Business Law Health Law Committee

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

The Department of Health Services (DHS) administers California’s Medi-Cal program and reimburses Medi-Cal hospital service providers for allowable costs. The Center for Medicare and Medicaid Services issues the Medicare Provider Reimbursement Manual, which governs what payments are owed. Read more

Section 1557 of the Patient Protection and Affordable Care Act (ACA) prohibits discrimination in the healthcare system by incorporating four nondiscrimination statutes—including the Rehabilitation Act, which prohibits certain types of disability discrimination. Andrea Schmitt, who has a severe hearing loss disability, filed a class action against Kaiser Foundation Health Plan, alleging that it unlawfully discriminated against her and other hearing-disabled plan members by excluding all hearing loss treatments except cochlear implants. Read more

Ben-E-Lect, a third party insurance claim administrator, developed a “wrapping” strategy for reducing employer health insurance costs by bundling low-premium, high-deductible health insurance with self-funded accounts to pay employee healthcare expenses within the annual deductible and any co-pay requirements. Ben-E-Lect sold its wrapping services through insurance brokers and agents to the small-employer market. Read more