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Mealey's Health Law - Supreme Court Rejects ACA Privacy Violations Challenge

WASHINGTON, D.C. - The Supreme Court on March 30 declined a challenge to the Patient Protection and Affordable Care Act (ACA) alleging that the individual mandate impermissibly required disclosure of confidential personal information (Nick Coons, et al. v. Jacob L. Lew, et al., No. 14-525, U.S. Sup....

Mealey's Health Law - Government: Representatives In ACA Funding Challenge Lack Standing

WASHINGTON, D.C. - A federal judge should ignore "alarmist" rhetoric and instead find that House of Representatives members lack standing to challenge how the government spends Patient Protection and Affordable Care Act (ACA) funds, the government argues in a March 31 brief (United States House...

Mealey's Health Law - Judge: Statute Precludes Challenge To Post-ACA Reimbursement Calculation

WASHINGTON, D.C. - The Medicare statute precludes a hospital's challenge to reimbursement calculations made under the amended rules of the Patient Protection and Affordable Care Act (ACA), a federal judge in the District of Columbia held March 31 (Florida Health Sciences Center Inc., d/b/a Tampa...

Mealey's Health Law - Resident Of Care Facility For Elderly Sues Over Staffing Levels

SAN LUIS OBISPO, Calif. - A resident of a California care facility for the elderly filed a class complaint against the owners and operators on April 6 in California state court, alleging negligent business practices and staffing assignments based on the number of residents rather than the needs of the...

Mealey's Health Law - Fiduciary Status Sufficiently Alleged In Case Over Denial Of Benefits, Judge Says

SAN FRANCISCO - A federal judge in California on April 7 denied United Behavioral Health's (UBH) motion to dismiss a putative class action alleging that the insurer denied claims for mental illness and substance abuse-related outpatient treatment in violation of the Employee Retirement Income Security...

Mealey's Health Law - Operator Of Medicare Billing Mill Sentenced To 30 Months In Prison

SAN DIEGO - One of the owners of an alleged Medicare billing mill in El Centro, Calif., was sentenced by a federal judge in California on April 6 to 30 months in prison and ordered to pay $964,011 in restitution (United States of America v. Gevorg "George" Kupelian, No. 14-cr-3419-BAS, S.D...

Mealey's Health Law - Missouri Law Regulating ACA Advisers Preempted, 8th Circuit Affirms

JEFFERSON CITY, Mo. - A judge properly enjoined portions of a Missouri law governing the conduct of advisers employed to help people navigate the Patient Protection and Affordable Care Act (ACA) exchange, an Eighth Circuit U.S. Court of Appeals panel held April 10 in partially affirming (St. Louis Effort...

Mealey's Health Law - Montana House Passes ACA Medicaid Expansion Legislation

HELENA, Mont. - Montana Legislature on April 9 appeared to ready to enact legislation expanding Medicaid under the Patient Protection and Affordable Care Act (ACA) after a newly introduced bill survived four failed motions for a second reading and two motions to re-refer the legislation to the House...

Mealey's Health Law - DOJ: 2 Diagnostic Companies Agree To Pay $48.5M Over Unneeded Testing

WASHINGTON, D.C. - Two cardiovascular disease testing companies agreed to pay a combined $48.5 million to resolve claims brought by three whistle-blowers that the companies paid physicians illegal kickbacks and billed Medicare for unnecessary medical testing for patients, the U.S. Department of Justice...

Mealey's Health Law - Doctor Sentenced To 135 Months In Prison Over Health Care Fraud Scheme

TYLER, Texas - A federal judge in Texas on April 14 sentenced a doctor found guilty of conspiracy to commit health care fraud, seven counts of health care fraud and seven counts of aggravated identity theft to 135 months in prison and ordered him to pay $599,128.02 in restitution (United States of America...

Mealey's Health Law - Home Health Care Company Owner Sentenced To 10 Years For Fraud

CHICAGO - The U.S. Attorney's Office for the Northern District of Illinois announced that a federal judge in Illinois on April 17 sentenced the owner of two home health care companies who pleaded guilty to submitting more than $20 million in fraudulent bills to Medicare to 10 years in prison and...

Mealey's Health Law - Podiatrist Sentenced To 1 Year In Prison Over Health Care Fraud

ST. LOUIS - The U.S. Attorney's Office for the Eastern District of Missouri on April 17 announced that a federal judge in Missouri sentenced a podiatrist to 12 months and one day in prison for his role in submitting false documents and reimbursement claims to Medicare.

Mealey's Health Law - DOJ: Texas Medical Center To Pay $21.7M To Resolve False Claims Act Suit

WASHINGTON, D.C. - The U.S. Department of Justice (DOJ) announced April 21 that Citizens Medical Center, a county-owned hospital in Texas, agreed to pay $21.7 million to resolve allegations that it violated the False Claims Act (FCA) by overcompensating cardiologists for their services and paid bonuses...

Mealey's Health Law - Top Court Vacates ACA Birth Control Ruling, Remands Case

WASHINGTON, D.C. - The U.S. Supreme Court on April 27 granted two Catholic groups' petition for certiorari and vacated a Sixth Circuit U.S. Court of Appeals ruling that the Patient Protection and Affordable Care Act's contraceptive mandate did not substantially burden religious beliefs. The court...

Mealey's Health Law - Indiana High Court Says Reinsurers Must Indemnify Self-Insured Company

INDIANAPOLIS - Indiana's high court on April 22 reversed a lower court and found that certain alleged wrongful acts by a self-insured managed health organization are covered under a number of reinsurance agreements (WellPoint, Inc. [f/k/a Anthem, Inc.], et al. v. National Union Fire Insurance Company...

Mealey's Health Law - DOJ: 5 California Ambulance Companies To Pay $11.5M Over Alleged Kickbacks

SAN DIEGO - The U.S. Department of Justice announced May 5 that five California-based ambulance companies have agreed to collectively pay more than $11.5 million to resolve allegations from the federal government and a whistle-blower that they paid illegal kickbacks to hospitals and skilled nursing facilities...

Mealey's Health Law - 3rd Circuit: Catalyst Theory Of Recovery Available In ERISA Fees Case

PHILADELPHIA - The Third Circuit U.S. Court of Appeals ruled May 8 that the "catalyst theory" of recovery of attorney fees is available under the Employee Retirement Income Security Act and that judicial action is not required under that theory in order to establish some degree of success on...

Mealey's Health Law - 4th Circuit Overturns Pretrial Evidentiary Rulings In Health Care Fraud Suit

RICHMOND, Va. - A federal judge in Virginia erred when granting three pretrial motions to exclude evidence filed by a dermatologist accused of health care fraud, a Fourth Circuit U.S. Court of Appeals panel ruled May 11, holding that the rulings restricted the latitude needed by the government to carry...

Mealey's Health Law - Restaurant Employees Allege Interference Under ERISA Related To ACA Compliance

NEW YORK - Nationwide restaurant/entertainment chain Dave & Buster's Inc. violated the Employee Retirement Income Security Act by reducing the hours of its work force in 2013 in order to avoid the costs associated with providing health insurance to its full-time employees in compliance with the...

Mealey's Health Law - Man Sentenced To 48 Months In Prison For Secondhand Drug Scheme

NEW YORK - A federal judge in New York on May 12 sentenced a man who pleaded guilty to two counts of health care fraud for his role in a scheme involving the sale of secondhand prescription drugs to 48 months in prison and ordered him to pay $2.9 million in restitution (United States of America v. Bladimir...

Mealey's Health Law - Panel: Lead Plaintiffs In Securities Suit Failed To Plead Loss Causation

ATLANTA - A federal district court judge did not err in dismissing a securities class action lawsuit because, despite having numerous opportunities to amend their complaint, the lead plaintiffs still failed to properly plead loss causation, a divided 11th Circuit U.S. Court of Appeals panel ruled May...

Mealey's Health Law - Plan Management Agreement Does Not Confer ERISA Standing, Divided 5th Circuit Rules

NEW ORLEANS - A plan management agreement between Humana Health Plan and a health plan's administrator, which provided that Humana would supply subrogation and recovery services, did not vest Humana with discretionary authority sufficient to make Humana a fiduciary with standing to bring claims under...

Mealey's Health Law - 7th Circuit Rejects Preliminary Injunction In ACA Opt-Out Challenge

CHICAGO - Notre Dame is not entitled to a preliminary injunction while it challenges the opt-out provision of the Patient Protection and Affordable Care Act (ACA)'s contraceptive mandate, a divided Seventh Circuit U.S. Court of Appeals held May 19 (University of Notre Dame v. Kathleen Sebelius, et...

Mealey's Health Law - Federal Judge Allows Most Cause-Of-Death Testimony In Medical Malpractice Case

MEMPHIS, Tenn. - A Tennessee federal judge on May 18 declined to strike or exclude testimony of three experts for a couple alleging medical malpractice in the death of their 11-year-old son but ruled that testimony by a fourth expert for the plaintiffs should be excluded from trial based on state law...

Mealey's Health Law - High Court Won't Review ERISA Preemption Ruling Involving Policy Cancellation

WASHINGTON, D.C. - The U.S. Supreme Court on May 26 declined to review the Eighth Circuit U.S. Court of Appeals ruling that a shareholder-owner's state law claims related to improper cancellation of her health care coverage were preempted by the Employee Retirement Income Security Act (CeCelia Catherine...