Mealey's Health Law - Illinois Federal Judge Dismisses All Claims In False Billing Suit

PEORIA, Ill. - An Illinois federal judge on July 1 dismissed with prejudice a first amended complaint alleging that a health care provider submitted false claims pursuant to Medicare and Medicaid, holding that the plaintiff failed to adequately plead his claims and would not be able to correct the deficiencies...

Mealey's Health Law - La. High Court Says Insured Has Private Right Of Action Under Balance Billing Law

NEW ORLEANS - A divided Louisiana Supreme Court on July 1 held that a health insurance beneficiary has a private right of action for damages against a health care provider under the state's balance billing act (Yana Anderson v. Ochsner Health System, et al., No. 3-13-2970, La. Sup.; 2014 La. LEXIS...

Mealey's Health Law - Trade Group Claims D.C. Funding Exchange On Back Of Non-Exchange Insurers

WASHINGTON, D.C. - To fund the "extraordinary" costs of its Patient Protection and Affordable Care Act (ACA) health insurance exchange, the District of Columbia assesses fees on insurers with no products in the exchange, a trade association alleges in a July 3 complaint (American Council of...

Mealey's Health Law - HHS Announces $100M For Expanded Primary Care, $83.4M In Training Awards

WASHINGTON, D.C. - The U.S. Department of Health and Human Services is making $100 million available to expand access to primary care under the Patient Protection and Affordable Care Act (ACA), the government announced July 8.

Mealey's Health Law - Additional Factual Allegations Allowed In Medicare Dispute; Additional Claims Denied

WASHINGTON, D.C. - A District of Columbia federal judge on July 7 partially granted plaintiffs' motion to amend their complaint challenging regulations governing Medicare reimbursements and allow the plaintiffs to include factual allegations concerning a Final Interim Rule, but not allowing the plaintiffs...

Mealey's Health Law - Appeals Court Reverses Decision, Says Reimbursement Decision Arbitrary

WASHINGTON, D.C. - In reversing a lower court, a District of Columbia Circuit U.S. Court of Appeals panel on July 8 held that the secretary of the U.S. Department of Health and Human Services' (HHS) conclusion that a group of long-term care hospitals operating out of buildings previously owned by...

Mealey's Health Law - Federal Judge Dismisses Suit Challenging Termination Of Medicaid Provider Contract

WASHINGTON, D.C. - A District of Columbia federal judge on July 7 dismissed a Medicaid vocational training program provider's claims challenging the termination of its Medicaid contract, saying that the plaintiff failed to adequately plead its claims and that amendment would be futile (New Vision...

Mealey's Health Law - ACA Birth Control Mandate Violates Belief System, Pro-Life Organization Claims

WASHINGTON, D.C. - The Patient Protection and Affordable Care Act (ACA)'s contraceptive mandate forces insurance coverage for items antithetical to the purpose of one of the nation's oldest pro-life organizations, March for Life alleges in a July 7 complaint (March for Life, Jeanne F. Monahan...

Mealey's Health Law - Divided Nevada High Court Holds Medicare Act Preempts State Law Negligence Claims

CARSON CITY, Nev. - A divided Nevada Supreme Court on July 10 held that the Medicare Act preempts a plaintiff's state common-law negligence claims regarding the retention and investigation of contracted Medicare providers (Louis Morrison v. Health Plan of Nevada, et al., No. 61082, Nev. Sup.; 2014...

Mealey's Health Law - N.J. Federal Judge Grants Final Approval In Class Action Reimbursement Suit

NEWARK, N.J. - In an unpublished opinion, a New Jersey federal judge on July 9 granted final approval of a class action settlement over wrongful reimbursements for out-of-network health care services (Cathleen McDonough v. Horizon Blue Cross Blue Shield of New Jersey, No. 09-571, D. N.J.; 2014 U.S. Dist...

Mealey's Health Law - Judge Remands Health Care Breach Of Contract Case, Says No ERISA Preemption

LOS ANGELES - In an unpublished opinion, a California federal judge on July 11 remanded a hospital's health care payment breach of contract case against a self-funded insurance plan to state court, saying the Employee Retirement Income Security Act did not preempt the claims (Cedars-Sinai Medical...

Mealey's Health Law - Judge Denies Government's Plea To Postpone ACA Permanent Injunction Hearing

PITTSBURGH - A Pennsylvania federal judge on July 15 denied the government's request to postpone a hearing on whether to issue a permanent injunction in a case challenging the Patient Protection and Affordable Care Act (ACA) contraceptive mandate (Most Reverend Lawrence E. Brandt, et al. v. Sylvia...

Mealey's Health Law - California Appeals Court Affirms Demurrer In Health Care Reimbursement Suit

LOS ANGELES - In an unpublished July 15 opinion, a California appeals court affirmed a health insurance company's demurrer without leave to amend in a health care reimbursement suit, finding that there was no contractual agreement requiring the insurer to pay the provider its usual and customary...

Mealey's Health Law - Senate Bill Envisions Making Some Contraceptives Over-The-Counter Medications

WASHINGTON, D.C. - Republicans on July 15 introduced legislation that would direct the Food and Drug Administration to study whether contraceptives could be made available without prescription and would eliminate the Patient Protection and Affordable Care Act (ACA)'s restriction on payment methods...

Mealey's Health Law - Senate Bill Seeking Reversal Of Hobby Lobby Fails To Advance

WASHINGTON, D.C. - A Democratic bill seeking to reverse the U.S. Supreme Court's recent opinion in Hobby Lobby and ensure employer-insurance-provided access to contraceptives under the Patient Protection and Affordable Care Act (ACA) failed to garner enough to votes to proceed on July 16.

Mealey's Health Law - HHS: Closely Held Companies Dropping Birth-Control Have 60-Day Notice Window

WASHINGTON, D.C. - Closely held companies terminating insurance coverage for contraceptive services mid-plan for religious reasons in light of Burwell v. Hobby Lobby, and subject to Employee Retirement Income Security Act (ERISA) regulations, must notify participants and beneficiaries of the change,...

Mealey's Health Law - 6th Circuit Reverses Decision; Private Right Of Action Exists In Medicare Payment Dispute

CINCINNATI - A panel of the Sixth Circuit U.S. Court of Appeals held July 16 that a health care provider can bring a claim under Medicare Secondary Payer Act's private cause of action against a non-group health plan that denies coverage for a reason other than Medicare eligibility (Michigan Spine...

Mealey's Health Law - Illinois Federal Judge Calls Secretary's Medicare Decision 'Arbitrary, Capricious'

CHICAGO - An Illinois federal judge on July 18 held that the secretary of Health and Human Services acted in an arbitrary and capricious manner in dismissing and refusing to reinstate a hospital's administrative appeal in a Medicare reimbursement dispute (The University of Chicago Medical Center...

Mealey's Health Law - Woman Sues Health Insurer In Nevada Federal Court For Denial Of Benefits

RENO, Nev. - A Nevada woman on July 18 sued her health insurer in federal court for allegedly wrongfully denying benefits related to her transportation by air ambulance (Mary Hubbard v. Aetna Life Insurance Co., No. 14-380, D. Nev.).

Mealey's Health Law - D.C. Circuit Strikes Down Subsidies For Federal Exchanges

WASHINGTON, D.C. - Patient Protection and Affordable Care Act (ACA) premium tax credits are available only for individuals who enrolled through state exchanges and not the federal exchange, a District of Columbia U.S. Circuit Court of Appeals panel majority held July 22. The dissent argued that the suit...

Mealey's Health Law - Judge Finds No Injury To Senator, Staff From ACA Regulations

GREEN BAY, Wis. - A U.S. senator lacks standing to challenge Patient Protection and Affordable Care Act (ACA) regulations governing insurance for congressional members and staffers, a Wisconsin federal judge held July 21 (Senator Ron Johnson, et al. v. U.S. Office of Personnel Management, et al., No...

Mealey's Health Law - California Appeals Court Affirms Judgment In Health Care Reimbursement Suit

FRESNO, Calif. - A California appeals court in an unpublished July 21 decision affirmed summary judgment in favor of a health care service plan in a suit brought by a hospital over reimbursement rates and agreed with the lower court that amendment would be futile because the trial court correctly concluded...

Mealey's Health Law - 4th Circuit Finds ACA Tax Credit Proper Under IRS Interpretation

RICHMOND, Va. - Patient Protection and Affordable Care Act (ACA) language governing whether individuals who enroll through the federal exchange are entitled to tax credits is ambiguous enough to defer to the Internal Revenue Service's interpretation, a Fourth Circuit U.S. Court of Appeals panel held...

Mealey's Health Law - Alabama Hospital System, Physician Group To Pay $24M Over Medicare Referrals

MOBILE, Ala. - A physician group and two clinics that are part of the Alabama-based Infirmary Health System Inc. (IHS) on July 21 agreed to pay $24 million to resolve a lawsuit brought by the federal government accusing the defendants of violating the False Claims Act by paying or receiving financial...

Mealey's Health Law - Parties Brief 10th Circuit On Hobby Lobby's Impact On Mandate Case

OKLAHOMA CITY - Parties in a religious employers' challenge to the Patient Protection and Affordable Care Act (ACA) contraceptive mandate briefed the 10th Circuit U.S. Court of Appeals on July 22 on the impact of the U.S. Supreme Court's ruling in Hobby Lobby (Southerrn Nazarene University, et...