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Legal Update - 3.23.16
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United Healthcare:

No new information here.

 

As always should you continue to have take backs from UHC you should appeal those decisions.

 

Humana:

We had some amazing news come back for the Federal Courts.  See below the email we received from our legal team:

 

“Since we argued our case against Humana at the Sixth Circuit Court of Appeals in October, we have been engaged in several rounds of unusual post-argument briefing that was ordered by the Court. The latest court order required the federal government to file a brief expressing its view on three dispositive issues in our case: (1) whether Humana’s removal of this case to federal court was proper, (2) whether we were required to go through the medical administrative appeals process before filing suit, and (3) whether our claims are expressly preempted by the Medicare Act. Yesterday the U.S. Department of Justice, on behalf of the Department of Health and Human Services, filed their brief with the Court addressing each of these issues. A copy is attached.

 

Honestly, I was expecting the government to take Humana’s side and essentially kill our case. Fortunately, I could not have been more wrong. The government’s brief takes our side on each issue that the Court asked them to address, and does so in a compelling and authoritative way. The government even concludes it’s brief by asking the Court of Appeals to reverse the district court and remand our case to state court, where we wanted it to be all along. While this latest submission from the government does not guarantee victory, I cannot see how the Court will find against us now that the federal government has favorably opined on these very important questions of first impression.

 

Response briefs are due next Monday, 3/21. I will plan on filing a very short response emphasizing some of the points made by the government. I expect that Humana was blindsided by this and will be struggling with their response. Throughout this entire case they have condescendingly held themselves out as the official spokesperson for HHS, and now that HHS has soundly rejected their arguments I think they will begin to reconsider their case.

 

While this does not guarantee victory, it is a huge step in that direction. I anticipate that the Court will finalize and issue its opinion over the next couple months, and based on this latest filing from HHS I am extremely optimistic about the result. Assuming that the Court of Appeals reverses the district court, the real work will begin once we are back in state court and have the opportunity to present our case to a jury and reclaim the funds wrongfully recouped by Humana.”

 

As you can imagine we are very pleased with this response. The OSCA will continue to keep our members up to date on this as we continue to push the issue.

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