- Volume 19, Issue #3
- 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" Rates Litigation under the Racketeer Influenced and Corrupt Organizations Act and the Sherman Act but not from bringing certain claims under the Employee Retirement Income Security Act (Medical Association of Georgia, et al. v. Wellpoint Inc., No. 14-554, U.S. Sup.; See 7/9/14, Page 20).
- 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 U.S. Dist. LEXIS 20488).
- Maine Federal Judge: Federal Law Preempts Part Of State's Prescription Drug Act
BANGOR, Maine - In granting the plaintiffs' motion for judgment on the pleadings, a Maine federal judge on Feb. 23 held that the federal Food, Drug and Cosmetics Act (FDCA) preempts certain amendments to the Maine Pharmacy Act (MPA) (Charles Ouellette, et al. v. Janet Mills, et al., No. 13-347, D. Maine; 2015 U.S. Dist. LEXIS 21137; See 8/6/14, Page 10).
- 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 for pancreatic cancer later than necessary (Kent Wilson v. Humana Health Plan Inc., No. 14-3259, D. Colo.; 2015 U.S. Dist. LEXIS 22672).
- Louisiana Appeals Court Affirms Class Action Status In Breach Of Contract Suit
LAKE CHARLES, La. - A Louisiana appeals court on Feb. 11 affirmed that a trial court properly granted class action status in a case in which a doctor is accusing a preferred provider organization of breaching its statutory duties for failing to properly notify health care providers of discounts applied to medical bills (Kerry Thibodeaux, M.D. v. American Lifecare Inc., No. CA 14-931, La. App., 3rd Cir.; 2015 La. App. LEXIS 258).
- New York Federal Judge Leaves Breach Claim In Health Care Billing Dispute
BROOKLYN, N.Y. - A New York federal judge on Feb. 4 declined to dismiss a breach of contract claim but did dismiss claims for negligence and breach of fiduciary duty in a dispute between a home health care company and its billing management company over the preparation and submission of claims (Excellent Home Care Services v. FGA Inc., No. 13-5390, E.D. N.Y.; 2015 U.S. Dist. LEXIS 13351).
- 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).
- 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 her claims (Nelli Stefanski v. The City of Chicago, No. 1-13-2844, Ill. App., 1st Dist. 6th Div.; 2015 Ill. App. LEXIS 133).
- 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 Act, finding that the insurers sufficiently pleaded claims under the Racketeer Influenced and Corrupt Organizations Act and Minnesota's Corporate Practice of Medicine Doctrine (CPMD) (Liberty Mutual Fire Insurance Company, et al. v. Acute Care Chiropractic Clinic P.A., et al., No. 14-cv-2651, D. Minn.; 2015 U.S. Dist. LEXIS 17933).
- 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 the funds came from a "primary plan" and that the plaintiff cannot invoke a New Jersey state law to avoid her reimbursement obligations (Cecelia A. Taransky v. Secretary of the U.S. Department of Health and Human Services, et al., No. 14-758, U.S. Sup.; See 8/6/14, Page 17).
- Dispute Over Termination Of Medicare Coverage Remanded To Appeals Council
NEW YORK - A New York federal magistrate judge on Feb. 11 remanded to the Medicare Appeals Council (MAC) a dispute over the termination of Medicare coverage for the plaintiff's home-health services, saying the MAC applied the wrong regulations in reviewing an administrative law judge's decision (Sonia Berman v. Kathleen Sebelius, No. 13-4513, S.D. N.Y.; 2015 U.S. Dist. LEXIS 16723).
- Kentucky Appeals Court: Insurer Breached Contract In Terminating Agreement
STANTON, Ky. - In an unpublished opinion, the Kentucky Court of Appeals on Feb. 6 affirmed that a managed care company that had contracted with the Commonwealth of Kentucky breached its contract to provide Medicaid services to state residents by terminating the contract early (Kentucky Spirit Health Plan Inc. v. Commonwealth of Kentucky, et al., Nos. 2014-CA-1050-MR, 2013-CA-1201-MR, Ky. App.; 2015 Ky. App. Unpub. LEXIS 85).
- 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" provisions (International Rehabilitative Sciences Inc. v. Sylvia M. Burwell, No. 08-5442, W.D. Wash.; 2015 U.S. Dist. LEXIS 18122; See 8/15/12, Page 21).
- 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, D/B/A Meadowlands Hospital Medical Center v. Healthfirst Inc., et al., No. 13-6036, D. N.J.; 2015 U.S. Dist. LEXIS 23699).
- 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 it could increase the number of comprehensive care beds it could obtain reimbursement for by Medicaid (Lutheran Homes Inc. v. Lock Realty Corporation IX, No. 14-102, N.D. Ind.; 2015 U.S. Dist. LEXIS 24588).
- 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, 12-cr-903, C.D. Calif.).
- 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 the District of Massachusetts.
- 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 after a massive breach of the company's systems (John Doe v. Anthem Inc., et al., No. 15-934, C.D. Calif.).
- Class Action Lawsuit Accuses Insurer Of Failing To Secure Health Data
SAN FRANCISCO - A California man who has health insurance issued through Anthem Inc. on Feb. 10 filed a class action lawsuit against the insurer in federal court, alleging that the defendant's failure to properly secure its data led to a massive breach that has the potential to financially cripple members covered by Anthem health plans (Fazi Zand v. Anthem Inc., et al., No. 15-638, N.D. Calif.).