Business Law Health Law Committee

Inferences based on hospital staff’s custom and practice are insufficient to prove that a patient authorized relatives to execute arbitration agreements on his behalf. Read more

Group health plan does not violate the Medicare as Secondary Payer (MSP) provisions when it reimburses dialysis services at the same rate, regardless of underlying diagnosis or Medicare eligibility. Read more

Payment by Medicare is not a prerequisite for suing to enforce the Medicare as Secondary Payer (MPS) provisions. Read more

The Dental Board of California filed an accusation against orthodontist Mohammadrez Yazdi, charging that he had failed to comply with its subpoenas seeking dental records of numerous patients and that he had failed to pay administrative fines. Read more

Suzanne Stone had a health care plan governed by ERISA. Stone’s daughter received in-state treatment for an eating disorder that was approved by the plan administrator, but was discharged with a referral to a facility in Colorado offering a higher level of care. Read more

Doctor network agreement may require arbitration review of an administrative dispute resolution panel’s decision. Read more

The Centers for Medicare and Medicaid Services (CMS) may make a “national coverage determination” (NCD) regarding whether Medicare will pay for “durable medical equipment.” Either the manufacturer or a Medicare beneficiary may seek an NCD determination. Read more

Physician may pursue whistleblower suit—alleging hospital’s exclusive staffing agreement was retaliatory—without first seeking writ relief. Read more

John Jarman stayed three months at an HCR ManorCare skilled nursing facility while recovering from hip surgery. About two years later, Jarman sued HCR, alleging violations of the “Patients Bill of Rights” (Health & Saf. Code, § 1430, subd. (b) (section 1430(b)), elder abuse, neglect, and negligence. Read more

Elizabeth Holley became a patient at the Silverado Senior Living facility when she was 77 years old and suffering from dementia and other medical problems. Diane and James Holley became Elizabeth’s temporary conservators. Read more