LexisNexis® Legal Newsroom
    Merck To Pay $688M To Settle 2 Securities Class Action Lawsuits

    WHITEHOUSE STATION, N.J. - Merck and Co. Inc. will pay $688 million to settle two securities class action lawsuits filed in New Jersey federal court alleging that the drug maker and others failed to disclose adverse results of a clinical trial for two cholesterol drugs Merck was developing, according to a Merck press release issued Feb. 14 (In Re: Merck & Co., Vytorin/Zetia Securities Litigation, No. 2:08-CV-2177, D. N.J.; In Re: Schering-Plough Corp./ENHANCE Securities Litigation, 08-397, D. N.J.).

    Judge: Third-Party Suit Over Medicare Payments Doesn't Fall Under Medicare Act

    HATTIESBURG, Miss. - A Mississippi federal judge on Feb. 12 denied a motion to dismiss a breach of contract action between a hospital and a data collection firm over the hospital's loss of Medicare payments from the U.S. Department of Health and Human Services (HHS) for failure to report patient surveys to the Centers for Medicare and Medicaid Services (CMS). The judge concluded that the action is merely a breach of contract action and is not dependent upon the hospital seeking administrative remedies through HHS (South Central Regional Medical Center v. Press Ganey Associates Inc., No. 2:12cv103, S.D. Miss., Hattiesburg Div.; 2013 U.S. Dist. LEXIS 18522).

    Judge: Arizona Law Defunding Planned Parenthood Violates Medicaid Statute

    PHOENIX - An Arizona federal judge on Feb. 8 granted a motion for summary judgment filed by Planned Parenthood Arizona Inc. and a number of Medicaid beneficiaries, saying an Arizona law barring any health care provider who performs elective abortions from receiving Medicaid funding violates the Medicaid statute's clause allowing beneficiaries the freedom to choose a "qualified" medical provider (Planned Parenthood Arizona Inc., et al., v. Tom Betlach, Director, Arizona Health Care Cost Containment System, et al., No. CV-12-01533, D. Ariz.; 2013 U.S. Dist. LEXIS 17392).

    Medical Providers Appeal Federal Judge's Dismissal Of Denial Of Benefits Claims

    WEST PALM BEACH, Fla. - Medical providers on Feb. 8 filed a notice of appeal of a Florida federal judge's order dismissing 996 purported derivative claims asserted on behalf of 500 patients related to providers' claims that health insurers violated the Employee Retirement Income Security Act by granting preapproval for medical procedures then denying coverage (Sanctuary Surgical Centre Inc., et al. v. UnitedHealthcare Inc., et al., No. 10-81589, S.D. Fla.).

    Federal Government Dismissed From Suit Over Change To State Medicaid Law

    COLUMBIA, S.C. - A South Carolina federal judge on Feb. 11 dismissed the federal government from a Medicaid dispute, saying the court lacked jurisdiction over the claims (Richard Stogsdill, et al. v. Kathleen Sebelius, et al., No. 12-7, D. S.C.; 2013 U.S. Dist. LEXIS 18062).

    Arizona Federal Judge Grants, Denies Summary Judgment Motions In Medicaid Case

    PRESCOTT, Ariz. - In ruling on multiple summary judgment motions in a Medicaid dispute case, an Arizona federal judge on Feb. 7 held that the federal government acted arbitrarily and capriciously in approving a demonstration project for low-income childless adults but that the state government did not violate the due process rights of the plaintiffs in sending out the notice of the change to copayment requirements (Flint Wood, et al. v. Thomas Betlach, et al., No. 12-8098, D. Ariz.; 2013 U.S. Dist. LEXIS 16601).

    Off-Label Use Of Drug Not Covered By Medicare, California Federal Judge Affirms

    OAKLAND, Calif. - A California federal judge on Feb. 7 granted summary judgment in favor of the federal government in a Medicare dispute, saying that an off-label use for a prescription drug that does not comport with the medically accepted indication requirement is not covered by Medicare Part D (Abraham Nievod v. Kathleen Sebelius, et al., No. 11-4134, N.D. Calif.; 2013 U.S. Dist. LEXIS 17550).

    5th Circuit Affirms Finding Of Medicare Violations At Mississippi Nursing Home

    NEW ORLEANS - A Fifth Circuit U.S. Court of Appeals panel on Feb. 7 in an unpublished opinion affirmed findings that a nursing home violated Medicare regulations after residents were found to be in immediate jeopardy (Mississippi Care Center of Greenville v. United States Department of Health and Human Service, No. 12-60420, 5th Cir.; 2013 U.S. App. LEXIS 2668).

    Federal Judge Dismisses Challenge To Birth Control Mandate For Lack Of Standing

    CHICAGO - A federal judge in Illinois on Feb. 8 dismissed a suit alleging that the Patient Protection and Affordable Care Act (PPACA) mandate requiring all health plans to provide preventive services for free, including those for birth control, violates the religious rights of religious organizations, finding that the plaintiffs lacked standing and that the claims were unripe for review (R. Daniel Conlon, Bishop of the Roman Catholic Diocese of Joliet, Illinois, et al. v. Kathleen Sebelius, No. 12-3932, N.D. Ill.; 2013 U.S. Dist. LEXIS 17407).

    Divided 3rd Circuit Denies Stay Pending Appeal Of Birth Control Mandate Suit

    PHILADELPHIA - A divided Third Circuit U.S. Court of Appeals panel on Feb. 7 denied a motion for stay pending appeal of the denial of preliminary injunction in a case challenging the "birth control mandate" in the Patient Protection and Affordable Care Act (PPACA) (Conestoga Wood Specialties Corp., et al. v. Secretary of the US. Department of Health and Human Services, et al., No. 13-1144, 3rd Cir.; 2013 U.S. App. LEXIS 2706).

    ERISA Plan Participants Seek Judge's Recusal In Reimbursement Suit

    NEWARK, N.J. - Health plan participants who are suing a health care insurer for using flawed data to calculate the reimbursement rate for out-of-network providers on Feb. 7 moved for the federal judge in New Jersey who is overseeing the action to recuse himself and vacate his decision denying class certification (Darlery Franco v. Connecticut General Life Insurance Co., et al., No. 07-6039, D. N.J.).

    Wisconsin Appeals Court Affirms $22M Drug-Pricing Judgment Against Pharmacia

    MADISON, Wis. - A Wisconsin appeals court panel on Feb. 6 upheld a $22 million judgment against Pharmacia Corp. for reporting inflated average wholesale prices (AWPs) that resulted in the state Medicaid program overpaying for prescription drugs (State of Wisconsin v. Abbott Laboratories, et al., No. 2010AP232-AC, Wis. App., Dist. IV).

    Federal Judge Allows Claims Against California In Reimbursement Suit

    SAN FRANCISCO - A federal judge in California on Feb. 1 granted a motion to dismiss declaratory claims against the U.S. Department of Health and Human Services (HHS) regarding an interpretation of agency rules regarding reporting requirements under the Medicaid statute. However, the judge determined that the health care provider could maintain a claim against the California Department of Healthcare Services (DHCS) and its director for failure to reimburse it for services provided to Medicaid-eligible beneficiaries under federal laws and regulations (Northeast Medical Services Inc. v. California Department of Healthcare Services, et al., No. C-12-2895, N.D. Calif.; 2013 U.S. Dist. LEXIS 14147).

    New Jersey Federal Judge Dismisses Health Care Reimbursement Suit

    NEWARK, N.J. - In an unpublished opinion, a New Jersey federal judge on Feb. 5 granted summary judgment in favor of the defendants in a health care insurance reimbursement dispute, saying the plaintiffs failed to exhaust administrative remedies before filing suit (Montvale Surgical Center LLC a/s/o Justin Gutschmidt v. Horizon Blue Cross Blue Shield of New Jersey, et al., No. 12-3685, D. N.J.; 2013 U.S. Dist. LEXIS 15327).

    8th Circuit Grants Injunction Pending Resolution Of Appeal Of Birth Control Case

    ST. LOUIS - A panel of the Eighth Circuit U.S. Court of Appeals on Feb. 1 granted a motion made by the manufacturer of medical devices for a preliminary injunction pending resolution of its appeal contesting the denial of a preliminary injunction in its suit challenging the "birth control" mandate contained in the Patient Protection and Affordable Care Act (PPACA) (Annex Medical Inc., et al. v. Kathleen Sebelius, et al., No. 13-1118, 8th Cir.).

    Motion To Intervene Denied In Case Challenging Missouri Health Insurance Law

    ST. LOUIS - A Missouri federal judge on Jan. 31 denied a motion by a not-for-profit corporation to intervene in a suit seeking a declaration that portions of a state law are unconstitutional because they are in direct conflict with portions of the federal Patient Protection and Affordable Care Act (PPACA) (Missouri Insurance Coalition, et al. v. John M. Huff, in his capacity as Director of the Missouri Department of Insurance, Financial Institutions, and Professional Registration, No. 12-2354, E.D. Mo.; 2013 U.S. Dist. LEXIS 13105).

    Split 7th Circuit Grants Injunction Pending Appeal In Birth Control Mandate Suit

    CHICAGO - In a split opinion, a panel of the Seventh Circuit U.S. Court of Appeals on Jan. 30 granted an injunction pending appeal of the denial of a motion for preliminary injunction brought by a vehicle safety manufacturer and its owners challenging the "birth control" mandate contained in the Patient Protection and Affordable Care Act (PPACA) (William D. Grote III, et al. v. Kathleen Sebelius, et al., No. 13-1077, 7th Cir.; 2013 U.S. App. LEXIS 2112).

    6th Circuit Affirms Dismissal Of Claims Challenging Individual Mandate

    CINCINNATI - A Sixth Circuit U.S. Court of Appeals panel on Feb. 1 affirmed the dismissal of some claims and the granting of summary judgment in favor of the federal government on the remaining claims in a challenge to the individual mandate contained in the Patient Protection and Affordable Care Act (PPACA) (U.S. Citizens Association, et al. v. Kathleen Sebelius, et al., Nos. 11-3327 &11-3798, 6th Cir.; 2013 U.S. App. LEXIS 2245).

    Federal Government Offers Rulemaking For Compromise On Birth Control Coverage

    WASHINGTON, D.C. - The U.S. Department of Health and Human Services on Feb. 1 issued a notice of proposed rulemaking on recommended changes to the preventive services policy contained in the Patient Protection and Affordable Care Act (PPACA).

    Appeals Court: Florida DCF Cannot Collect Medicaid Overpayment

    MIAMI - The Third District Florida Court of Appeal on Jan. 30 reversed an agency decision by the Florida Department of Children and Families (DCF) Office of Appeals Hearings affirming a DCF action to establish two claims of overpayment of Medicaid assistance against a Medicaid beneficiary totaling $42,716.53. The court found that DCF failed to meet its legal obligations to properly notify the beneficiary of his need to create a qualified income trust (QIT) to help pay his nursing home bills and qualify for Medicaid assistance based upon his income (Sergio Garcia v. Department of Children and Families, No. 3D12-834, Fla. App., 3rd Dist.; 2012 Fla. App. LEXIS 1228).

    Catholic Health System Denied Medicare Payment For Depreciation After Merger

    WASHINGTON, D.C. - A judge in the U.S. District Court for the District of Columbia affirmed an administrative ruling by the U.S. Department of Health and Human Services (HHS) denying depreciation reimbursement under the Medicare program to a Catholic health care system after a merger with two other Catholic-related hospitals, saying the merger was not a bona fide sale because the hospitals were not given proper consideration for their assets in exchange for their debts (Catholic Healthcare West v. Kathleen Sebelius, in her official capacity as Secretary of Health and Human Services, No. 11-459, D. D.C.; 2013 U.S. Dist. LEXIS 11320).

    6th Circuit Affirms Civil Money Penalty In Nursing Home Medicare Case

    CINCINNATI - A panel of the Sixth Circuit U.S. Court of Appeals on Jan. 28 in an unpublished opinion affirmed the imposition of a civil money penalty for a nursing home's failure to comply with Medicare regulations over a 28-day period (Omni Manor Nursing Home v. U.S. Department of Health and Human Services, No. 12-3223, 6th Cir.; 2013 U.S. App. LEXIS 2060).

    Federal Judge Dismisses Challenge To Birth Control Mandate, Says Case Not Ripe

    ST. LOUIS - A Missouri federal judge on Jan. 29 dismissed a case brought by a group of Catholic institutions challenging a provision in the Patient Protection and Affordable Care Act (PPACA) mandating that all health plans provide preventive services for free, including those for birth control (Archdiocese of St. Louis, et al. v. Kathleen Sebelius, et al., No. 12-924, E.D. Mo.; 2013 U.S. Dist. LEXIS 11578).

    Washington Appeals Court: Hospital Was Overpaid For Medicaid Patient Care

    SEATTLE - The Washington Court of Appeals, Division Two, on Jan. 29 affirmed a trial court order finding that a Medicaid-participating hospital was overpaid after it failed to deduct the patient liability amount for health care services prior to billing the state's Department of Social and Health Services for the care (Multicare d/b/a Mary Bridge Children's Hospital, v. State of Washington Department of Social and Health Services, No. 42567-0-11, Wash. App., Div. 2; 2013 Wash. App. LEXIS 197).

    Construction Owners File Appeals Brief Challenging Birth Control Mandate

    CHICAGO - A construction company and its owners appealing the denial of their motion for a preliminary injunction to enjoin the implementation of the "birth control" mandate contained in the Patient Protection and Affordable Care Act (PPACA) on Jan. 28 filed their appeal brief in the Seventh Circuit U.S. Court of Appeals (Cyril B. Korte, et al. v. Kathleen Sebelius, et al., No. 12-3841, 7th Cir.).