CEDAR RAPIDS, Iowa - The government has not shown that the accommodation it offers religious employers with objections to the Patient Protection and Affordable Care Act (ACA)'s contraceptive mandate is the least restrictive means of accomplishing its goals, two colleges told the Eighth Circuit U.S. Court of Appeals on Nov. 4 (Dordt College and Cornerstone University v. Sylvia Burwell, et al., No. 14-2726, 8th Cir.).
WASHINGTON, D.C. - Reading the Patient Protection and Affordable Care Act (ACA)'s language in context clearly indicates Congress' intent to offer states a choice, not to threaten them and the viability of the statute through disastrous language, the government told the en banc District of Columbia U.S. Circuit Court of Appeals Nov. 3 (Jacqueline Halbig, et al. v. Sylvia M. Burwell, et al., No. 14-5018, D.C. Cir.).
HARRISBURG, Pa. - The Pennsylvania Supreme Court on Oct. 31 reversed an appeals court decision and held that a lower court was permitted to reach the substantive claim made by a plaintiff challenging a health care insurer's decision to use its policy's place-of-service exclusion to deny autism-related benefits at a child's school instead of his home (Anthony Burke, by his parent and natural guardian, John Burke v. Independence Blue Cross, No. J-2-2014, Pa. Sup.).
WASHINGTON, D.C. - A federal judge in the District of Columbia on Oct 31 granted summary judgment in favor of the secretary of Health and Human Services (HHS) in a suit challenging the method used by the secretary to calculate the plaintiff hospital's reimbursement rates for services provided to Medicare patients following a change in calculation methods, saying that the secretary reasonably interpreted the Medicare statute and its implementing regulations (Washington Regional Medicorp v. Sylvia Mathews Burwell, No. 13-622, D. D.C.; 2014 U.S. Dist. LEXIS 154660).
MIAMI - Having Patient Protection and Affordable Care Act (ACA) contraceptive mandate challengers notify the government does not warrant a change in outcome from cases decided under the previous rule, which had them notify third-party administrators, a Florida federal judge held Oct. 28 (Ave Maria School of Law v. Sylvia Burwell, et al., No. 13-795, M.D. Fla.; 2014 U.S. Dist. LEXIS 152738).
BOSTON - Biomet Inc. and its parent company have agreed to pay $6.07 million to resolve False Claims Act allegations that Biomet paid kickbacks to health care providers to prescribe the company's bone growth stimulators, the U.S. attorney for the District of Massachusetts announced Oct. 29 (United States of America, ex rel. Yu v. Biomet, Inc., No. 09-1731, D. N.J.).
BOSTON - A federal judge in Massachusetts on Oct. 27 held that a plaintiff in a qui tam action alleging that a pharmaceutical manufacturer schemed to submit false claims for reimbursement to government programs, including Medicare, sufficiently pleaded facts to support his claims, except one for conspiracy (United States of America et al. ex rel. Timothy Leysock v. Forest Laboratories Inc., et al., No. 12-11354, D. Mass.; 2014 U.S. Dist. LEXIS 151685).
DENVER - A dialysis center based in Denver has agreed to pay $350 million to resolve claims that it violated the False Claims Act by paying kickbacks to have patients referred to its clinics, the U.S. Department of Justice announced Oct. 22 (United States of America, ex rel. David Barbetta v. DaVita Inc., No. 09-cv-02175-WJM-KMT, D. Colo.).
CHICAGO - A jury in federal court in Illinois found a dermatologist guilty of submitting false claims for more than 800 patients resulting in $2.6 million in unnecessary payments from Medicare and other private health insurers (United States of America v. Robert Kolbusz, No. 12-cr-00782, N.D. Ill.).
HOUSTON - A jury in U.S. District Court for the Southern District of Texas on Oct. 20 found that the president of the Riverside General Hospital, his son and two other individuals were guilty of being involved in a $158 million Medicare fraud scheme (United States of America v. Earnest Gibson III, et al. No. 12-cr-00600, S.D. Texas).
WASHINGTON, D.C. - An anti-abortion group and its employees lack standing and miscast the standard for review in a futile effort to save a doomed case, the government told a District of Columbia federal judge on Oct. 21 (March for Life, Jeanne F. Monahan and Bethany A. Goodman v. Sylvia M. Burwell, et al., No. 14-1149, D. D.C.).
PHILADELPHIA - The Third Circuit U.S. Court of Appeals on Oct. 20 affirmed the dismissal with prejudice of a relator's False Claims Act (FCA) lawsuit against AstraZeneca Pharmaceuticals LP and Bristol-Myers Squibb Co., agreeing with a trial court that the whistle-blower failed to show that he was the original source of information about alleged wrongdoing (United States of America, ex rel. Karl S. Schumann, et al. v. AstraZeneca Pharmaceuticals L.P., et al., No. 13-1489, 3rd Cir.).
PITTSBURGH - Finding a treating physician's opinion to be reliable and admissible, a Pennsylvania federal judge Oct. 20 denied a nursing home's motion to exclude it in a lawsuit alleging violations of the Federal Nursing Home Reform Act (FNHRA) (Lawrence M. Clutter v. Washington County Health Center, No. 2:13-cv-00185, W.D. Pa.; 2014 U.S. Dist. LEXIS 148505).
WHITE PLAINS, N.Y. - A federal judge in New York on Oct. 16 sentenced a cardiologist to three years in prison and ordered him to pay $2 million in forfeiture and restitution for fraudulently billing Medicare and other insurance providers for services that were not medically necessary from 2007 until 2011 (United States of America v. Rohan Wijetilaka, No. 12-cr-00924, S.D. N.Y.).
BRADENTON, Fla. - A Florida state court jury on Oct. 17 returned a unanimous defense verdict for a pediatrician in a medical malpractice case involving the death of a 15-year-old girl (Virginia Chapman, et al. v. Snehal V. Parikh, M.D., et al., No. 12CA03280, Fla. Cir., 12th Jud., Manatee Co.).
WASHINGTON, D.C. - The U.S. Supreme Court on Oct. 20 denied review of a Sixth Circuit U.S. Court of Appeals ruling that affirmed a $6 million judgment against Blue Cross Blue Shield of Michigan (BCBSM) for breaching its fiduciary duty and engaging in self-dealing in violation of the Employee Retirement Income Security Act by collecting administrative fees that were not revealed in its administrative service contracts with the sponsor of a self-funded employee health benefit plan (Blue Cross Blue Shield of Michigan v. Hi-Lex Controls, Inc., et al., No. 14-168, U.S. Sup.).
RENO, Nev. - A federal judge in Nevada on Oct. 16 denied a health care company's motion to dismiss a False Claims Act suit against it, ruling that the dissemination of audit results concerning its billing practices to doctors employed by the company did not constitute a public disclosure (United States, ex rel. Cecilia Guardiola v. Renown Health, et al., No. 12-cv-00295-LRH-VPC, D. Nev.; 2014 U.S. Dist. LEXIS 148227).
HOUSTON - The owners of two diagnostic centers in Texas on Oct. 16 agreed to pay a combined $2.6 million to resolve claims from three whistle-blowers alleging that the owners violated the False Claims Act and Stark statute, according to filings in Texas federal court (United States, ex rel. Maribeth Holderith v. One Step Diagnostics Inc., et al., No. 12-cv-2988, S.D. Texas).
PHILADELPHIA - The Third Circuit U.S. Court of Appeals' ruling that a welfare plan administrator acted arbitrarily and capriciously in denying benefits for continued inpatient treatment for a participant who suffered from an eating disorder is contrary to the decision of the U.S. Supreme Court in Rush Prudential HMO, Inc. v. Moran, the administrator contends in its Oct. 10 petition seeking rehearing and rehearing en banc (Lisa Mirsky v. Horizon Blue Cross and Blue Shield of New Jersey, No. 13-4121, 3rd Cir.; 2014 U.S. App. LEXIS 18484).
PHILADELPHIA - Cephalon Inc. will continue to face some False Claims Act allegations about off-label marketing and kickbacks after a Pennsylvania federal judge on Oct. 9 issued three rulings in two cases (United States of America ex rel. Matthew Cestra, et al. v. Cephalon, Inc., et al., No. 14-1842, and United States of America ex rel. Bruce Boise, et al. v. Cephalon, Inc., No. 08-287, E.D. Pa.).
PHILADELPHIA - A nationwide nursing home company will pay $38 million to resolve allegations made in a whistle-blower qui tam action that it provided inappropriate rehabilitation therapy to elderly patients in order to increase Medicare and Medicaid billings, according to a settlement agreement announced Oct. 9 by the U.S. Department of Justice (United States ex rel. Tracy L. Lovvorn v. Extendicare Real Estate Investment Trust, No. 10-1580, E.D. Pa.).
OLYMPIA, Wash. - The Washington Supreme Court on Oct. 9 held that health insurance blanket exclusions of neurodevelopmental therapies in plaintiffs' health plans are void and unenforceable under the state's Mental Health Parity Act and neurodevelopmental therapies (NDT) mandate (O.S.T., et al. v. Regence Blueshield, No. 88940-6, Wash. Sup.; 2014 Wash. LEXIS 839).
WASHINGTON, D.C. - The government must respond to a man's petition for rehearing en banc in a case challenging the origination of the Patient Protection and Affordable Care Act (ACA), the District of Columbia U.S. Circuit Court of Appeals said Oct. 9 (Matt Sissel v. United States Department of Health and Human Services, et al., No. 13-5202, D.C. Cir.).
ST. LOUIS - The Eighth Circuit U.S. Court of Appeals on Oct. 6 once again remanded an Patient Protection and Affordable Care Act (ACA) contraceptive mandate challenge brought by a closely held for-profit corporation for an inquiry into whether its inability to find insurance without such coverage arises from government conduct (Annex Medical Inc., et al. v. Sylvia Mathews Burwell, et al., No. 13-1118, 8th Cir.).
WASHINGTON, D.C. - No conflict among courts exists regarding the availability of tax credits for individuals obtaining insurance through federal exchanges, an outcome supported by the language and structure of the Patient Protection and Affordable Care Act (ACA), the government told the U.S. Supreme Court Oct. 3 (David King, et al. v. Sylvia Mathew Burwell, et al., No. 14-114, U.S. Sup.).