Mealey's Health Law - California Federal Judge: Fraud Claim Continues In Reimbursement Case

LOS ANGELES - A California federal judge on Feb. 9 allowed a fraud claim to continue in a health care reimbursement suit, but dismissed three other claims (Mountain View Surgical Center v. CIGNA Health Corp., No. 13-8083, C.D. Calif.; 2015 U.S. Dist. LEXIS 15320).

Mealey's Health Law - Class Action Lawsuit Accuses Anthem Of Failing To Secure Private Data

LOS ANGELES - A California resident on Feb. 9 filed a class action lawsuit in federal court accusing Anthem Inc. of violating, among other things, the state's unfair competition law (UCL) in failing to safeguard personal information contained on the defendant's information technology (IT) systems...

Mealey's Health Law - DOJ: Home Health Care Facility To Pay $5.6M Over Fraudulent Billing

WASHINGTON, D.C. - An Iowa home health care facility agreed to pay $5.6 million to resolve allegations that it submitted false billing claims to Medicare and Medicaid in violation of the False Claims Act (FCA), the U.S. Department of Justice announced Feb. 10.

Mealey's Health Law - Ambulance Company Manager Sentenced To 78 Months Over Fraudulent Billing Scheme

LOS ANGELES - The general manager of a California ambulance company was sentenced to 78 months in prison and ordered to pay $1.3 million in restitution by a federal judge in California on Feb. 9 for his role in a $5.5 million scheme to defraud Medicare (United States of America v. Wesley H. Kingsbury...

Mealey's Health Law - 3rd Circuit: ACA Birth Control Mandate Accommodation Doesn't Burden Religion

PHILADELPHIA - The accommodation through which those who object to the contraceptive mandate of the Patient Protection and Affordable Care Act (ACA) can avoid providing or paying for the insurance coverage does not burden religious practice, a Third Circuit U.S. Court of Appeals panel held Feb. 11 (Geneva...

Mealey's Health Law - Washington Federal Judge: Supplier Not Entitled To Medicare Reimbursement

TACOMA, Wash. - Upon remand by the Ninth Circuit U.S. Court of Appeals, a Washington federal judge on Feb. 13 determined that the supplier of a piece of durable medical equipment used to treat osteoarthritis of the knee was not entitled to the benefits of any of Medicare's "limited liability"...

Mealey's Health Law - 11th Circuit Denies Rehearing In ACA Employer Mandate Implementation Challenge

MIAMI - The 11th Circuit U.S. Court of Appeals on Feb. 13 declined to rehear a Patient Protection and Affordable Care Act (ACA) case, leaving stand a divided panel's conclusion that an orthodontist lacked standing to challenge delayed implementation of the law's employer mandate (Kawa Orthodontics...

Mealey's Health Law - Federal Judge Lifts Stay Of ACA Birth Control Mandate Challenge In Michigan

GRAND RAPIDS, Mich. - Right to Life Michigan's action challenging implementation of the Patient Protection and Affordable Care Act (ACA) contraceptive mandate will proceed after a federal judge lifted his stay of the case on Feb. 17 (Right to Life of Michigan v. Sylvia Mathews Burwell, et al., No...

Mealey's Health Law - Judge Rejects Man's Challenge To Legitimacy Of Anti-ACA Bill's Fiscal Note

NASHVILLE, Tenn. - A man lacks standing to pursue a suit accusing a government official of fraudulently concocting a fiscal note to torpedo a Tennessee bill blocking implementation of the Patient Protection and Affordable Care Act (ACA), a federal judge held Feb. 18 (Louie E. Johnston Jr. v. Lucien C...

Mealey's Health Law - Judge Denies Defendants' Motion To Dismiss Insurers' Fraudulent Billing Lawsuit

MINNEAPOLIS - A federal judge in Minnesota on Feb. 13 denied a motion filed by a number of chiropractic centers and their owners, seeking dismissal of a lawsuit brought by numerous insurance companies claiming that the defendants submitted fraudulent bills under Minnesota's No-Fault Automobile Insurance...

Mealey's Health Law - Magistrate Judge Recommends Accepting Guilty Plea In Health Care Fraud Suit

MIAMI - A federal magistrate judge in Florida on Feb. 17 recommended accepting a home health care clinic owner's guilty plea in a $13 million Medicare fraud scheme, finding that the defendant was capable and competent in entering an informed plea (United States of America v. Alexander Lara, No. 15...

Mealey's Health Law - Federal Judge Declines To Dismiss Antitrust Claims In Surgery Center Dispute

DENVER - A Colorado federal judge on Feb. 20 declined to dismiss antitrust claims in a suit alleging that health insurers conspired with hospitals to drive multiple ambulatory surgical centers out of business (Arapahoe Surgery Center, et al. v. CIGNA Healthcare Inc., et al., No. 13-3422, D. Colo.; 2015...

Mealey's Health Law - High Court Denies Certiorari In Suit Over Involving Antitrust, ERISA Claims

WASHINGTON, D.C. - The U.S. Supreme Court on Feb. 23 declined to grant certiorari, which left standing an agreement reached in In re Managed Care Litigation that bars several physicians and physician groups from bringing claims against WellPoint Inc. in In re WellPoint, Inc. Out-of-Network "UCR"...

Mealey's Health Law - High Court Denies Certiorari In Medicare Reimbursement Dispute

WASHINGTON, D.C. - The U.S. Supreme Court on Feb. 23 denied certiorari, leaving stand a Third Circuit U.S. Court of Appeals decision holding that the Medicare as a Secondary Payer Act (MSP Act) authorizes the government to seek reimbursement from a settlement a plaintiff receives from a tortfeasor because...

Mealey's Health Law - High Court Denies Review Of 3rd Circuit Reimbursement Ruling

WASHINGTON, D.C. - The U.S. Supreme Court on Feb. 23 let stand a Third Circuit U.S. Court of Appeals ruling that a multiemployer welfare benefits plan may seek reimbursement of health benefits paid on behalf of a plan participant who later received a third-party settlement because the plan language established...

Mealey's Health Law - High Court Will Not Review Preemption Ruling In Subrogation Case

WASHINGTON, D.C. - The U.S. Supreme Court on Feb. 23 declined to review a Second Circuit U.S. Court of Appeals ruling that the Employee Retirement Income Security Act does not preempt a New York state anti-subrogation law that prohibits insurers from obtaining reimbursement of medical benefits from participants'...

Mealey's Health Law - Judge Denies Health Care Fraud Defendant's Motion For Acquittal

NEW YORK - The federal government provided sufficient evidence to a jury that a female doctor was only a paper owner of a New York medical clinic who made material misrepresentations to insurance companies as part of a conspiracy to commit health care fraud, a federal judge in New York ruled Feb. 26...

Mealey's Health Law - Judge Denies Man's Motion To Dismiss Insurer's Fraud Suit Against Him

CHICAGO - A federal judge in Illinois on Feb. 26 denied a man's motion to dismiss his insurance company's lawsuit accusing him of violating the Illinois Insurance Fraud Statute and stayed the case for the company to assert a portion of its allegations as a counterclaim to a separate suit brought...

Mealey's Health Law - Divided Illinois Appeals Court Reverses Class Action Status In Subrogation Suit

CHICAGO - A divided Illinois appeals court on Feb. 27 reversed and vacated the judgment of a trial court granting the plaintiff's motion for summary judgment and class certification in a health care subrogation dispute, saying the plaintiff had no right to rely on the common fund doctrine to support...

Mealey's Health Law - New Jersey Federal Judge Dismisses Health Care Reimbursement Suit

NEWARK, N.J. - A federal judge in New Jersey on Feb. 27 dismissed a health care reimbursement suit, saying that the plaintiff failed to follow administrative procedures for the Medicaid-related claims and that federal law preempted the common-law claims related to the Medicare-based claims (MHS LLC,...

Mealey's Health Law - House Republicans Tell Judge Standing Exists In ACA Funding Challenge

WASHINGTON, D.C. - The House of Representatives' role as controller of the purse strings gives it sufficient injury to challenge the administration's alleged misallocation of public funds related to the Patient Protection and Affordable Care Act (ACA), Republicans told a federal judge in the...

Mealey's Health Law - Colorado Federal Judge Declines To Dismiss Health Care Breach Of Contract Suit

DENVER - A federal judge in Colorado on Feb. 25 declined to dismiss a suit in which the plaintiff accused his health insurance company of breach of contract for allegedly wrongfully informing him that the effective date of his coverage was later than it really was, causing the plaintiff to receive treatment...

Mealey's Health Law - New York Nursing Chain Pays $3.5 Million To Resolve Inflated Medicare Claims

BOSTON - A New York operator of skilled nursing facilities has entered into an agreement with the United States to pay $3.5 million to resolve allegations concerning inflated Medicare claims for rehabilitation therapy, according to a March 2 news release issued by the U.S. Attorney Carmen M. Ortiz for...

Mealey's Health Law - Illinois Court Finds Dual Jury Instruction Proper, Affirms Defense Verdict

CHICAGO - A trial judge did not err in instructing a jury on both institutional and professional negligence in a suit alleging that the death of an elderly woman was the result of negligence on the part of a nursing home and its staff, the Illinois Appellate Court for the First Judicial District ruled...

Mealey's Health Law - Indiana Federal Judge Grants Plaintiff Summary Judgment In Medicaid Dispute

FORT WAYNE, Ind. - An Indiana federal judge on March 2 granted summary judgment in favor of a nursing facility in its suit against another nursing facility for breach of contract for the defendant's failure to pay for the transfer of Medicaid certification rights that the defendant had sought so...