Source Shorts
Update: Carolinas Healthcare Argues DOJ Fails to Allege Actual Competitive Harm in Anti-Steering Suit
Anna Zaret, Managing Editor September 24, 2016
September 2016 Update: We previously blogged about the suit filed in June by the Department of Justice and the North Carolina Attorney General against Carolinas Healthcare System (“CHS”). The case involves a Sherman Act Section 1 challenge to anti-steering provisions in CHS’ contracts with insurers. In August, CHS moved for judgment on the pleadings. CHS filed its reply brief in support of the motion on Wednesday. In its brief, CHS argues that the DOJ complaint is insufficient as a matter of law because it fails to show that the anti-steering …
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Update: Appeals Court Reinstates Florida Plaintiffs’ Class Claims in Challenge to Unreasonable Hospital Rates
Anne Marie Helm, Managing Editor July 20, 2016
July 2016 Update: In April, the U.S. Court of Appeals for the 11th Circuit overturned the district court’s February 2015 decision dismissing the class-wide allegations in this case. The case charges certain Florida medical centers and Nashville, Tenn.-based HCA with billing exorbitant and unreasonable fees for emergency radiological services covered in part by Florida Personal Injury Protection (“PIP”) insurance. Under Florida’s No Fault Car Insurance Law, drivers are required to have $10,000 in PIP insurance, and the complaint alleges that patients covered by PIP who received radiological services at emergency rooms following …
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Sutter Plaintiffs Win 9th Circuit Appeal of 2014 Case Dismissal
Anne Marie Helm, Managing Editor July 18, 2016
At long last, a three-judge panel has ruled in favor of the plaintiffs/appellants in their Ninth Circuit appeal of the dismissal of the putative class action Sidibe v. Sutter Health, filed in federal district court in San Francisco in September 2012 and dismissed in June 2014. The Ninth Circuit heard arguments on July 8, and issued this unpublished opinion a week later. The district court dismissed the third amended complaint on the grounds that the plaintiffs’ geographic market definition, one of the bases for claims brought under the Sherman Antitrust …
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Sutter loses appeal re arbitration|must litigate against union in state court
Anne Marie Helm, Managing Editor April 28, 2016
See UFCW & Employers Benefit Trust v. Sutter Health case page. The Source has been following UFCW &|Employers Benefit Trust v. Sutter Health, since the complaint it was filed in state court in San Francisco in April 7, 2014. A grocery store union is the named plaintiff in the putative class action whose class includes all self-funded payers in California who compensated Sutter for acute care services while the company was engaging in anticompetitive practices alleged to violate California’s antitrust law, the Cartwright Act, and other state statutes relating to unfair …
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FTC Expresses Concerns About West VA’s Pro-Healthcare Merger Legislation
Anne Marie Helm, Managing Editor March 10, 2016
The FTC today expressed concerns about proposed legislation in West Virginia aimed at facilitating provider mergers in official written comments to the measure. The state’s legislation was drafted after the FTC challenged a West Virginia hospital merger in November, which we blogged about here. The FTC’s concerns are laid out in its press release, included below. In short, the FTC says it isn’t trying to prevent the good healthcare mergers, just the bad ones. March, 10, 2016 FTC Press Release: Federal Trade Commission staff submitted written comments on the competitive impact …
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Court Rules 6-2 in Gobeille: ERISA Pre-empts VT Transparency Law
Elizabeth Nicholson, Research Fellow March 2, 2016
Today, the Supreme Court decided Gobeille v. Liberty Mutual Insurance Co. in favor of Respondent, Liberty Mutual. The Court held that ERISA does, in fact, pre-empt Vermont’s all-payer claims database (“APCD”) statute as the statute applies to ERISA plans. Earlier, we included this case brief on the Source Blog. THE MAJORITY OPINION Justice Kennedy authored the majority opinion. He was joined by Justices Roberts, Thomas, Breyer, Alito, and Kagan. In its majority opinion, the Court acknowledged that Section 1144(a) of ERISA—that “any and all state laws insofar as they may …
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Source Advisory Board Member Greaney Weighs in on Big Insurance Mergers
Anne Marie Helm, Managing Editor February 25, 2016
Last month, in a letter to the U.S. Department of Justice (DOJ) Antitrust Division, the American Antitrust Institute described the competitive and consumer concerns surrounding the proposed health insurance mergers of Aetna-Humana and Anthem-Cigna. Source Advisory Board Member and AAI Advisor Tim Greaney co-authored the letter with AAI President Diana Moss. Professor Greaney testified before a House subcommittee last September on the dangers posed by the mergers, and submitted this prepared statement (as did Source Executive Editor Jaime King, who submitted this prepared statement). AAI’s letter argues, based on economic evidence, …
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Post Update: Parties & Court Still Working Out How Much Confidentiality Providers’ Antitrust Filings Will Get
Anne Marie Helm, Managing Editor January 7, 2016
UPDATE: On November 6, we blogged about Judge Darrow’s ruling that antitrust defendant OSF Healthcare System could not file its entire summary judgment motion, along with exhibits, under seal. In fact, it is not just OSF that wants confidentiality in the case. Plaintiff Methodist Health Services Corporation has also supported the imposition of a protective order, and the designation of documents as confidential. In the latest on the back-and-forth over how much of the summary judgment motion and opposition briefs will are to be filed under seal, plaintiff Methodist filed, …
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Most-favored Nations Clauses Come Back to Haunt Blue Cross Blue Shield of Michigan
Anne Marie Helm, Managing Editor August 27, 2015
The BC/BS multi-district litigation over alleged market allocation and other antitrust violations by the insurer and their Association caught our eye again this week when Defendant Blue Cross Blue Shield of Michigan filed a motion to preclude certain discovery. The discovery requests BCBSM objects to relate to Aetna’s lawsuit against BCBSM that settled in May after five years in federal court in Michigan. As you recall, Aetna’s antitrust suit against Blue Shield of Michigan that began with this 2011 complaint had been set to go to trail on May 26, 2015, but …
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More on Executive Pay: Healthcare Non-Profits Are Paying More & More to CEOs
Anne Marie Helm, Managing Editor August 12, 2015
Just after we wrote last week about the SEC’s new pay ratio disclosure rule under Dodd-Frank, Modern Healthcare published a story on executive pay in not-for-profit healthcare entities that we want to draw your attention to. State laws governing non-profits provide a check on CEO salaries by requiring that those salaries be “market rates,” and attempting to ensure that they do not amount to misuses of the entities’ charitable assets. Notwithstanding, Modern Healthcare’s review of recent non-profit healthcare executives’ pay shows an increase of 29.6% in pay for the 20 …
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