Mealey's Health Law - Alabama High Court: Networks Do Not Have To Contract With Health Care Provider

    MONTGOMERY, Ala. - A divided Alabama Supreme Court on Jan. 24 held that a trial court erred in submitting a claim for intentional interference with business relationship to a jury in a health care network dispute, saying the defendants had no obligation to do business with the plaintiff health care provider (Alabama Psychiatric Services, et al. v. A Center for Eating Disorders, No. 1110703, Ala. Sup.; 2014 Ala. LEXIS 9).

    Mealey's Health Law - Arizona Appeals Court Affirms Denial Of Prescription Drug Coverage

    PHOENIX - An Arizona state appeals court in a Jan. 23 unpublished opinion affirmed that a health insurance company properly denied benefits for a prescription drug because the plan and state law expressly prohibited coverage for drugs not included in the plan's formulary (Deanna M. Cancino v. Arizona Health Cost Containment Administration, et al., No. 13-130, Ariz. App., Div. 1; 2014 Ariz. App. Unpub. LEXIS 84).

    Mealey's Health Law - Miss. Federal Judge Leaves Breach Of Contract Claim In Denial Of Benefits Suit

    HATTIESBURG, Miss. - A Mississippi federal judge on Jan. 22 denied a health insurance company's motion for summary judgment on a plaintiff's breach of contract claim in a dispute over denial of benefits but granted the motion as to the plaintiff's remaining claims (Larry R. Mixon v. The Golden Rule Insurance Co., No. 12-234, S.D. Miss.; 2014 U.S. Dist. LEXIS 7760).

    Mealey's Health Law - Mo. Federal Judge Grants Injunction, Halts Law Regulating Insurance Exchanges

    JEFFERSON CITY, Mo. - A Missouri federal judge on Jan. 23 granted a motion for preliminary injunction, enjoining the enforcement of Missouri's Health Insurance Market Innovation Act (HIMIA) as it applies to entities and individuals certified under federal law to provide services or perform functions pursuant to the Patient Protection and Affordable Care Act (PPACA) (St. Louis Effort for Aids, et al. v. John Huff, director of the Missouri Department of Insurance, Financial Institutions and Professional Registration, No. 13-4246, W.D. Mo.; 2014 U.S. Dist. LEXIS 8187).

    Mealey's Health Law - Supreme Court Blocks Enforcement Of Birth Control Mandate

    WASHINGTON, D.C. - The U.S. Supreme Court on Jan 24 enjoined the federal government from enforcing the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) against an order of Catholic nuns pending final disposition of an appeal by the 10th Circuit U.S. Court of Appeals (Little Sisters of the Poor Home for the Aged, et al. v. Kathleen Sebelius, et al., No. 13A691, U.S. Sup.).

    N.Y. Federal Judge Declines To Reinstate Injunction Pending Appeal Of Dismissal

    ROCHESTER, N.Y. - A New York federal judge on Jan. 16 denied a motion by a nursing home operator to reinstate a preliminary injunction pending its appeal of a decision dismissing its suit challenging the termination of its Medicare and Medicaid provider agreement (Blossom South v. Kathleen Sebelius, et al., No. 13-6474, W.D. N.Y.; 2014 U.S. Dist. LEXIS 6474).

    N.J. Federal Judge Remands Reimbursement Dispute; No Federal Jurisdiction Exists

    NEWARK, N.J. - In an unpublished opinion, a New Jersey federal judge on Jan. 21 granted a plaintiffs' motion to remand its health care reimbursement suit, saying neither complete preemption nor an embedded federal question of jurisdiction existed (MHA d/b/a Meadowlands Hospital Medical Center v. UnitedHealth Group Inc., et al., No. 13-6130, D. N.J.; 2014 U.S. Dist. LEXIS 7035).

    Federal Magistrate Declines To Transfer Denial Of Benefits Case To Other Court

    MILWAUKEE - A Wisconsin federal magistrate judge on Jan. 15 denied a defendant's motion to transfer a wrongful denial of benefits case to another federal court (Ryan M. Redmond v. Sirius International Insurance Corp., No. 12-587, E.D. Wis.; 2014 U.S. Dist. LEXIS 5089).

    Podiatrist Admits Lying To Grand Jury Investigating Orthofix Health Care Fraud

    BOSTON - A Virginia podiatrist on Jan. 15 pleaded guilty to lying to a federal grand jury during an investigation into health care fraud and kickbacks related to bone growth stimulators sold by Orthofix Holdings Inc. (United States of America v. Ilene Terrell, No. 1:13-10180, D. Mass.).

    Judge: Act Authorizes Tax Credits For Insurance Bought On Federal Exchanges

    WASHINGTON, D.C. - A District of Columbia federal judge on Jan. 15 granted summary judgment in favor of the federal government 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.).

    Arkansas Federal Judge Affirms Decision Disallowing Medicare Payments

    LITTLE ROCK, Ark. - An Arkansas federal judge on Jan. 10 granted summary judgment in favor of the federal government in a challenge to a final decision of the secretary of the U.S. Department of Health and Human Service (DHHS) to disallow Medicare payments to a diagnostic audiological testing facility when the tests were not ordered by physicians (Doctors Testing Centers v. U.S. Department of Health and Human Services, et al., No. 11-857, E.D. Ark.; 2014 U.S. Dist. LEXIS 3781).

    Michigan Federal Judge Grants Injunction In Birth Control Case

    DETROIT - A Michigan federal judge on Jan. 13 granted a preliminary injunction in favor of five religious organizations challenging the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) (The Ave Marie Foundation, et al. v. Kathleen Sebelius, et al., No. 13-15198, E.D. Mich.; 2014 U.S. Dist. LEXIS 3516).

    9th Circuit Reverses Injunction In California Medi-Cal Dispute

    SAN FRANCISCO - A Ninth Circuit U.S. Court of Appeals panel on Jan. 9 reversed a decision affirming a preliminary injunction prohibiting the California Department of Health Care Service (DHCS) from implementing Medicaid reimbursement rate reductions, saying the lower court erroneously interpreted the statute governing the reimbursements (Santa Rosa Memorial Hospital, et al. v. Toby Douglas, No. 09-17633, 9th Cir.; 2014 U.S. App. LEXIS 449).

    8th Circuit Affirms Dismissal Of Medicare False Billings Case

    ST. LOUIS - An Eighth Circuit U.S. Court of Appeals panel on Jan. 9 affirmed the dismissal of a Medicare false claims billing case, saying the plaintiff failed to plead fraud with the sufficient particularity required (United States of America, ex rel. Michael Dunn v. North Memorial Health Care, et al., No. 13-1099, 8th Cir.; 2014 U.S. App. LEXIS 413).

    Pennsylvania Court: Methodology For Setting Medicaid Reimbursement Rational

    HARRISBURG, Pa. - A Pennsylvania court on Jan. 8 affirmed that the Pennsylvania Department of Public Welfare's (DPW) new methodology for determining Medicaid reimbursement rates was rational (Armstrong County Memorial Hospital v. Department of Public Welfare, No. 711 C.D. 2013, Pa. Comm., 2014 Pa. Commw. LEXIS 40).

    Supreme Court Denies Petition In Suits Over Medicaid Reimbursements

    WASHINGTON, D.C. - The U.S. Supreme Court on Jan. 13 denied a petition for writ of certiorari in two cases in which the Ninth Circuit U.S. Court of Appeals vacated preliminary injunctions prohibiting the California Department of Health Care Services and its director from implementing Medi-Cal reimbursement reductions authorized by the California Legislature and approved by the secretary of Health and Human Services (Managed Pharmacy Care, et al. v. Kathleen Sebelius, et al., No. 13-253, California Medical Association v. Kathleen Sebelius, et al., No. 13-380, U.S. Sup.).

    High Court Will Not Review ERISA Benefit And Disclosure Claims

    WASHINGTON, D.C. - The U.S. Supreme Court on Jan. 13 denied a plan participant's petition for a writ of certiorari seeking review of an 11th Circuit U.S. Court of Appeals ruling that a health plan insurer did not abuse its discretion in calculating benefits and that the insurer was not liable for penalties for failing to disclose documents it relied on in calculating the amount of the benefit (Brian Fox v. Blue Cross and Blue Shield of Florida Inc., No. 13-342, U.S. Sup.).

    U.S. Supreme Court Denies Certiorari In Medicare Part D Challenge

    WASHINGTON, D.C. - The U.S. Supreme Court on Jan. 13 denied a petition for certiorari in a case seeking review of an appeals court decision affirming 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 (Southwest Pharmacy Solutions v. Centers for Medicare and Medicaid Services, No. 13-144, U.S. Sup.).

    Judge Dismisses Suit Over Individual, Employer Mandates In Health Care Act

    HOUSTON - A Texas federal judge on Jan. 10 dismissed a case challenging the individual and employer mandates contained in the Patient Protection and Affordable Care Act (PPACA), holding that the mandates did not violate the origination clause of the U.S. Constitution or the taking clause of the Fifth Amendment. Also on Jan. 10, the plaintiffs filed a notice indicating their intent to appeal the decision to the Fifth Circuit U.S. Court of Appeals (Steven F. Hotze, M.D., et al. v. Kathleen Sebelius, et al., No. 13-1318, S.D. Texas; 2014 U.S. Dist. LEXIS 3149).

    5th Circuit Affirms Convictions Of 3 People For Health Care Fraud

    NEW ORLEANS - A Fifth Circuit U.S. Court of Appeals panel on Jan. 7 affirmed the convictions of three people accused of health care fraud related to Medicare and Medicaid billing (United States of America v. Umawa Oke Imo, et al., No. 11-20791, 5th Cir.; 2014 U.S. App. LEXIS 280).

    D.C. Federal Judge Grants Defense Summary Judgment In Medicare Suit

    WASHINGTON, D.C. - A District of Columbia federal judge on Jan. 6 granted summary judgment in favor of the U.S. Department of Health and Human Services in a Medicare reimbursement dispute, saying that the secretary's methodology in setting the rates was not arbitrary and capricious (District Hospital Partners, et al. v. Kathleen Sebelius, No. 11-0116, D. D.C.; 2014 U.S. Dist. LEXIS 738).

    Injunction Pending Appeal Granted After Judge Dismisses Birth Control Case

    WASHINGTON, D.C. - A divided District of Columbia Circuit U.S. Court of Appeals panel on Dec. 31 granted an emergency motion for injunction pending appeal in a nonprofit religious organization's case challenging the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA). By its own motion, the court consolidated the case with a similar case (Priests for Life, et al. v. U.S. Department of Health and Human Services, et al., No. 13-1261, D.C. Cir.).

    6th Circuit Grants Injunction Pending Appeal In Birth Control Suit

    GRAND RAPIDS, Mich. - The Sixth Circuit U.S. Court of Appeals on Dec. 31 granted an injunction pending appeal in favor of two Catholic institutions after a Michigan federal judge on Dec. 27 declined to grant a preliminary injunction in favor of the plaintiffs in their suit seeking to keep the government from implementing the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) against them and their health plans (Michigan Conference, et al. v. Kathleen Sebelius, et al., No. 13-2723, 6th Cir.).

    Texas Federal Judge Grants Injunction To Halt Implementation Of Mandate

    BEAUMONT, Texas - A Texas federal judge on Jan. 2 granted a permanent injunction to halt the implementation of the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) against the Catholic Diocese of Beaumont and Catholic Charities of Southeast Texas Inc. but dismissed a claim for violation of the Administrative Procedure Act (APA) (Catholic Diocese of Beaumont, et al. v. Kathleen Sebelius, et al., No. 13-709, E.D. Texas; 2014 U.S. Dist. LEXIS 467).

    9th Circuit Vacates Injunctions In Medicare Secondary Payer Class Action Suit

    SAN FRANCISCO - A Ninth Circuit U.S. Court of Appeals panel on Jan. 2 filed an amended opinion vacating injunctions entered by a lower court prohibiting the secretary of the U.S. Department of Health and Human Services (DHHS) from demanding "up front" reimbursement for secondary payments from beneficiaries who have appealed a Medicare reimbursement determination and remanded the class action case with instructions for the lower court to consider the merits of the plaintiffs' due process claim (Patricia Haro, et al. v. Kathleen Sebelius, No. 11-16606, 9th Cir.; 2014 U.S. App. LEXIS 61).