OKLAHOMA CITY - An Oklahoma federal judge on Nov. 7 declined to remand a breach of contract health insurance dispute to state court, saying that the plaintiff's claims could have been brought under the Employee Retirement Income Security Act and, therefore, federal jurisdiction was warranted (Elizabeth Cates v. Integris Health Inc., No. 12-763, W.D. Okla.; 2012 U.S. Dist. LEXIS 159568).
NEWARK, N.J. - A New Jersey federal judge on Nov. 9 dismissed for failure to state a claim a putative class action case brought by multiple chiropractors seeking to hold health insurers accountable for past abuses of allegedly illegally bundling claims for chiropractic services into one type of treatment despite separate and distinct treatments being provided (Alphonse A. DeMaria, D.C., et al. v. Horizon Healthcare Services Inc., et al., No. 11-7298, D. N.J., 2012 U.S. Dist. LEXIS 161241).
ATLANTA - A federal district court properly exercised its discretion in not excusing a health benefits plan participant's failure to exhaust her administrative remedies before filing an action under the Employee Retirement Income Security Act challenging the plan's denial of benefits, the 11th Circuit U.S. Court of Appeals affirmed Nov. 6 in an unpublished opinion (Florida Health Sciences Center, Inc., et al. v. Total Plastics, Inc., No. 12-11537, 11th Cir.; 2012 U.S. App. LEXIS 22770).
ST. LOUIS - Plaintiffs on Nov. 5 filed an appeal brief asking the Eighth Circuit U.S. Court of Appeals to reverse the dismissal of their suit challenging a provision contained in the Patient Protection and Affordable Care Act (PPACA), 111 P.L. 148 that requires health plans to provide preventive services for free, including those for birth control (State of Nebraska, et al. v. United States Department of Health and Human Services, et al., No. 12-3238, 8th Cir.).
CHICAGO - An Illinois federal judge on Nov. 6 dismissed one of the plaintiff's claims and the defendants' counterclaim in a health insurance reimbursement dispute (Northwestern Memorial Hospital v. Lake County Board of Commissioners Employee Health Benefit Plan, et al., No. 11-1811, N.D. Ill.; 2012 U.S. Dist. LEXIS 159070).
WASHINGTON, D.C. - The federal government on Nov. 5 filed an appeal brief, asking the District of Columbia U.S. Circuit Court of Appeals to affirm that a lower court correctly dismissed for lack of standing two cases challenging a Patient Protection and Affordable Care Act (PPACA), 111 P.L. 148, mandate requiring all health plans to provide "preventative services" for free, including those for birth control (Wheaton College v. Kathleen Sebelius, et al., No. 12-5273; Belmont Abbey College v. Kathleen Sebelius, et al., No. 12-5291, D.C. Cir.).
NEW ORLEANS - A panel of the Fifth Circuit U.S. Court of Appeals in a Nov. 2 per curiam opinion affirmed the conviction, sentences and restitution orders for a couple charged with submitting fraudulent Medicare, Medicaid and insurance claims through their ambulance service (United States of America v. Robert Earl Read, et al., No. 11-40643, 5th Cir.; 2012 U.S. App. LEXIS 22617).
DETROIT - A Michigan federal judge on Oct. 31 granted a preliminary injunction in favor of two plaintiffs challenging a provision contained in the Patient Protection and Affordable Care Act (PPACA), 111 P.L. 148, requiring that all group health plans, other than those that are "grandfathered," provide a full range of Federal Drug Administration-approved contraceptive methods without cost sharing (Legatus, et al. V. Kathleen Sebelius, et al., No. 12-12061, E.D. Mich.; 2012 U.S. Dist. LEXIS 156144).
WASHINGTON, D.C. - A District of Columbia federal judge on Oct. 31 dismissed a case challenging changes to Medicare arising from the Patient Protection and Affordable Care Act (PPACA), 111 P.L. 148, saying the plaintiffs lacked standing to challenge some of their claims and failed to state claims for which relief could be granted (Association of American Physicians & Surgeons Inc., et al. v. Kathleen G Sebelius, et al., No. 10-499, D. D.C.; 2012 U.S. Dist. LEXIS 155839).
ALBANY, N.Y. - The New York Court of Appeals on Oct. 30 affirmed an appellate court order that the state's Department Of Health failed, and will likely continue to fail, to timely respond to requests for emergency medical assistance benefits. The high court agreed that the "likely to recur" mootness doctrine should be applied to the plaintiff's claim seeking damages for lack of notification of benefits availability (Barbara Coleman, etc., v. Richard F. Daines, M.D., etc., No. 152, N.Y. App.; 2012 N.Y. LEXIS 3263).
AUSTIN, Texas - A Texas federal judge on Oct. 29 granted dismissal in favor of the state's executive commissioner of the Texas Health and Human Services Commission (HHSC) in a Medicaid reimbursement suit, saying that some of the plaintiffs lacked standing and that the plaintiffs failed to support the claims (Pharmacy Busying Association Inc., et al. v. Kathleen Sebelius, et al., No. 12-156, W.D. Texas; 2012 U.S. Dist. LEXIS 154529).
KEY WEST, Fla. - A Florida federal judge on Oct. 24 granted the defendants' motion to dismiss a Medicare dispute, holding that the relators failed to satisfy False Claims Act pleading obligations (United States of America; ex rel. Bruce L. Boros, M.D., et al. v. Health Management Associates Inc., et al., No. 10-10013, S.D. Fla.; 2012 U.S. Dist. LEXIS 153792).
ATLANTA - A letter sent by a dental services provider to an insurer requesting information about the insurer's partial denial of a patient's claim did not constitute initiating an administrative appeal, the 11th Circuit U.S. Court of Appeals affirmed Oct. 23 in an unpublished opinion holding that the provider failed to exhaust his administrative remedies under the Employee Retirement Income Security Act (ERISA), 29 U.S.C.S. § 1001 et seq. (American Dental Association, et al. v. WellPoint Health Networks Inc., et al., No. 11-11208, 11th Cir.; 2012 U.S. App. LEXIS 22007).
WEST PALM BEACH, Fla. - The majority of claims by medical providers alleging that health insurers violated the Employee Retirement Income Security Act (ERISA), 29 U.S.C.S. § 1001 et seq. by granting preapproval for medical procedures and then denying coverage are sufficient to survive the insurers' motion to dismiss, a federal judge in Florida ruled Oct. 22 (Sanctuary Surgical Centre, Inc., et al. v. UnitedHealthcare, Inc., et al., No. 10-81589, S.D. Fla.; 2012 U.S. Dist. LEXIS 151404).
LOS ANGELES - The Second District California Court of Appeal, Division Two, on Oct. 23 affirmed a trial court's denial of reimbursement of Medicaid benefits to a Medi-Cal beneficiary, saying the beneficiary lacked proper, detailed evidence that he paid for medical services out of pocket (Nikrouz Ghazibayat v. California Department of Health Care Services, No. B239705, Calif. App., 2nd Dist., Div. 2; 2012 Cal. App. Unpub. LEXIS 7679).
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).