Estate Practice & Elder Law Community News

Woman Sues Insurer In Kentucky Federal Court For Denying Coverage For Mammogram

anonymous@localhost.com (Liz Barrett) — Wed, 15 May 2013 15:12:00 -0400

COVINGTON, Ky. - A Kentucky woman on April 30 sued her health insurer and its agent in federal court for allegedly failing to pay the proper amount for her mammogram (Julie A. Lester v. Business Benefits Inc., et al., No. 13-69, E.D. Ky.)

Surgeon Sues Insurer In New Jersey Federal Court, Seeks Full Reimbursement

anonymous@localhost.com (Liz Barrett) — Wed, 15 May 2013 15:12:00 -0400

NEWARK, N.J. - A New Jersey orthopedic surgeon on May 3 sued a health insurer in federal court for allegedly failing to pay the proper reimbursement rate for out-of-network services he provided to a patient insured by the defendant (Dr. Christopher Johnson v. Blue Cross Blue Shield of Oklahoma, et al., No. 13-2875, D. N.J.).

Illinois Federal Judge Orders Government To Provide Information In Medicare Suit

anonymous@localhost.com (Liz Barrett) — Wed, 15 May 2013 15:12:00 -0400

CHICAGO - An Illinois federal judge on May 6 partially granted a defendant's motion for an order directing the federal government to file a bill of particulars in its case against him for Medicare fraud (United States of America v. Robert Kolbusz, No. 12-782, N.D. Ill.; 2013 U.S. Dist. LEXIS 64043).

Florida Federal Judge Affirms Order Revoking Facility Billing Privileges

anonymous@localhost.com (Liz Barrett) — Wed, 15 May 2013 15:12:00 -0400

MIAMI - A federal judge in the U.S. District Court for the Southern District of Florida on April 30 affirmed a U.S. Department of Health and Human Services (HHS) ruling that an outpatient rehabilitation facility's Medicare billing privileges were properly revoked because the facility was not properly staffed with qualified medical professionals (CompRehab Wellness Group Inc. v. Kathleen Sebelius, Secretary of Health and Human Services, No. 1:11cv23377, S.D. Fla.; 2013 U.S. Dist. LEXIS 61567).

Federal Judge Dismisses Medicare Suit For Lack Of Jurisdiction

anonymous@localhost.com (Liz Barrett) — Wed, 15 May 2013 15:12:00 -0400

BOSTON - A Massachusetts federal judge on May 9 dismissed a Medicare payment dispute, saying that the plaintiff home health agency failed to exhaust administrative remedies and that, therefore, the court lacked jurisdiction to hear the case (MJG Management Associates Inc. v. NHIC Corp., et al., No. 12-11414, D. Mass.; 2013 U.S. Dist. LEXIS 66238).

5th Circuit Affirms Order Denying Judicial Review Of Part D Coverage Dispute

anonymous@localhost.com (Liz Barrett) — Wed, 15 May 2013 15:12:00 -0400

NEW ORLEANS - The Fifth Circuit U.S. Court of Appeals on May 1 affirmed a federal trial court order denying judicial review of a challenge to the U.S. Department of Health and Human Services (HHS) Medicare Part D rule allowing prescription drug plans (PDPs) to establish preferred pharmacy networks. The appeals court found that the limited exception to the requirement of exhausting the administrative appeals process does not apply in the instant case (Southwest Pharmacy Solutions Inc. v. Centers for Medicare and Medicaid Services, et al., No. 12-40097, 5th Cir.; 2013 U.S. App. LEXIS 8923).

Appeals Court: 2-Visit Rule Applies To Psychology Services For Medicaid Patients

anonymous@localhost.com (Liz Barrett) — Wed, 15 May 2013 15:12:00 -0400

SACRAMENTO, Calif. - A California appeals court on May 2 held that federal law does not prohibit the application of California's two-visit rule to psychology services provided by federally qualified health centers (FQHCs) to Medi-Cal patients (Mendocino Community Health Clinic, et al. v. State Department of Health Care Services, No. C067826, Calif. App., 3rd Dist.; 2013 Cal. App. LEXIS 350).

3rd Circuit Affirms Penalty, Denial Of Attorney Fees For Late COBRA Notice

anonymous@localhost.com (Liz Barrett) — Wed, 15 May 2013 15:12:00 -0400

PHILADELPHIA - A federal judge properly imposed a $10 per day penalty on a former employer under the Comprehensive Omnibus Budget Reconciliation Act of 1986 (COBRA) because the former employer was 293 days late in providing notice to its employee of her rights, even though the former employer mistakenly continued the employee's coverage after the termination of her employment, the Third Circuit U.S. Court of Appeals ruled April 10 in an unpublished opinion (Sarah Fama v. Design Assistance Corporation, et al., Nos. 12-2414, 12-2474, 3rd Cir.; 2013 U.S. App. LEXIS 7225).

Claims Against Blue Cross In Case Alleging Hidden Administrative Fees Continue

anonymous@localhost.com (Liz Barrett) — Wed, 15 May 2013 15:12:00 -0400

FLINT, Mich. - A federal judge in Michigan on May 3 declined to dismiss on statute of limitations grounds an employer's claim that Blue Cross and Blue Shield of Michigan (BCBS) violated the Employee Retirement Income Security Act by charging hidden fees that were not included in the parties' administrative service contract (ASC) (East Jordan Plastics, Inc., et al. v. Blue Cross and Blue Shield of Michigan, No. 12-cv-15621, E.D. Mich.; 2013 U.S. Dist. LEXIS 63475).

Louisiana Federal Judge Denies Motion To Remand Denial Of Benefits Case

anonymous@localhost.com (Liz Barrett) — Wed, 15 May 2013 15:12:00 -0400

LAFAYETTE, La. - A Louisiana federal judge on May 1 denied a plaintiff's motion to remand her wrongful denial of prescription benefits case to state court (Amelia Simon v. Express Scripts Inc., et al., No. 13-187, W.D. La.; 2013 U.S. Dist. LEXIS 63132).

Plan May Seek Reimbursement From Special Needs Trust, En Banc 5th Circuit Rules

anonymous@localhost.com (Liz Barrett) — Wed, 15 May 2013 15:12:00 -0400

NEW ORLEANS - A divided en banc Fifth Circuit U.S. Court of Appeals on May 7 held that the Employee Retirement Income Security Act permits health plan fiduciaries to seek reimbursement for medical benefits the plan paid on behalf of a participant from a special needs trust funded by a third-party tortfeasor settlement (ACS Recovery Services, Inc., et al. v. Larry Griffin, et al., No. 11-40446, 5th Cir.; 2013 U.S. App. LEXIS 9324; See 8/15/12, Page 18).

Judge Dismisses 1 Claim From Reimbursement Suit, Remands Remaining Claims

anonymous@localhost.com (Liz Barrett) — Wed, 15 May 2013 15:12:00 -0400

LOS ANGELES - A California federal judge on April 29 dismissed a federal false advertising claim from a reimbursement dispute between medical providers and health insurers and declined to exercise supplemental jurisdiction over the remaining state claims (Los Angeles County Medical Association, et al. V. Aetna Health of California Inc., et al., No. 12-11020, C.D. Calif.).

Texas Federal Judge Allows Amendment To Add Defendant In Reimbursement Suit

anonymous@localhost.com (Liz Barrett) — Wed, 15 May 2013 15:12:00 -0400

DALLAS - A Texas federal judge on May 2 granted health care providers' motion to amend their complaint against insurance companies in a reimbursement dispute, saying that defendant the plaintiffs sought to add was a necessary party to the action (Paragon Office Services, et al. v. Aetna Inc., et al., No. 11-1898, N.D. Texas; 2013 U.S. Dist. LEXIS 62804; See 7/5/12, Page 11).

California Appeals Court Affirms Hospital Has No Duty To Prevent Balance Billing

anonymous@localhost.com (Liz Barrett) — Wed, 15 May 2013 15:12:00 -0400

SAN JOSE, Calif. - A California appeals court panel held in a May 9 unpublished opinion that a hospital has no duty to inform patients admitted to the emergency room that emergency room physicians do not accept a particular health care plan and to take action to prevent emergency room physicians from "balance billing" (Maria Leon, et al. v. Watsonville Hospital Corp., No. H037288, Calif. App., 6th Dist.; 2013 Cal. App. Unpub. LEXIS 3297).

Fla. Federal Judge Dismisses Suit Alleging Insurer Schemed To Avoid Paying Rebates

anonymous@localhost.com (Liz Barrett) — Wed, 15 May 2013 15:12:00 -0400

FORT LAUDERDALE, Fla. - A Florida federal judge on May 7 dismissed a putative class action case against a health insurer and a third-party administrator accused of inflating medical loss ratios to avoid paying rebates for excessive premiums to subscribers as mandated by the Patient Protection and Affordable Care Act (PPACA) for lack of standing and ordered arbitration for claims against a second third-party administrator (MRI Scan Center v. National Imaging Associates Inc., et al., No. 13-60051, S.D. Fla.).

Plaintiffs Seek Reversal Of Denial Of Injunction In Birth Control Suit

anonymous@localhost.com (Liz Barrett) — Wed, 15 May 2013 15:12:00 -0400

WASHINGTON, D.C. - Plaintiffs challenging the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) on April 30 asked the District of Columbia Circuit U.S. Court of Appeals to reverse a lower court decision denying their motion for preliminary injunction for their violation of the Religious Freedom Restoration Act (RFRA) claim (Francis A. Gilardi, et al. v. United States Department of Health and Human Services, et al., No. 13-5069, D.C. Cir.; See 4/3/13, Page 4).

D.C. Circuit Court Dismisses Appeal In Birth Control Suit

anonymous@localhost.com (Liz Barrett) — Wed, 15 May 2013 15:12:00 -0400

WASHINGTON, D.C. - A District of Columbia Circuit U.S. Court of Appeals panel on May 3 granted the federal government's motion for voluntary dismissal of interlocutory appeal in a case challenging the grant of a preliminary injunction in favor of a for-profit Christian publishing company seeking to halt the implementation of the contraception mandate contained in the Patient Protection and Affordable Care Act (PPACA) (Tyndale House Publishers Inc., et al. v. Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, et al., No. 13-5018, D.C. Cir.; See 12/5/12, Page 6).

New York Federal Judge Halts Proceedings In Birth Control Suit

anonymous@localhost.com (Liz Barrett) — Wed, 15 May 2013 15:12:00 -0400

BROOKLYN, N.Y. - A New York federal judge on April 24 partially granted the federal government's emergency motion to halt proceedings in a challenge to a provision in the Patient Protection and Affordable Care Act (PPACA) mandating that all health plans provide preventive services for free, including those for birth control (The Roman Catholic Archdiocese of New York, et al. v. Kathleen Sebelius, No. 12-2542, E.D. N.Y.; See 12/19/12, Page 5).

Pa. Federal Judge Reconsiders Dismissal Order In Birth Control Mandate Suit

anonymous@localhost.com (Liz Barrett) — Wed, 15 May 2013 15:12:00 -0400

PITTSBURGH - A Pennsylvania federal judge on May 8 granted a motion to reconsider the dismissal of claims brought by a private, nonprofit college, two for-profit entities and the owners of those entities who are challenging the "birth control" mandate contained in the Patient Protection and Affordable Care Act (PPACA), saying that the claims are now ripe for review. The judge then went on to partially grant and partially deny the defendants' motion to dismiss (Geneva College, et al. v. Kathleen Sebelius, et al., No. 12-207, W.D. Pa.; 2013 U.S. Dist. LEXIS 65685; See 5/1/13, Page 4).

Medical Practice Sues Insurer In Federal Court For Wrongful Denial Of Benefits

anonymous@localhost.com (Liz Barrett) — Wed, 01 May 2013 14:36:00 -0400

NEWARK, N.J. - A health care provider that received an assignment of benefits from one of its patients sued a health insurance company on April 11 in a New Jersey federal court for allegedly wrongfully denying benefits (North Jersey Brain & Spine Center v. Anthem Blue Cross Life and Health Insurance Co., No. 13-2312, D. N.J.).

Hospital Sues Insurer In S.C. Federal Court For Failure To Pay Benefits

anonymous@localhost.com (Liz Barrett) — Wed, 01 May 2013 14:36:00 -0400

GREENVILLE, S.C. - A South Carolina hospital sued a health insurer in federal court on April 29, alleging that it failed to pay benefits for services provided to the defendant's insured (Greenville Hospital System v. United Healthcare Insurance Co., No. 13-1145, D. S.C.).

Class Action Lawsuit Alleges Antitrust Violations Against Blue Cross Blue Shield

anonymous@localhost.com (Liz Barrett) — Wed, 01 May 2013 14:36:00 -0400

LITTLE ROCK, Ark. - An Arkansas resident filed a class action lawsuit on March 21 in an Arkansas federal court, alleging that agreements between Blue Cross Blue Shield Association (BCBSA) and its licensees divide and allocate health insurance markets throughout the United States in violation of the Sherman Act (Linda L. Mills v. Usable Mutual Insurance Co., et al., No. 13-165, E.D. Ark.).

Va. Provider Must Repay Medicaid For Services By Unqualified Workers

anonymous@localhost.com (Liz Barrett) — Wed, 01 May 2013 14:36:00 -0400

RICHMOND, Va. - The Virginia Court of Appeals on April 16 affirmed a trial court order granting summary judgment to the Virginia Department of Medical Assistance Services (DMAS) ordering the Family Redirection Institute Inc. (FRI) to reimburse the state Medicaid program for payments made to FRI for services by unqualified mental health care professionals (Family at Redirection Institute Inc. v. Commonwealth of Virginia Department of Medical Assistance Services, No. 1274-12-2, Va. App.; 2013 Va. App. LEXIS 116).

4th Circuit Affirms Health Care Fraud Conviction Against Doctor

anonymous@localhost.com (Liz Barrett) — Wed, 01 May 2013 14:36:00 -0400

RICHMOND, Va. - The Fourth Circuit U.S. Court of Appeals on April 23 affirmed a federal jury conviction of a Maryland cardiologist for health care fraud, saying there was sufficient evidence that he willfully made false statements and submitted fraudulent bills to Medicare, Medicaid and private insurers for medically unnecessary cardiac stent procedures (United States of America v. John R. McLean, No. 11-5130, 4th Cir.; 2013 U.S. App. LEXIS 8160).

Judge Finds 'Expense Incurred' Applies To Insured's Medicare-Adjusted Amount

anonymous@localhost.com (Liz Barrett) — Wed, 01 May 2013 14:36:00 -0400

BEAUFORT, S.C. - A health insurance provider properly reimbursed its insured for the actual amount paid to a medical provider after adjustments were made by Medicare, a South Carolina federal judge ruled April 24, granting summary judgment to the insurer on bad faith and breach of contract claims against it (Dennis Barker v. Washington National Insurance Co., No. 9:12-cv-01901, D. S.C.; 2013 U.S. Dist. LEXIS 58437).