Medicare: Ninth Circuit Limits Rates Providers Can Charge Medigap Insurers

2003 ◽  
Vol 31 (1) ◽  
pp. 159-160
Author(s):  
Ed Caldie
Keyword(s):  
Medical Treatment ◽  
District Court ◽  
Insurance Company ◽  
Insurance Policy ◽  
Breach Of Contract ◽  
Ninth Circuit ◽  
Court Of Appeals ◽  
Medicare Coverage ◽  
Summary Judgment ◽  
The U.S

In Vencor, Inc. v. National States Insurance Co., the U.S. Court of Appeals for the Ninth Circuit held that a Medigap insurance provider was only obligated to pay the rates that Medicare would have paid for the same care.Clarence Rollins purchased a Medigap insurance policy from National States Insurance Company (NSIC) to supplement his Medicare coverage. When Rollins became ill and required care beyond that which Medicare would cover, he received his medical treatment from Vencor Hospital-Phoenix (Vencor). Upon Rollins's death, NSIC paid Vencor $38,760. Vencor claimed that NSIC owed an additional $132,438 because NSIC was not entitled to the lower care rates established by Medicare. NSIC refused to pay Vencor's higher rates. As a result, Vencor sued NSIC for breach of contract.The U.S. District Court for the District of Arizona held, on a motion for summary judgment, that no breach occurred, and that NSIC was obligated to pay only the lower rates established by Mediare. The Ninth Circuit affirmed this decision.

EMTALA: Screening Can Satisfy EMTALA, Despite Misdiagnosis

2003 ◽  
Vol 31 (1) ◽  
pp. 169-170 ◽  
Author(s):  
Hemanth Gundavaram
Keyword(s):  
Blood Pressure ◽  
Medical Treatment ◽  
Emergency Room ◽  
Urinary Retention ◽  
Court Of Appeals ◽  
Statutory Duty ◽  
Active Labor ◽  
Summary Judgment ◽  
De Medicina ◽  
The U.S

In Del Carmen Guadalupe v. Agosto, the U.S. Court of Appeals for the First Circuit held that a hospital fulfills its statutory duty to screen patiens in is emergency room if it provides for a “screening examination reasonably calculated to identify critical medical conditions” that may be afflicting symptomatic patients and if it “provides that level of screening uniformly to all those who present substantially similar complaints.” The First Circuit affirmed the lower court's decision to grant summary judgment to the hospital in a claim raised under the Emergency Medical Treatment and Active Labor Act (EMTALA).Maria del Carmen Guadalupe brought her husband, Narciso Figueroa, to the Hospital Interamericano De Medicina Avanzada, Inc., (HIMA) on October 3, 1998, with symptoms of urinary retention, edema in the legs, high blood pressure, pain, increased respiratory difficulty, a dry cough, fever, and drowsiness.

Medicaid & Medicare: D.C. Appellate Court Denies Claim for Medicare Reimbursement of GME Cost

1999 ◽  
Vol 27 (2) ◽  
pp. 205-205
Author(s):  
choeffel Amy
Keyword(s):  
Medical Center ◽  
Federal District ◽  
Federal Court ◽  
University Of Pennsylvania ◽  
District Court ◽  
Appellate Court ◽  
Court Of Appeals ◽  
Department Of Health ◽  
Administrative Proceedings ◽  
Summary Judgment

The U.S. Court of Appeals for the District of Columbia upheld, in Presbyterian Medical Center of the University of Pennsylvania Health System v. Shalala, 170 F.3d 1146 (D.C. Cir. 1999), a federal district court ruling granting summary judgment to the Department of Health and Human Services (DHHS) in a case in which Presbyterian Medical Center (PMC) challenged Medicare's requirement of contemporaneous documentation of $828,000 in graduate medical education (GME) expenses prior to increasing reimbursement amounts. DHHS Secretary Donna Shalala denied PMC's request for reimbursement for increased GME costs. The appellants then brought suit in federal court challenging the legality of an interpretative rule that requires requested increases in reimbursement to be supported by contemporaneous documentation. PMC also alleged that an error was made in the administrative proceedings to prejudice its claims because Aetna, the hospital's fiscal intermediary, failed to provide the hospital with a written report explaining why it was denied the GME reimbursement.

Antitrust: U.S. Supreme Court Affirms FTC Jurisdiction but Vacates Scope of Analysis on CDA Policy

1999 ◽  
Vol 27 (2) ◽  
pp. 197-198
Author(s):  
Joseph R. Zakhary
Keyword(s):  
Public Relations ◽  
Supreme Court ◽  
Federal Trade Commission ◽  
Ninth Circuit ◽  
Court Of Appeals ◽  
For Profit ◽  
Rule Of Reason ◽  
Antitrust Analysis ◽  
Business Financing ◽  
The U.S

In California Dental Association v. FTC, 119 S. Ct. 1604 (1999), the U.S. Supreme Court reviewed a decision by the U.S. Court of Appeals for the Ninth Circuit that a nonprofit affiliation of dentists violated section 5 of the Federal Trade Commission Act (FTCA), 15 U.S.C.A. § 45 (1998), which prohibits unfair competition. The Court examined two issues: (1) the Federal Trade Commission's (FTC) jurisdiction over the California Dental Association (CDA); and (2) the proper scope of antitrust analysis. The Court unanimously held that CDA was subject to FTC's jurisdiction, but split 5-4 in its finding that the district court's use of abbreviated rule-of-reason analysis was inappropriate.CDA is a voluntary, nonprofit association of local dental societies. It boasts approximately 19,000 members, who constitute roughly threequarters of the dentists practicing in California. Although a nonprofit, CDA includes for-profit subsidiaries that financially benefit CDA members. CDA gives its members access to insurance and business financing, and lobbies and litigates on their behalf. Members also benefit from CDA marketing and public relations campaigns.

United States v. Stuart

1989 ◽  
Vol 83 (4) ◽  
pp. 918-923
Author(s):  
Daniel M. Price
Keyword(s):  
United States ◽  
The United States ◽  
Good Faith ◽  
District Court ◽  
Criminal Prosecution ◽  
Justice Department ◽  
Court Of Appeals ◽  
Canadian Law ◽  
History Of ◽  
The U.S

In response to a request by Canadian tax authorities under the United States-Canada Double Taxation Convention (Convention), the U.S. Internal Revenue Service (IRS) issued summonses to obtain U.S. bank records concerning certain accounts of respondents, Canadian citizens whose Canadian tax liability was under investigation. Respondents sought to quash the summonses, arguing that because under 26 U.S.C. §7609(b) the IRS is prohibited by U.S. law from using its summons authority to obtain information about a U.S. taxpayer once a case is referred to the Justice Department for prosecution, and because the tax investigation of respondents was part of a Canadian criminal investigation, the IRS should be precluded from using its summons authority to honor the Canadian request under the Convention. Unsuccessful in the district court, respondents prevailed in the U.S. Court of Appeals for the Ninth Circuit, which held that under the “good faith” standard applicable to enforcement of domestic summonses, the IRS may issue a summons pursuant to a Convention request only if it first determines and makes an affirmative statement to the effect that the Canadian investigation has not reached a stage analogous to a Justice Department referral by the IRS. The U.S. Supreme Court (per Brennan, J.) reversed, and held: (1) that if the summons is issued in good faith, it is enforceable regardless of whether the Canadian request is directed toward criminal prosecution under Canadian law; and (2) neither United States law nor anything in the text or the ratification history of the Convention supports the imposition of additional requirements. Justice Kennedy (joined by O’Connor, J.), concurring in part and in the judgment, filed a brief opinion to state his view that it is unnecessary to decide whether Senate preratification materials are authoritative sources for treaty interpretation. Justice Scalia, concurring in the judgment, wrote separately to oppose the use of such materials in treaty construction.

Lee v. Dong-A Ilbo

1989 ◽  
Vol 83 (1) ◽  
pp. 90-94
Author(s):  
Sonya D. Winner
Keyword(s):  
United States ◽  
The United States ◽  
Korean American ◽  
District Court ◽  
Public Television ◽  
Court Of Appeals ◽  
South Korean ◽  
Official Report ◽  
Foreign Governments ◽  
Summary Judgment

In 1985 two intelligence agencies of the South Korean Government announced that they had successfully disrupted a North Korean spy ring operating in the United States. Their press release, which was widely publicized in the Korean press, named Chang-Sin Lee as a North Korean agent associated with a spy ring at Western Illinois University, where Lee had been a student. The story was picked up and reported in the United States by six Korean-American newspapers and a public television station. When Lee sued for libel, the defendants relied upon the official report privilege, which gives absolute protection to the accurate republication of official government reports. The district court, holding that the privilege applied and that Lee had not overcome it by showing malice, dismissed the case. Plaintiff appealed to the U.S. Court of Appeals for the Second Circuit, which in a two to one decision reversed (per Ervin, J.) and held: that the official report privilege does not apply to the republication of official reports of foreign governments. Judge Kaufman, sitting by designation, dissented from the majority’s reversal of the district court’s grant of summary judgment.

Signing, Sectarian Schools, and the Law

2020 ◽  
pp. 121-151
Author(s):  
Bruce J. Dierenfield ◽  
David A. Gerber
Keyword(s):  
Federal District ◽  
Catholic School ◽  
Establishment Clause ◽  
District Court ◽  
Parochial School ◽  
Court Of Appeals ◽  
Government Aid ◽  
Sectarian Schools ◽  
Civil Libertarian ◽  
The U.S

This chapter examines and analyzes the five-year journey of Zobrest v. Catalina Foothills School District (1993) from the federal district court in Tucson to the U.S. Court of Appeals for the Ninth Circuit to the U.S. Supreme Court. William Bentley Ball, the Zobrests’ attorney, and John Richardson, the school district’s attorney, clashed over whether the Establishment Clause permitted any government aid to a Catholic school. Many religious and civil libertarian groups—but just one national deaf association—filed arguments to sway the court. Chief Justice William Rehnquist, who wrote the majority decision favoring the Zobrests, misunderstood the complicated function of a sign language interpreter to permit what he regarded as incidental parochial school aid. Rehnquist maintained the aid was permissible because the plaintiffs and their deaf son were its main beneficiaries.

Employment: Protecting Public Health Abrogates Due Process Requirement for Suspension Proceedings

2003 ◽  
Vol 31 (1) ◽  
pp. 167-168
Author(s):  
Guillermo A. Montero
Keyword(s):  
Civil Rights ◽  
Health Care Quality ◽  
Due Process ◽  
Medical Center ◽  
Care Quality ◽  
Memorial Hospital ◽  
District Court ◽  
Court Of Appeals ◽  
Health Care Quality Improvement ◽  
The U.S

In Patel v. Midland Memorial Hospital & Medical Center, the U.S. Court of Appeals for the Fifth Circuit held that the defendant hospital did not violate the plaintiff's due process rights by suspending his clinical privileges without a pre-suspension hearing, where there were reasonable grounds for assuming that patient safety was at risk. Dr. P.V. Patel, a board-certified cardiologist, brought an action against Midland Memorial Hospital and several of its doctors, alleging that the suspension of his clinical privileges violated his right to a pre-suspension hearing; was the result of racial discrimination; and resulted in anticompetitive behavior in violation of antitrust laws. The U.S. District Court for the Western District of Texas granted Midland's motion for summary judgment. The parties filed cross appeals, Dr. Patel on the ground that there were genuine issues of fact for all of his claims, and Midland on the ground that, with the exception of the civil rights claim, it was immune from all of Dr. Patel's claims under the Health Care Quality Improvement Act of 1986 (HCQIA).

Owning a Face: Publicity and Advertising

2017 ◽  
Author(s):  
Sarah K. Fields
Keyword(s):  
Alcohol Abuse ◽  
Major League Baseball ◽  
Federal District ◽  
District Court ◽  
Lower Court ◽  
Court Of Appeals ◽  
Recovering Alcoholic ◽  
The Right ◽  
Drug And Alcohol ◽  
The U.S

This chapter explores the Don Newcombe's lawsuit against Coors Brewing Company Newcombe played in the Negro baseball leagues until 1949, when the Brooklyn Dodgers signed him after Jackie Robinson broke the color barrier in 1947. He had a stellar career, winning the Most Valuable Player award, the Cy Young Award, and the Rookie of the Year award. However, his career in Major League Baseball was cut short in 1960, in part because of a continuing battle with alcohol. Eventually, Newcombe acknowledged his problem, and, as a recovering alcoholic, he served as a spokesman for the National Institute on Drug and Alcohol Abuse. As an anti-alcohol advocate, Newcombe was shocked when he discovered an advertisement for Killian's Irish Red Beer (a brand produced by Coors Brewing) that featured a drawing of an old-time baseball game in which the pitcher was a recognizable version of Newcombe. He sued Coors for a violation of his right of publicity but lost in the federal district court. Despite that decision, the Ninth Circuit of the U.S. Court of Appeals agreed with Newcombe and overturned the lower court, establishing that celebrity athletes had the right to choose how their image was used in advertising and allowing them to disassociate themselves from products they found distasteful.

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