CHICAGO - The Seventh Circuit U.S. Court of Appeals on Oct. 23 affirmed a trial court's grant of a preliminary injunction against the Indiana State Department of Health in enforcing a state law stripping Medicaid funds from Planned Parenthood of Indiana Inc. because the agency provides abortions. The appeals court concluded that the state defunding law violates the "free-choice-of-provider" section of the Medicaid law under 42 U.S. Code Section 1396a(a)(23) (Planned Parenthood of Indiana Inc., et al., v. Commissioner of the Indiana State Department of Health, et al., No. 11-2464, 7th Cir.; 2012 U.S. Appl. LEXIS 22006).
ANDERSON, S.C. - A South Carolina federal judge on Oct. 22 granted summary judgment in favor of a plaintiff suing his health care plan for failing to pay the appropriate amount for his hospitalization (John G. Hill v. Senenet Inc. Employee Health Care Plan, No. 10-1913, D. S.C.; 2012 U.S. Dist. LEXIS 151399).
PHOENIX - An Arizona federal judge on Oct. 19 granted a preliminary injunction in favor of health care providers seeking to enjoin the enforcement of state legislation prohibiting health care providers who perform elective abortions from receiving Medicaid funding (Planned Parenthood Inc., et al. v. Tom Betlach, director, Arizona Health Care Cost Containment System, et al., No. 12-01533, D. Ariz.; 2012 U.S. Dist. LEXIS 150596).
NEW ORLEANS - The Fifth Circuit U.S. Court of Appeals, in a per curiam opinion issued Oct. 17, affirmed a trial court order on summary judgment in favor of the U.S. Department of Health and Human Services (HHS), finding that a due process claim against the agency seeking reimbursement for approved Medicare services was moot. The trial court had concluded that HHS had already paid the claims and that the suit seeking payment was unnecessary (Randall D. Wolcott, M.D., P.A., v. Kathleen Sebelius, in her official capacity as Secretary of Health and Human Services, et al., No. 12-10010, 5th Cir.; 2012 U.S. App. LEXIS 21583).
PHILADELPHIA - A federal judge in Pennsylvania on Oct. 16 ordered the U.S. Department of Health and Human Services to produce the complete administrative record, as well as the rulemaking record, regarding Medicare's Disproportionate Share Hospital (DSH) regulations. Two Pennsylvania hospitals are challenging whether inpatient hospital services provided under the state's general medical assistance program are to be counted in Medicare's DSH calculation (Nazareth Hospital, et al., v. Kathleen Sebelius, Secretary of Health and Human Services, No. 10-3513, E.D. Pa.; 2012 U.S. Dist. LEXIS 148745).
EAST ST. LOUIS, Ill. - An Illinois federal judge on Oct. 15 declined to grant class certification in an unfair trade practice case against a health insurance company (Charlotte Phillips, et al. v. WellPoint Inc., et al., No. 10-357, S.D. Ill.; 2012 U.S. Dist. LEXIS 147736).
GREEN BAY, Wis. - A Wisconsin federal judge on Oct. 15 denied cross-motions for summary judgment in a health care insurance subrogation dispute (Winsert Inc., et al. v. Kathleen F. Hasenfus, No. 11-251, E.D. Wis.; 2012 U.S. Dist. LEXIS 147941).
FRANKFORT, Ky. - A Kentucky appeals court panel on Oct. 12 vacated verdicts totaling more than $130.7 million against two drug makers for publishing inflated average wholesale prices (AWPs), saying the Kentucky Medicaid program was well aware of the practice and was complicit in the scheme (Sandoz Inc. v. Commonwealth of Kentucky, ex rel. Jack Conway, et al., No. 2011-CA-000225-MR, AstraZeneca, LP, et al. v. Commonwealth of Kentucky, ex rel. Jack Conway, et al., No. 04-CI-01487, Ky. App.).
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CHICAGO - In separate opinions issued Oct. 12, an Illinois federal judge issued rulings on motions for summary judgment and for judgment on the pleadings and declined to grant class certification to 32 proposed classes in a wrongful reimbursement suit brought by chiropractors (Pennsylvania Chiropractic Association, et al. v. Blue Cross Blue Shield Association, et al., No. 09-5619, N.D. Ill; 2012 U.S. Dist. LEXIS 147026; 2012 U.S. Dist. LEXIS 146955).
KANSAS CITY, Mo. - A Missouri federal judge on Oct. 12 gave final approval to a settlement valued at more than $3.32 million in a class suit claiming that a health insurance company charged excessive co-pays to its customers (Joy Holling-Fry v. Coventry Health Care of Kansas Inc., No. 07-92, W.D. Mo.; 2012 U.S. Dist. LEXIS 147142).
BELLEFONTAINE, Ohio - The Ohio Third District Court of Appeals on Oct. 9 affirmed a trial court ruling that the transfer of a house from a revocable trust directly to a "community spouse" was an improper transfer under the rules for Medicaid eligibility for nursing home care (Helen Williams v. Ohio Department of Job and Family Services, No. 8-11-18, Ohio App., 3rd Dist., Logan Co.; 2012 Ohio App. LEXIS 4097).
CINCINNATI - The Sixth Circuit U.S. Court of Appeals on Oct. 5 overturned a U.S. Department of Health and Human Services (HHS) Department Appeals Board (DAB) decision finding that the Cal Turner Extended Care Pavilion was not in compliance with several provisions of the Medicare Act, resulting in "immediate jeopardy" to its residents (Cal Turner Extended Care Pavilion v. United States Department of Health & Human Services, et al., No. 11-3832, 6th Cir.; 2012 U.S. App. LEXIS 20855).
BALTIMORE - A Maryland federal judge on Oct. 5 remanded a reimbursement dispute to state court, holding that the Employee Retirement Income Security Act (ERISA), 29 U.S.C.S. § 1001 et seq., did not preempt the plaintiff's claims (Feldman's Medical Center Pharmacy Inc., et al. v. CareFirst Inc., et al., No. 12-613, D. Md.; 2012 U.S. Dist. LEXIS 144784).
WASHINGTON, D.C. - The U.S. Supreme Court on Oct. 9 denied review of a Sixth Circuit U.S. Court of Appeals ruling that a company is liable for retiree health care benefits and reimbursement for Medicare Part B premiums for retirees of the company's predecessors (Newell Window Furnishings Inc., et al. v. Willard Bender, et al., No. 12-163, U.S. Sup.).
NEW YORK - A medical service provider's claim based on a health insurer's denial of coverage because an assistant surgeon was not "medically necessary," which was a term defined by the plan, is a right-to-payment claim that is preempted by the Employee Retirement Income Security Act (ERISA), 29 U.S.C.S. § 1001 et seq., a federal judge in New York ruled Oct. 4 (Neuroaxis Neurosurgical Associates, PC, v. CIGNA Healthcare of New York, Inc., No. 11 Civ. 8517, S.D. N.Y.; 2012 U.S. Dist. LEXIS 144921).
NEW ORLEANS - The Employee Retirement Income Security Act (ERISA), 29 U.S.C.S. § 1001 et seq., does not preempt a third-party medical device provider's state law claims for negligent misrepresentation, promissory estoppel and violations of the Texas Insurance Code that alleged that the ERISA plan administrator misled it regarding plan beneficiaries' coverage, the en banc Fifth Circuit U.S. Court of Appeals ruled Oct. 5 (Access Mediquip v. UnitedHealthcare Insurance Co., No. 10-20868, 5th Cir.; 2012 U.S. App. LEXIS 20809).
ST. LOUIS - An Eighth Circuit U.S. Court of Appeals panel on Oct. 4 affirmed the dismissal of a challenge to the Patient Protection and Affordable Care Act (PPACA), 111 P.L. 148, for lack of standing (Peter Kinder, et al. v. Timothy Geithner, et al., No. 11-1973, 8th Cir.; 2012 U.S. App. LEXIS 20686).
SAN DIEGO - A health-care provider's claims against insurers alleging that the insurers misappropriated his name and made misrepresentations to his patients by holding him out as a contracted provider, which negatively impacted his ability to recover additional amounts owed under his contracts with his patients, are not completely preempted by the Employee Retirement Income Security Act, 29 U.S.C.S. § 1001 et seq., a federal judge in California ruled Oct. 2 in remanding the case to state court (Sanjay Ghosh, M.D., v. Aetna Health of California, Inc., et al., No. 3:12-CV-1557-JM (BGS), S.D. Calif.; 2012 U.S. Dist. LEXIS 142673).
SPRINGFIELD, Ill. - A judge in the U.S. District Court for the Central District of Illinois, Springfield Division, on Oct. 3 denied an Illinois Department of Healthcare and Family Services motion to dismiss an injunctive and declaratory relief action filed under the Medicaid, Americans for Disabilities Act (ADA) and Rehabilitation Act statutes, saying the plaintiff properly stated claims against the state in her challenge to a decision denying her residential psychiatric treatment (S.B., et al. v. Julie Hamos, in her Official Capacity as Director of the Illinois Department of Healthcare and Family Services, No. 3:12cv03077, C.D. Ill., Springfield Div.; 2012 U.S. Dist. LEXIS 142851).
NEW YORK - The Second Circuit U.S. Court of Appeals on Oct. 2 affirmed a federal court ruling that the payment stream from a single premium annuity purchased before applying for Medicaid benefits from the State of Connecticut are protected assets and cannot be considered as an excess resource that must be spent down so the institutionalized spouse can received Medicaid benefits under the Medicare Catastrophic Coverage Act of 1988 (MCCA) (John F. Lopes, et al., v. Department of Social Services, et al., No. 10-3741, 2nd Cir.; 2012 LEXIS 20535).
NEW HAVEN, Conn. - A federal judge in Connecticut on Sept. 29 denied judicial review of a final Medicare reimbursement decision by Kathleen Sebelius, secretary for Health and Human Services (HHS), in which the federal department said the plaintiff hospitals are not entitled to include in their calculation of their Medicare Disproportionate Share Hospital (DSH) adjustment patient days for patients covered by Connecticut's State Administered General Assistance (SAGA) program (Waterbury Hospital Center, et al., v. Kathleen Sebelius, Secretary of Health and Human Services, No. 3:09cv1701, D. Conn.; 2012 U.S. Dist. LEXIS 141523).
BATON ROUGE, La. - A Louisiana appeals court on Sept. 28 reversed a trial court's decision upholding the validity of a contract awarded by the state for health benefit plans for state employees, dependents and retirees (United Healthcare Insurance Co. v. State of Louisiana, et al., No. 2011 CA 1398, La. App., 1st. Cir.; 2012 La. App. LEXIS 1237).
DETROIT - A Michigan federal magistrate judge on Oct. 1 ordered Blue Cross Blue Shield of Michigan and two nonparty hospitals to produce documents to the U.S. Department of Justice and the state in an action seeking to enjoin Blue Cross from including "most favored nation" (MFN) clauses in its contracts with hospitals in Michigan (United States of America and the State of Michigan v. Blue Cross Blue Shield of Michigan, No. 10-14155, E.D. Mich.; 2012 U.S. Dist. LEXIS 141355).
PORTLAND, Maine - A Maine federal judge on Sept. 28 ordered the State of Maine to pay attorney fees to plaintiffs who won a challenge to stop the state from implementing the state's prescription privacy law (IMS Health Corp., et al. v. G. Steven Rowe, attorney general of the state of Maine, No. 07-127, D. Maine; 2012 U.S. Dist. LEXIS 140180).
BENTON, Ill. - In ruling on a motion to dismiss, an Illinois federal judge dismissed on Sept. 27 all but breach of contract and unfair conduct claims from a class action unfair trade practices cases (Charlotte Phillips, et al. v. WellPoint Inc., et al., No. 10-357, S.D. Ill.; 2012 U.S. Dist. LEXIS 139623).