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Appellate Updates

Overview

Appellate Updates

Appellate Updates

Hospitals have no duty to post signs disclosing the ER fees published in the chargemaster
Posted July 18, 2022

Saini v.

Appellate Updates

Noncontracted providers of nonemergency services to Medi-Cal managed care plan enrollees are not entitled to reimbursement exceeding Medi-Cal fee schedule rates
Posted July 12, 2022

Allied Anesthesia Medical Group, Inc. v.

Appellate Updates

Ostensible agency theory fails where patient’s personal physician performs surgery at a hospital
Posted July 12, 2022

Magallanes de Valle v.

Appellate Updates

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

Becerra v. Empire Health Foundation, 597 U.S. __, No. 20–1312, 2022 WL 2276810 (June 24, 2022)

Appellate Updates

The government must prove beyond a reasonable doubt that a physician knowingly or intentionally acted in an unauthorized manner to convict under the Controlled Substance Act

Ruan v. United States, 597 U.S. __, No. 20–1410, 2022 WL 2295024 (June 27, 2022)

Appellate Updates

Group health plans do not violate Medicare’s Secondary Payer statute by offering all participants the same limited dialysis coverage

Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita Inc., 596 U.S. __, No. 20–1641, 2022 WL 2203328 (June 21, 2022)

Appellate Updates

Healthcare providers may not enforce the Medicaid Act’s anti-reassignment provision under 42 U.S.C. § 1983

Polk v. Yee, __ F.4th __, No. 20–55266, 2022 WL 2062316 (9th Cir. June 8, 2022)

Appellate Updates

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

American Hosp. Assn v. Beccera, 596 U.S. __, No. 20–1114, 2022 WL 2135490 (June 15, 2022)

Appellate Updates

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

Gallardo v. Marstiller, 596 U.S. __, No. 20–1263, 2022 WL 1914096 (June 6, 2022)

Appellate Updates

State may lien a Medi-Cal beneficiary’s third-party tort settlement allocated to past medical expenses

Daniel C. v. White Memorial Medical Center (May 26, 2022, B308253) __ Cal.App.5th __ [2022 WL 1682925]

Appellate Updates

Party not bearing the burden of proof need not present medical causation evidence to a reasonable degree of medical probability.

Kline v. Zimmer, Inc. (May 26, 2022, B302544) __ Cal.App.5th ___ [2022 WL 1679539]

Appellate Updates

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

County of Santa Clara v. Superior Court (Apr. 26, 2022, H048486) __ Cal.App.5th __ [2022 WL 1223254]

Appellate Updates

Code of Civil Procedure section 425.13 broadly bars untimely punitive damages claims against health care providers arising from professional negligence.

Divino Plastic Surgery v. Superior Court of San Diego County (April 22, 2022, D079661) __ Cal.App.5th __ [2022 WL ________]

Appellate Updates

Nondisclosure of hospital’s emergency room evaluation and management fee does not violate the Consumer Legal Remedies Act

Torres v. Adventist Health System/West (Apr. 14, 2022, F081415) __ Cal.App.5th __ [2022 WL 1115068]

Appellate Updates

Medicare need not reimburse critical access hospitals for the cost of keeping nonemergency specialty doctors on call

St. Helena Clear Lake Hospital v. Becerra, __ F.4th __, 2022 WL 1051987 (D.C. Cir. March 31, 2021)

Appellate Updates

Medicare Advantage plan beneficiaries must exhaust administrative remedies before seeking judicial review of a benefits claim

Global Rescue Jets, LLC v. Kaiser Foundation Health Plan, Inc., ___ F.4th ___, 2022 WL 1052671 (9th Cir. Apr. 8, 2022)

Appellate Updates

Section 1278.5 whistleblower claims are analyzed under the McDonald Douglas framework, not the Lawson framework

Scheer v. Regents of the Univ. of California (Mar. 28, 2022, B303379) __ Cal.App.5th __ [2022 WL 896766]

Appellate Updates

Hospital liable for adopting policies that failed to protect female mental patients against the risk of sexual assault

Samantha B. v. Aurora Vista Del Mar, LLC (April 5, 2022, B302321) __ Cal.App.5th __ [2022 WL 1010252]

Appellate Updates

State regulatory board actions may violate the Sherman Antitrust Act

SmileDirectClub, LLC v. Tippins (9th Cir. March 17, 2022, No. 20-55735) _ F.4th _ [2022 WL 804146]

Appellate Updates

The rule of academic deference is no defense against a medical resident’s FEHA discrimination and retaliation claims

Khoiny v. Dignity Health (Mar. 16, 2022, B301486) __ Cal.App.5th __ [2022 WL 794826]