The recognition of a new intentional tort of inadequately reimbursing a hospital was at odds with the purposes of the Knox-Keene Act. 		Health Care 2DCA/2 Nov. 5, 2021
Family Health Centers of San Diego v. State Dept. of Health Care Services
An administrative law judge did not err in using a materiality standard to determine how to apportion costs for a clinic receiving Medi-Cal reimbursement. 		Health Care 3DCA Nov. 2, 2021
Gray v. Dignity Health
It is not unfair for hospitals to not disclose a billing that included an emergency room charge prior to providing emergency medical treatment. 		Health Care 1DCA/1 Oct. 15, 2021
L.Q. v. California Hospital Medical Center
California Department of Health Care Services is entitled to recover the portion of Medi-Cal beneficiary's settlement attributable to past medical care paid through the Medi-Cal program. 		Health Care 2DCA/3 Oct. 5, 2021
Agendia v. Becerra
Medicare Act's notice-and-comment provision did not apply to local coverage determinations because such determinations did not establish or change substantive legal standard. 		Health Care 9th Jul. 19, 2021
Beverly Oaks v. Blue Cross & Blue Shield
Plaintiff, an assignee of its patients, sufficiently alleged that defendant waived an anti-assignment provision in ERISA plan documents as a reason for denying the benefits claim. 		Health Care 9th Dec. 18, 2020
Rutledge v. Pharmaceutical Care Management Assn.
Arkansas Act 900 has neither an impermissible connection with, nor reference, to Employee Retirement Income Security Act of 1974 and is therefore not pre-empted. 		Health Care USSC Dec. 11, 2020
John Doe v. CVS Pharmacy
No healthcare-specific anti-discrimination standard exists under Affordable Care Act, permitting plaintiffs to borrow standards from other anti-discrimination statutes. 		Health Care 9th Dec. 10, 2020
Davita Inc. v. Amy's Kitchen Inc.
Employee benefit health plans with identical reimbursement rates regardless of underlying diagnoses or Medicare eligibility comport with Medicare as Secondary Payor provisions. 		Health Care 9th Nov. 27, 2020
Davita Inc. v. Virginia Mason Memorial Hospital
Congress did not intend payment by Medicare to be prerequisite to bringing private cause of action under Medicare as Secondary Payer provisions. 		Health Care 9th Nov. 27, 2020
Stone v. UnitedHealthcare Insurance Co.
Denial of coverage did not violate Parity Act because it was based solely on plan's exclusion of coverage for out-of-state treatment, which applied equally to mental and physical illnesses. 		Health Care 9th Nov. 10, 2020
Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania
Under Affordable Care Act, government has statutory authority to provide exemptions from regulatory contraceptive requirements for employers with religious and conscientious objections. 		Health Care USSC Jul. 9, 2020
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