ARC Costs Lawyers and Draftsmen’s Post

Civil Procedure Etc Opinions Caris MPI v. UnitedHealthcare, Incorporated Court: US Court of Appeals for the Fifth Circuit Docket: 23-10901 Opinion Date: July 16, 2024 Judge: Wilson Areas of Law: Civil Procedure, Health Law Caris MPI, Inc. (Caris) provided cancer diagnostic services to UnitedHealthcare, Inc. (United) for over ten years without a written contract. United audited Caris’s past claims and determined that Caris had used incorrect billing codes, resulting in overpayments. United began recouping these overpayments by offsetting them against new payment claims from Caris. Caris challenged United’s recoupment through United’s internal process, but after United rejected Caris’s appeals, Caris filed suit in Texas state court alleging various state law claims. United removed the case to the United States District Court for the Northern District of Texas, asserting federal officer jurisdiction under 28 U.S.C. § 1442(a)(1). The district court denied Caris’s motion to remand and dismissed Caris’s claims without prejudice, finding that Caris failed to exhaust administrative remedies under the Medicare Act. The United States Court of Appeals for the Fifth Circuit reviewed the case and agreed that federal officer jurisdiction existed. However, the court found that the district court erred in dismissing Caris’s claims for failure to exhaust administrative remedies. The Fifth Circuit held that the administrative review process under Medicare Part C does not extend to claims where an enrollee has no interest, and there were no administrative remedies for Caris to exhaust. The court distinguished this case from others by noting that no enrollee had requested an organization determination or appeal, and all enrollees had already received the services for which United sought recoupment. Consequently, the court affirmed the denial of the remand motion, reversed the dismissal of Caris’s claims, and remanded the case for further proceedings.

In a break from my usual posts about our wonderful London Ashurst office, for those with an interest in all things Part 26A with a dose of novel procedure the proposed Consort Healthcare restructuring plan has just offered up yet another ‘first’ for Part 26A jurisprudence. The plan is already the first to seek to amend a PFI contract to compromise an adjudication debt awarded to an NHS trust. In a new development - while the sanction hearing is pending - the High Court has now granted the NHS trust’s application for security for costs despite the plan company arguing that such an order risks stifling the plan. This is the first time such an application has been made in a Part 26 / Part 26A context. As a result, the plan company has been ordered to provide security for costs in the amount of 50% claimed by the NHS trust (c. £500,000) in respect of the costs risk to the trust if the plan is sanctioned. The High Court refused the company’s request for leave to appeal although it may still seek leave from the Court of Appeal. A security for costs order is discretionary, but it seems likely we will see applications for security for costs used more often in future by creditors seeking to challenge a plan. If you would like to discuss further do contact us. Olga Galazoula Drew Sainsbury Ru-Woei Foong Richard Bulmore Simon Clarke Inga West Charlotte Evans (née Harvey) #ashurst #contentiousinsolvency

WHEN AN NHS COMPLAINT ISN’T ENOUGH – UNDERSTANDING YOUR RIGHT TO LEGAL ACTION Filing a complaint with the NHS is a right every patient holds when care or treatment doesn’t meet expectations. However, complaints don’t always bring the resolution you need, especially if financial compensation or accountability is sought. When this happens, legal action may be a necessary next step. If you're considering pursuing a claim, it's important to remember the 3-year limitation period which typically starts from the date of the alleged negligence or from when you became aware of it. Acting within this period is essential to preserve your right to seek compensation. Working with a Waldrons solicitor specialising in medical negligence can make a significant difference, offering guidance through the complexities of NHS claims and helping you understand your legal rights and options. Remember, making a complaint or considering a claim should never impact the quality of care you receive. If you’re uncertain about your eligibility for a claim or need advice on taking that next step, don’t hesitate to reach out for guidance. You have a right to complain to the NHS if you are not satisfied as a patient. Your complaint should not affect your care or treatment. If you are considering a claim, contact us and our medical negligence team. Our experienced team of Medical Negligence Lawyers will be able to provide you with advice about what can be done when something goes wrong. https://lnkd.in/eZs-T_DT LAW IS OUR BUSINESS. IT HAS BEEN SINCE 1867. ⌨️ www.waldrons.co.uk 📞 01384 811 811 @BCCCmembers #Wearewaldrons #ConveyancingSolicitor #PersonalInjury #MedicalNegligence #FamilyLaw #BusinessLaw #EmploymentLaw #WorkplaceSafety #LegalSupport #PersonalInjury #LegalAdvice #DisputeResolution #probate #estateplanning #wills #powerofattorney #trusts #estateplanningattorney #estateplanning #CommercialLaw #ShareholderAgreements #TermsAndConditions #EmploymentBill #WorkersRights #FlexibleWorking #ZeroHoursContracts #LegislationUpdate #EmploymentLaw#NHSComplaints #LegalAdvice #PatientRights

A helpful guide to the CPR updates, well worth a read to keep you up to date!

A very helpful summary of the key changes on the horizon for the CPR. Click below to read

Clients and grantors should be educated about the role of the Attorney for Personal Care to help reduce the exponential rise in care disputes. Read Susan J. Hyatt's blog post for some things you should know. #ElderManagement #PoA #CareDisputes

There are a few Real Estate related articles in our first Quarterly General Practice Bulletin as well as informative pieces on the Network Contract DES and succession planning. Let me know if you have any burning questions about these topics or suggestions for content you would like us to cover in the future? #primarycare #healthproperty #hilldickinson

The previous government had intended to impose fixed recoverable costs (FRCs) on all claims valued up to £25,000, as well as introduce a new streamlined process for claims. Those plans were halted by the general election and the changes were never implemented, as had once been envisaged, last month. It has now emerged that the issue was not discussed at the Civil Procedure Rule Committee meeting on 4 October, suggesting that the idea has been quietly shelved for now. It is understood that the committee, which would need to formulate and approve the necessary rule amendments to allow FRC for clinical negligence claims, is not actively considering the matter. Practitioners are starting to believe they may not have to deal with fixed recoverable costs for some time. Clinical negligence specialist Ian Cohen, director of the Cohen Consultancy, said a potential April 2025 implementation date was now ‘almost impossible to achieve’ and that there are questions whether the scheme will ever see the light of day. #medicolegal #healthcare #fixedcost #mlsm

Planning for the future of a loved one with special needs requires careful consideration and expert guidance. Before meeting with a special needs planning attorney, it's essential to prepare thoroughly to make the most of your consultation. Here are some top things to do beforehand: * Gather Important Documents: Collect relevant documents such as medical records, financial statements, and legal documents related to your loved one's special needs and current care arrangements. * List Your Concerns and Goals: Take time to identify your concerns, priorities, and long-term goals for your loved one's future. This will help guide your discussion with the attorney and ensure your needs are addressed. * Educate Yourself: Familiarize yourself with basic concepts of special needs planning, including government benefit programs, legal structures like special needs trusts, and strategies for preserving eligibility for benefits. * Think About Future Care Needs: Consider your loved one's current and future care needs, including housing, healthcare, education, and quality of life preferences. Discussing these factors with the attorney will help tailor a plan to meet your loved one's unique needs. * Make a List of Questions: Write down any questions or concerns you have about special needs planning, estate planning, or government benefits. Having a list prepared will ensure you cover all relevant topics during your meeting. By taking these proactive steps, you'll be better prepared to engage in a productive discussion with your special needs planning attorney and develop a comprehensive plan to secure your loved one's future. Get all of your special needs planning questions answered. Contact Houck Menninger Law at (937)985-0059 or visit https://lnkd.in/d4rBUZJH #HMLaw #HouckMenningerLaw #AssetProtection #Probate #EstateSettlement #EstatePlanning #Medicaid #Trusts #EstateTaxes #SpecialNeedsPlanning