TRENTON, N.J. - A New Jersey appeals court on Dec. 11 affirmed the dismissal of a wrongful-denial-of-health-benefits suit, saying that the plaintiff brought his challenge of the final decision denying the benefits in the wrong court (Irvin B. Beaver v. Magellan Health Services Inc., No. A-1311-12T3, N.S. Super., App. Div.; 2013 N.J. Super. LEXIS 175).
WASHINGTON, D.C. - The U.S. Supreme Court ruled Dec. 16 that the contractual limitations provision of a disability benefits plan that requires participants to bring suit within three years after "proof of loss" is due is enforceable under the Employee Retirement Income Security Act, even if the limitations period commences before the plan resolved the claim for benefits (Julie Heimeshoff v. Hartford Life & Accident Insurance Co., et al., No. 12-729, U.S. Sup.).
CHICAGO - End payers who purchased inpatient and outpatient health care services directly from NorthShore University HealthSystem and alleged that NorthShore illegally monopolized the market for such services following the merger of hospitals demonstrated that class adjudication of the antitrust claims was superior, a federal judge in Illinois ruled Dec. 10 in granting the purchasers' motion for class certification (In re: Evanston Northwestern Corporation Antitrust Litigation, No. 07-cv-04446, N.D. Ill.; 2013 U.S. Dist. LEXIS 173794).
BROOKLYN, N.Y. - Multiple Catholic organizations on Dec. 10 asked a New York federal judge to grant a temporary restraining order barring implementation and enforcement of the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) until the court can rule on their motion for a preliminary injunction (The Roman Catholic Archdiocese of New York, et al. v. Kathleen Sebelius, No. 12-2542, E.D. N.Y.).
WASHINGTON, D.C. - The federal government on Dec. 9 urged the District of Columbia Circuit U.S. Court of Appeals to affirm a decision dismissing a suit challenging payments made to the Internal Revenue Service related to the individual mandate contained in the Patient Protection and Affordable Care Act (PPACA) decision (Matt Sissel v. U.S. Department of Health and Human Services, et al., No. 13-5202, D.C. Cir.).
NEW HAVEN, Conn. - A Connecticut federal judge on Dec. 5 granted a preliminary injunction to keep a health insurance company group from terminating approximately 2,200 physicians from its Medicare Advantage program (Fairfield County Medical Association, et al. v. United Healthcare of New England, et al., No. 13-1621, D. Conn.).
NEW HAVEN, Conn. - A Connecticut federal judge on Dec. 6 held that the court has jurisdiction to hear a hospital's challenge of whether the regulatory scheme governing the Medicare Geographic Classification Review Board (MGCRB) violates the Medicare Act and the Administrative Procedure Act but denied the plaintiff's request for a preliminary injunction to halt the defendants from applying the scheme to its current and future reclassification applications (Lawrence & Memorial Hospital v. Kathleen Sebelius, et al., No. 13-1495, D. Conn.; 2013 U.S. Dist. LEXIS 172120).
TRENTON - The New Jersey Supreme Court on Dec. 6 denied a petition for certification of a Superior Court ruling that Employee Retirement Income Security Act Section 514(a) expressly preempts a medical provider's claims against the ERISA plan for payment of the provider's customary fees for the services it rendered to patients, rather than the discounted fees the plan would have been legally entitled to pay had it not breached its contractual obligation for timely payment (St. Peter's University Hospital v. New Jersey Building Laborers Statewide Welfare Fund, et al. v. Union Labor Life Insurance Company, No. C-224 September Term 2013, N.J. Sup.).
DENVER - A federal judge in Colorado ruled Dec. 3 that the third-party administrator of the NFL Player Insurance Plan abused its discretion in denying claims for chiropractic treatment as being work-related without considering the medical provider's opinion (Nelson Vetanze v. NFL Player Insurance Plan, No. 1:11-cv-02734, D. Colo.; 2013 U.S. Dist. LEXIS 170312).
SAN FRANCISCO - In an unpublished opinion, a Ninth Circuit U.S. Court of Appeals panel affirmed a citation and fine issued to a skilled nursing facility for improperly failing to monitor a patient as required by Medicare laws (Del Rosa Villa v. Kathleen Sebelius, No. 12-71685, 9th Cir; 2013 U.S. App. LEXIS 23796).
MUSKOGEE, Okla. - An Oklahoma federal magistrate judge on Nov. 26 denied a motion to dismiss a wrongful denial of health care benefits case (Samuel Howard Logan Jr. v. Healthcare International Global Networks, et al., No. 13-144, E.D. Okla.; 2013 U.S. Dist. LEXIS 167631).
WASHINGTON, D.C. - The U.S. Supreme Court on Nov. 26 announced that it granted certiorari in two cases challenging the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA). Both of the cases involve for-profit companies opposed to the mandate on religious grounds. In one of the cases, the lower court granted a preliminary injunction to halt the implementation of the mandate, and in the other case, the lower court denied a preliminary injunction (Hobby Lobby Stores Inc., et al. v. Kathleen Sebelius, et al., No. 13-354, U.S. Sup.; Conestoga Woods Specialties Corp., et al. v. Kathleen Sebelius, et al., No. 13-356, U.S. Sup.).
ATLANTA - Plaintiffs challenging the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) asked the 11th Circuit U.S. Court of Appeals on Nov. 20 to affirm the grant of a preliminary injunction in their favor (Beckwith Electric Co. Inc., et al. v. Kathleen Sebelius, et al., No. 13-13879, 11th Cir.).
DENVER - Catholic organizations challenging the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) moved in a Colorado federal court on Nov. 22 opposing dismissal of their case (Little Sisters of the Poor Home for the Aged, et al. v. Kathleen Sebelius, et al., No. 13-02611, D. Colo.).
PITTSBURGH - A Pennsylvania federal judge on Nov. 21 granted motions for expedited preliminary injunctions in two separate cases brought by Catholic organizations challenging the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) (Most Reverend David A. Zubik, et al. v. Kathleen Sebelius, et al., No. 13-1459, Most Reverend Lawrence T. Persico, et al. v. Kathleen Sebelius, et al., No. 13-303, W.D. Pa.; 2013 U.S. Dist. LEXIS 165922).
CHARLESTON, W. Va. - The West Virginia Supreme Court of Appeals on Nov. 21 affirmed that a state statute does not provide for an express or implied private cause of action by a Medicaid provider for judicial review of reimbursement rates for medical services (Appalachian Regional Healthcare Inc. v. West Virginia Department of Health and Human Resources, et al., No. 11-1187, W. Va. Sup.; 2013 W. Va. LEXIS 1338).
MINNEAPOLIS - A Minnesota federal judge on Nov. 21 dismissed two defendants from a wrongful denial of benefits suit related to treatment covering autism spectrum disorder and partially dismissed claims against a third defendant (Tracy L. Reid, individually and on behalf of M.A.R. v. BCBSM Inc., et al., No. 12-3005, D. Minn.; 2013 U.S. Dist. LEXIS 165364).
NASHVILLE, Tenn. - A Tennessee federal judge on Nov. 18 dismissed a qui tam case in which the operator of multiple health care facilities was accused of submitting false claims to Medicare, saying the plaintiff failed to support his allegations (United States of America ex rel. Stephen McCullen v. Ascension Health, et al., No. 12-501, M.D. Tenn.).
LOS ANGELES - In two separate cases, skilled nursing provider Ensign Group Inc. agreed to pay $48 million to resolve allegations that it knowingly submitted Medicare false claims for medically unnecessary rehabilitation services, according to a Nov. 19 press release issued by the U.S. Department of Justice (United States of America ex rel. Gloria Patterson v. Ensign Group Inc., No. 06-6956, United States of America ex rel. Carol Sanchez v. Ensign Group Inc., No. 06-0643, C.D. Calif.).
WHITE PLAINS, N.Y. - A New York federal judge on Nov. 14 partially granted the defendants' motion to dismiss a health care reimbursement dispute (Bridget M. Curran v. Aetna Life Insurance Co., et al., No. 13-289, S.D. N.Y.; 2013 U.S. Dist. LEXIS 163162).
FLORENCE, S.C. - A South Carolina federal judge on Nov. 13 declined to grant a preliminary injunction in favor of a nursing home in a termination of Medicare provider dispute (Marion Nursing Center Inc. v. Kathleen Sebelius, No. 13-2593, D. S.C.; 2013 U.S. Dist. LEXIS 161621).
ORLANDO, Fla. - A Florida federal judge on Nov. 13 partially granted summary judgment in favor of the federal government in a Medicare claims payment dispute (USA and Elin Baklid-Kunz v. Halifax Hospital Medical Center, et al., No. 09-1002, M.D. Fla.; 2013 U.S. Dist. LEXIS 161718).
NEWARK, N.J. - A New Jersey federal magistrate judge in a Nov. 13 unpublished opinion recommended that the only federal claim in a health care reimbursement suit be dismissed and the case remanded to state court (Catherine Mazzola, M.D., et al. v. AmeriChoice of New Jersey Inc., et al., No. 13-429, D. N.J.; 2013 U.S. Dist. LEXIS 161587).
WASHINGTON, D.C. - The federal government on Nov. 12 moved for summary judgment in a suit challenging an Internal Revenue Service regulation imposed under the Patient Protection and Affordable Care Act (PPACA) that extends eligibility for premium assistance subsidies to people who purchase health insurance through exchanges established by the PPACA (Jacqueline Halbig, et al. v. Kathleen Sebelius, et al., No. 13-623, D. D.C.).
LAFAYETTE, La. - A Louisiana federal judge on Nov. 8 granted a motion to dismiss a qui tam action for the false billing of Medicare claims, saying the plaintiff failed to support his allegations (Craig Thompson v. LifePoint Hospitals Inc., et al., No. 11-1771, W.D. La.; 2013 U.S. Dist. LEXIS 160678).