Mealey's Health Law - 11th Circuit: Standing Lacking In ACA Employer Mandate Implementation Challenge

MIAMI - An orthodontics company lacks standing to challenge the delay in implementing the Patient Protection and Affordable Care Act (ACA)'s employer mandate, a divided 11th Circuit U.S. Court of Appeals panel held Dec. 2 (Kawa Orthodontics LLP v. Secretary, U.S. Department of the Treasury, et al...

Mealey's Health Law - Federal Judge Expands Injunction To Cover ACA Insurers, Administrators

OKLAHOMA CITY - A federal judge in Oklahoma on Dec. 3 modified an order enjoining the implementation of the Patient Protection and Affordable Care Act (ACA) contraceptive mandate, expanding it to prevent the government from interfering with insurers or third-party administrators (The Catholic Benefits...

Mealey's Health Law - 9th Circuit Rules On Permissible Offsets To Disability Benefits

SAN FRANCISCO - A long-term disability plan governed by the Employee Retirement Income Security Act properly offset a firefighters' workers' compensation settlement, but remand is necessary to determine the amount of salary continuation benefits that the plan can properly offset under the plan...

Mealey's Health Law - 10th Circuit: Denial Under Plan Proper Despite Award Of Social Security Benefits

DENVER - A disability insurer did not act arbitrarily or capriciously by terminating benefits under the any-reasonable-occupation disability standard of a plan governed by the Employee Retirement Income Security Act, despite a contrary determination by the Social Security Administration (SSA) under the...

Mealey's Health Law - Claims Over Fraudulent Billing Of Medicare Claims For Hospice Benefits Continue

BIRMINGHAM, Ala. - A federal judge in Alabama on Dec. 4 declined to dismiss False Claims Act (FCA) claims brought against the operator of 60 hospice facilities for allegedly submitting fraudulent claims to Medicare for people who were not eligible to receive hospice benefits, saying genuine issues of...

Mealey's Health Law - Connecticut Federal Judge Dismisses Medicare Case; Plaintiffs Have No Standing

NEW HAVEN, Conn. - A federal judge in Connecticut on Dec. 8 dismissed a class action lawsuit over the denial of Medicare benefits, holding that Medicare patients do not have standing to sue if Medicare denies a health care claim, but then Medicaid ends up paying the claim (Carolyn Hull v. Sylvia Burwell...

Mealey's Health Law - Nursing Assistant Sentenced To 150 Months For Role In Medicare Fraud Scheme

MIAMI - A nursing assistant was sentenced by a federal judge in Florida on Dec. 8 to 150 months in prison and ordered to pay $18.2 million in restitution for participating in a $200 million scheme to fraudulently bill Medicare for mental health services (United States v. Rodolfo Santaya, No. 14-cr-20052...

Mealey's Health Law - Parties In Pro-Life Group's Birth-Control Mandate Challenge Brief Court On Priests

WASHINGTON, D.C. - A pro-life employer and the government filed supplemental briefs on Dec. 10 in the District of Columbia federal court on the impact of a recent District of Columbia Circuit U.S. Court of Appeals ruling on the Patient Protection and Affordable Care Act (ACA) contraceptive mandate (March...

Mealey's Health Law - Solicitor General View Sought Regarding ERISA Preemption Of State Database Law

WASHINGTON, D.C. - The U.S. Supreme Court on Dec. 15 invited the solicitor general to weigh in on whether the court should grant review of a divided Second Circuit U.S. Court of Appeals ruling that the Employee Retirement Income Security Act preempts Vermont's health care data collection law as applied...

Mealey's Health Law - Petition Denied; Law Prohibiting Use Of Abortion- Inducing Drugs Enjoined

WASHINGTON, D.C. - In denying a petition for writ of certiorari, the U.S. Supreme Court on Dec. 15 left standing a Ninth Circuit U.S. Court of Appeals decision reversing a lower court's decision denying Planned Parenthood of Arizona's motion for a preliminary injunction and remanding the case...

Mealey's Health Law - Judge: Government's Loss Of Evidence Warrants Dismissal Of Fraud Indictment

SALT LAKE CITY - The government's loss of computer data from a women's health care clinic operated by a woman accused of defrauding Medicare by coaching illegal aliens to apply for benefits under the Baby Your Baby (BYB) program warrants the dismissal of her indictment, a federal judge in Utah...

Mealey's Health Law - 4th Circuit Affirms Verdict, Sentencing In Health Care Fraud Case

RICHMOND, Va. - A Fourth Circuit U.S. Court of Appeals panel on Dec. 19 upheld a jury's verdict finding a dermatologist guilty of 13 counts of health care fraud and affirmed a judge's sentencing of the defendant, holding that the evidence presented during the trial supported the jury's decision...

Mealey's Health Law - Preliminary Injunction Halts Recoupment Of Medicaid Funds To Pediatric Hospitals

WASHINGTON, D.C. - A federal judge in the District of Columbia on Dec. 29 granted a preliminary injunction to enjoin the U.S. Department of Health and Human Services (HHS) from recouping any federal disproportionate-share hospital (DSH) funds provided to two pediatric teaching and research hospitals...

Mealey's Health Law - Decision Reverses Injunction Enjoining Termination Of Provider Agreement

BATON ROUGE, La. - In a Dec. 29 unpublished opinion, a Louisiana appeals court reversed a summary judgment opinion granting a permanent injunction to halt the termination of a health care clinic's Medicaid provider agreement, saying the plaintiff failed to meet its required prima facie showing of...

Mealey's Health Law - 3rd Circuit Affirms Sentence Given To Doctor Who Violated Medicare, Medicaid

PHILADELPHIA - A panel of the Third Circuit U.S. Court of Appeals on Dec. 31 affirmed the sentence given to a radiologist who pleaded guilty to illegally paying physicians to refer their patients to his facility so he could obtain more reimbursement from Medicare and Medicaid (United States of America...

Mealey's Health Law - Physical Injury Not Needed For Medical-Monitoring Claim, Nevada High Court Rules

CARSON CITY, Nev. - Members of a health maintenance organization who seek medical monitoring for potential exposure to blood-borne diseases may maintain negligence claims against the HMO, the Nevada Supreme Court ruled Dec. 31, finding in a case of first impression under Nevada law that "a plaintiff...

Mealey's Health Law - Federal Judge Allows Home-Care Group's Challenge To ACA

WASHINGTON, D.C. - A home-care association with at least one member denied reimbursement from Medicare has standing to challenge Patient Protection and Affordable Care Act (ACA) rules and need not exhaust administrative remedies first given the unlikelihood of success, a District of Columbia federal...

Mealey's Health Law - Federal Judge Dismisses 1 Claim From Health Care Reimbursement Suit

TAMPA, Fla. - A Florida federal judge on Jan. 12 partially dismissed a complaint alleging that a health insurance company wrongfully declined to reimburse two health care providers for services, dismissing a fraud claim and granting the plaintiff leave to amend the complaint to assert claims under the...

Mealey's Health Law - Owners Of Mental Health Clinic Sentenced For Medicare Fraud Scheme

HOUSTON - Two physician owners of a mental health clinic were sentenced to 148 months and 120 months, respectively, in prison for their roles in a $97 million Medicare fraud scheme, according to docket entries entered Jan. 12 in Texas federal court (United States of America v. Mansour Sanjar, et al....

Mealey's Health Law - State Of Oregon Wins Dismissal Of Copyright Infringement Claims

PORTLAND, Ore. - Allegations by Oracle America Inc. that the State of Oregon infringed its copyrighted software were rejected Jan. 13 by an Oregon federal judge, on the basis of sovereign immunity (Oracle America Inc. v. The Oregon Health Insurance Exchange Corporation, et al., No. 14-1279, D. Ore.;...

Mealey's Health Law - Pharmacy Employee Sentenced To 13 Months For Scheme To Defraud Benefits Programs

BALTIMORE - A pharmacy employee was sentenced by a federal judge in Maryland on Jan. 15 to 13 months in prison and ordered to pay $102,066.25 in restitution for his role in a scheme to defraud Medicare, Medicaid and the Federal Employees Health Benefits Program by submitting false prescriptions for refills...

Mealey's Health Law - Osteopathic Physician Pleads Guilty To Committing Health Care Fraud

HARTFORD, Conn. - An osteopathic physician on Jan. 16 pleaded guilty in Connecticut federal court to one count of committing health care fraud and agreed to pay the government $270,528 to resolve federal civil claims arising from his conduct (United States of America v. David Lester Johnston, No. 14...

Mealey's Health Law - Michigan Doctor Sentenced To 15 Months For Role In Health Care Fraud

DETROIT - A doctor was sentenced to 15 months in prison and ordered to pay $1.3 million in restitution by a federal judge in Michigan on Jan. 14 for her role in a $2.1 million home health care fraud scheme, the U.S. Department of Justice announced (United States of America v. Paula Williamson, No. 13...

Mealey's Health Law - Federal Judge Dismisses Self-Funded Employee Plan's Subrogation Suit

PRESCOTT, Ariz. - An Arizona federal judge on Jan. 16 dismissed a self-funded employee welfare benefit plan's subrogation lawsuit against the estate of a plan participant regarding settlement proceeds in an underlying wrongful death action because the participant's children did not incur health...

Mealey's Health Law - 1st Circuit Approves Class Certification In Nexium Pay-For-Delay Lawsuit

BOSTON - The presence of a few uninjured members in a class does not prevent certification, the First Circuit U.S. Court of Appeals ruled Jan. 21, affirming the certification of the class of indirect purchasers of Nexium in a pay-for-delay lawsuit over the heartburn drug (In re Nexium Antitrust Litigation...