Business Law Health Law Committee

After plaintiff Dar Saini was treated at a Sutter Health emergency room, he received a $4,593 bill that included a $2,811 evaluation and management services (EMS) fee. Read more

Ostensible agency theory fails where patient’s personal physician performs surgery at a hospital. Read more

Medicare’s low-income patient hospital reimbursement adjustment is based on individuals “entitled” to Part A benefits, even if Medicare doesn’t pay for their treatment. Read more

California’s In-Home Support Services (IHSS) program uses Medicaid funding to provide assistance with daily activities to elderly and disabled beneficiaries, often by family members. Read more

HHS may not vary Medicare prescription drug reimbursement rates by hospital group unless it surveys hospital acquisition costs. Read more

Medicare’s Secondary Payer statute, 42 U.S.C. § 1395y(b), makes Medicare a “secondary” payer for certain medical services when an individual’s insurance plan also provides coverage. Read more

State-law formula for allocating tort settlement funds between past and future medical expenses not preempted by the Medicaid Act. Read more

Daniel C. was born with severe disabilities after his congenital abnormalities were not detected during his mother’s pregnancy until after viability. The California Department of Health Care Services (DHCS) paid for his medical care through the Medi-Cal program. Read more

Gary Kline was implanted with an artificial hip joint manufactured by Zimmer, Inc. The surgery was unsuccessful. Kline underwent further procedures and therapy for the next eight years. He then sued Zimmer on a products defect theory. Read more

The Knox-Keene Act does not permit (and the Government Claims Act otherwise bars) unaffiliated hospitals from suing counties for emergency services reimbursements. Read more