Kan. Federal Judge Denies Motion To Acquit Defendant Convicted Of Medicaid Fraud

    TOPEKA, Kan. - A Kansas federal judge on Sept. 20 denied a defendant's motion for acquittal or, in the alternative, a new trial following her conviction for 12 counts of health care benefit fraud and conspiracy to commit health care fraud in violation of Medicaid laws (United States of America v. Caela M. White-Kinchion, No. 11-40023, D. Kan.; 2013 U.S. Dist. LEXIS 134516).

    Federal Judge Declines To Dismiss Fraudulent Advertising Of Health Policy Claim

    MADISON, Wis. - A Wisconsin federal judge on Sept. 20 declined to dismiss a complaint alleging that a health insurer and companies hired to advertise its policies on television committed fraud and bad faith in their advertising practices, allowed the plaintiffs to amend their complaint and declined to grant class action status to the case (Harry R. Wiedenbeck, et al. v. Cinergy Health Inc., et al., No. 12-508, W.D. Wis.; 2013 U.S. Dist. LEXIS 134672).

    Kentucky Federal Judge Declines To Vacate Contempt Order In Medicaid Waiver Suit

    LEXINGTON, Ky. - A Kentucky federal judge on Sept. 18 denied the Kentucky Cabinet for Health and Family Service's request to vacate and dissolve a partial finding of contempt issued against the cabinet for failing to properly process requests by Medicaid patients to transfer from one in-network Coventry Health and Life Insurance Co. facility to another facility in light of Coventry's impending termination of its provider contract with Appalachian Regional Healthcare Inc. and ARH Breckenridge Health Services Inc. (collectively, ARH) Appalachian Regional Healthcare, et al. v. Coventry Health and Life Insurance Co., et al., No. 12-114, E.D. Ky.; 2013 U.S. Dist. LEXIS 133126).

    Massachusetts Federal Judge Dismisses Provider's Suit, Says Fax Is Not Advertisement

    BOSTON - A Massachusetts federal judge on Sept. 18 dismissed a health care provider's suit against a network facilitator for violations of the Telephone Consumer Protection Act (TCPA) and the Junk Fax Prevention Act (JFPA), saying that the fax in question was not an advertisement (Physicians Healthsource Inc. v. Multiplan Services Corp., No. 12-11693, D. Mass.; 2013 U.S. Dist. LEXIS 133397).

    California Federal Judge Remands Health Care Payment Dispute; No ERISA Preemption

    LOS ANGELES - A California federal judge on Sept. 18 remanded a breach of health care contract suit to state court, saying that the Employee Retirement Income Security Act did not preempt the claims (Port Medical Wellness Inc. v. Connecticut General Life Insurance Co., et al., No. 13-3604, C. D. Calif.; 2013 U.S. Dist. LEXIS 134612).

    9th Circuit Denies Rehearing In California Medicaid Coverage Lawsuit

    SAN FRANCISCO - The Ninth Circuit U.S. Court of Appeals on Sept. 17 denied a motion for rehearing and rehearing en banc filed by the California Department of Health Services, thus reaffirming its ruling that California legislation eliminating coverage for certain health care services conflicted with the Medicaid Act and, therefore, was invalid (California Association of Rural Health Clinics, et al. v. Toby Douglas, et al., Nos. 10-17574, 10-17622, 9th Cir.).

    D.C. Court: HHS Within Its Discretion To Not Join Medicare Qui Tam Suit

    WASHINGTON, D.C. - A federal judge in the District of Columbia on Sept. 16 held that the federal government's decision to not intervene in two qui tam actions filed under the U.S. False Claims Act was within its discretion and cannot be reviewed by the court, concluding that the federal agencies may choose not to intervene in a qui tam action even when evidence suggested fraud under the Medicare statute has been committed (Michael L. Davis v. U.S. Department of Health and Human Services, et al., No. 12-1246, D. D.C.; 2013 U.S. Dist. LEXIS 131796).

    Colorado Federal Judge Grants Injunction In Health Care Act Case

    DENVER - A Colorado federal judge on Sept. 17 enjoined the federal government from enforcing the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) against a mortgage company and its owners, who had argued that adhering to the mandate would violate their religious beliefs (W.L. Armstrong, et al. v. Kathleen Sebelius, et al., No. 13-563, D. Colo.; 2013 U.S. Dist. LEXIS 132841).

    6th Circuit Affirms Denial Of Preliminary Injunction In Health Care Act Case

    CINCINNATI - A Sixth Circuit U.S. Court of Appeals panel on Sept. 17 affirmed the denial of a preliminary injunction sought by the owners of for-profit, secular corporations in a challenge to the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) and ordered the individual plaintiffs dismissed for lack of standing (Autocam Corp., et al. v. Kathleen Sebelius, et al., No. 12-2673, 6th Cir.; 2013 U.S. App. LEXIS 19152).

    Louisiana Federal Judge Remands Reimbursement Suit, Says Jurisdiction Lacking

    NEW ORLEANS - A Louisiana federal judge on Sept. 16 remanded a health care reimbursement suit to state court, finding that the court lacked subject matter jurisdiction (Omega Hospital v. Louisiana Health Service & Indemnity Co., et al., No. 13-21, E.D. La.; 2013 U.S. Dist. LEXIS 131988).

    Michigan Federal Judge Denies Injunction In Health Care Act Suit

    DETROIT - A Michigan federal judge on Sept. 13 denied a motion by a business owner and his company for a preliminary injunction halting the implementation of the "birth control" mandate contained in the Patient Protection and Affordable Care Act (PPACA) case (MK Chambers Co., et al. v. Department of Health and Human Services, et al., No. 13-11379, E.D. Mich.; 2013 U.S. Dist. LEXIS 130880).

    Health Plan May Seek Attorney Fees In ERISA Action, 2nd Circuit Rules

    NEW YORK - A health plan may seek attorney fees under the Employee Retirement Income Security Act because a restitution claim against it was dismissed on summary judgment, the Second Circuit U.S. Court of Appeals ruled Sept. 10 (Nicholas Scarangella v. Scarangella & Sons, Inc., et al., No. 12-2750-cv, 2nd Cir.; 2013 U.S. App. LEXIS 18761).

    Judge Declines To Dismiss Health Care Suit; Issues On Alter-Ego Liability Exist

    CHICAGO - An Illinois federal judge on Sept. 10 denied a motion to dismiss a health care insurance suit alleging breach of contract and violation of the Consolidated Omnibus Budget Reconciliation Act (COBRA) but granted the plaintiff's motion to strike an affidavit the defendants filed in support of their dismissal motion (Victoria Weiland v. AssureCare Inc., et al., No. 12-1947, N.D. Ill.; 2013 U.S. Dist. LEXIS 128750).

    Massachusetts High Court Affirms Exclusion Of Medical Cost Data

    BOSTON - The Supreme Judicial Court of Massachusetts affirmed the exclusion of evidence that a defendant sought to submit in a health care reimbursement suit from a database company, saying that the trial judge did not abuse his discretion in excluding evidence that could not be fully verified (NE Physical Therapy Plus Inc. v. Liberty Mutual Insurance Co., No. SJC-11284, Mass. Sup. Jud. Ct.; 2013 Mass. LEXIS 706).

    Terminated Employee's Denial Of Benefits, Fiduciary Duty Claims Fail, 7th Circuit Rules

    CHICAGO - A plan sponsor did not wrongfully deny health insurance benefits or breach its fiduciary duties under the Employee Retirement Income Security Act to a former employee whose employment was terminated because his work-related injuries prevented him from returning to work where the plan terms did not promise post-employment benefits, the Seventh Circuit U.S. Court of Appeals ruled Sept. 6 (James Brooks v. Pactiv Corporation, et al., No. 12-1155, 7th Cir.; 2013 U.S. App. LEXIS 18651).

    6th Circuit Affirms Imposition Of Monetary Penalty In Medicare Case

    CINCINNATI - In an unpublished opinion, a panel of the Sixth Circuit U.S. Court of Appeals on Sept. 6 affirmed the imposition of a civil monetary penalty (CMP) against a skilled nursing facility for failing to comply with participation requirements set by the Centers for Medicare and Medicaid Services (CMS) (Life Care Center of Bardstown v. Secretary of United States Department of Health and Human Services, No. 12-4420, 6th Cir.; U.S. App. LEXIS 18657).

    New Jersey Appeals Court Affirms Termination Of Medicaid Beneficiaries

    NEWARK, N.J. - In an unpublished, consolidated opinion, a New Jersey appeals court on Sept. 9 affirmed four financial agency decisions of the New Jersey Department of Human Services (DHS), Division of Medical Assistance and Health Services (DMAHS) terminating appellants from the New Jersey Family Care Medicaid Program (NJFC) (B.D. v. New Jersey Department of Human Services, Division of Medical Assistance and Health Services, No. A-2456-11T3; M.M., et al. v. New Jersey Department of Human Services, Division of Medical Assistance and Health Services, No. A-4744-11T2; T.J. v. New Jersey Department of Human Services, Division of Medical Assistance and Health Services; No. A-5761-11T1, G.G. v. New Jersey Department of Human Services, Division of Medical Assistance and Health Services, No. A-0109-12T1, N.J. Sup. Ct., App. Div.).

    Colorado Federal Judge Grants Injunction In Birth Control Mandate Suit

    DENVER - A Colorado federal judge on Sept. 6 granted a motion for a preliminary injunction to stop the implementation of the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) against an owner of for-profit senior care assisted living centers and skilled nursing centers (Stephen W. Briscoe, et al. v. Kathleen Sebelius, et al., No. 13-285, D. Colo.; 2013 U.S. Dist. LEXIS 127510).

    Puerto Rico Federal Judge Retains Jurisdiction In Dentists' Reimbursement Suit

    SAN JUAN, Puerto Rico - A Puerto Rico federal judge on Sept. 6 held that federal jurisdiction remains in a reimbursement suit brought by dentists and their employers against multiple health insurers following the denial of class certification under the Class Action Fairness Act (CAFA) (College of Dental Surgeons of Puerto Rico v. Triple S Management Inc., No. 09-1209, D. Puerto Rico; 2013 U.S. Dist. LEXIS 127747).

    9th Circuit Vacates Injunction In Medicare Suit, Orders Court To Consider Merits

    SAN FRANCISCO - A panel of the Ninth Circuit U.S. Court of Appeals on Sept. 4 vacated an injunction 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.; 2013 U.S. App. LEXIS 18353).

    D.C. Federal Judge Grants Government Summary Judgment In Medicare Dispute

    WASHINGTON, D.C. - A District of Columbia federal judge on Sept. 5 granted summary judgment in favor of the government in a Medicare dispute, saying that the secretary of the U.S. Department of Health and Human Service (DHHS) did not act arbitrarily or capriciously in denying reimbursements for costs associated with off-site resident training (Borgess Medical Center, et al. v. Kathleen Sebelius, No. 12-144, D. D.C.; 2013 U.S. Dist. LEXIS 126442).

    Arizona Appeals Court Finds State's Subrogation Law Not Preempted

    PHOENIX - In a matter of first impression, an Arizona appeals court on Sept. 5 held that the Federal Employee Health Benefits Act (FEHBA) does not preempt Arizona state law forbidding subrogation in personal injury cases (Matthew Kobold v. The Aetna Life Insurance Co., No. 12-0315, Ariz. App., Div. 1; 2013 Ariz. App. LEXIS 187).

    8th Circuit: Medicare Doesn't Require Written Reports For Surgical Pathology Slides

    MINNEAPOLIS - The Eighth Circuit U.S. Court of Appeals on Sept. 4 affirmed the dismissal of a qui tam lawsuit filed against the Mayo Foundation under the federal False Claims Act (FCA), saying the Mayo Foundation and its related entities filed false and fraudulent claims for reimbursement to the Centers for Medicare and Medicaid Services when the Mayo Foundation and its related entities failed to submit written reports for each permanent surgical pathology slide it created for each patient treated (United States of America, ex rel. David Ketroser, et al., v. Mayo Foundation, et al., No. 12-3206, 8th Cir.; 2013 LEXIS 18330).

    Missouri Federal Judge Denies Summary Judgment In Medicare False Claims Suit

    ST. LOUIS - A Missouri federal on Aug. 30 denied summary judgment motions made by the parties in a Medicare false claims billing case, finding that a jury could reach a decision in favor of either party (United States of America ex rel. Health Dimensions Rehabilitation Inc. v. RehabCare Group Inc., et al., No. 12-848, E.D. Mo.; 2013 U.S. Dist. LEXIS 123204).

    Texas Federal Judge Allows Intervention In Health Care Act Suit

    HOUSTON - A Texas federal judge on Aug. 30 granted a motion to intervene in a case challenging the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) made by a graduate theological seminary (East Texas Baptist University, et al. v. Kathleen Sebelius, et al., No. 12-3009, S.D. Texas; 2013 U.S. Dist. LEXIS 124347).