Mealey's Health Law - Judge Allows Evidence Of Noneconomic Damages In Denial Of Benefits Trial

TRENTON, N.J. - In an unpublished opinion, a federal judge in New Jersey on Sept. 24 granted a plaintiff's motion in limine, which will allow her to introduce evidence of noneconomic damages at trial in her case alleging that a health insurer was negligent when it delayed approval of health benefits...

Mealey's Health Law - Federal Judge Dismisses RICO Claims In Drug Copay Case

CHICAGO - A federal judge in Illinois on Sept. 25 dismissed Racketeer Influenced and Corrupt Organizations Act claims against the manufacturer of Humira and AndroGel, saying the plaintiff failed to show the existence of a viable enterprise in the defendants' practice of offering savings cards that...

Mealey's Health Law - Judge Rejects IRS Rule, Finds ACA Tax Subsidies Apply Only In State Exchanges

MUSKOGEE, Okla. - Tax subsidies are available only to individuals who enroll through state exchanges under the language Congress chose to include in the Patient Protection and Affordable Care Act (ACA), and it is not a judge's place to revise those terms, an Oklahoma federal judge held Sept. 30 ...

Mealey's Health Law - ACA Changes Help Doom Suit Targeting San Francisco's Welfare Code Compliance

SAN FRANCISCO - Enactment of the Patient Protection and Affordable Care Act (ACA) reduced the City and County of San Francisco's duties under state law, and plaintiffs lack public interest standing in a case challenging compliance with those duties, a California appeals court held Sept. 26 (Wilfredo...

Mealey's Health Law - Federal Judge Partially Grants Motion To Dismiss In Medicare Anti-Kickback Case

CAMDEN, N.J. - A federal judge in New Jersey on Sept. 29 dismissed federal False Claims Act (FCA) claims that predated March 4, 2005, as barred by the statute of limitations, but otherwise declined to dismiss the qui tam Medicare dispute (United States of America, ex rel. Marc Silver, et al. v. Omnicare...

Mealey's Health Law - Texas Federal Judge Allows Breach Claims To Continue In Reimbursement Suit

DALLAS - On Sept. 30, a federal judge in Texas granted in part and denied in part a health insurer's motion to dismiss reimbursement claims, finding that some of the claims were subject to arbitration or that the plaintiff failed to exhaust administrative remedies. Claims for breach of the patients...

Mealey's Health Law - ACA Changes To False Claims Act Disclosure Bar Apply Prospectively, Judge Says

SAVANNAH, Ga. - Changes the Patient Protection and Affordable Care Act (ACA) made to the False Claims Act public disclosure bar apply prospectively, a Georgia federal judge held Sept. 29 (United States of America and State of Georgia, ex rel. Chad Willis v. SouthernCare Inc., No. 10-124, S.D. Ga.; 2014...

Mealey's Health Law - Nevada Supreme Court Holds Lower Court Erred In Sua Sponte Granting Judgment

CARSON CITY, Nev. - The Nevada Supreme Court on Oct. 2 held that a lower court erred in granting summary judgment in favor of the plaintiff on two claims for relief in suit challenging a hospital's lien for payment that were not argued in the summary judgment briefing or at oral argument because...

Mealey's Health Law - Government Tells High Court ACA Language Supports Broad Tax Subsidy Availability

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...

Mealey's Health Law - 8th Circuit Remands ACA Birth-Control Case For Injury Inquiry

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...

Mealey's Health Law - D.C. Circuit Seeks Government Response In ACA 'Origination Clause' Attack

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...

Mealey's Health Law - Washington High Court: Insurer Violates Mental Health Treatment Requirements

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...

Mealey's Health Law - Settlement Reached In Medicare, Medicaid False Claims Act Suit

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...

Mealey's Health Law - Cephalon Escapes Some Claims, Not Others In 2 False Claims Lawsuits

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,...

Mealey's Health Law - Insurer Seeks Rehearing Of 3rd Circuit Ruling In Denial Of Benefits Case

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...

Mealey's Health Law - Owners Of 2 Diagnostic Centers To Pay $2.6M To Resolve False Claims Suit

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...

Mealey's Health Law - Judge Finds Disclosure Of Audit Results Not Fatal To Suit

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...

Mealey's Health Law - High Court Lets Stand Judgment In Hidden Administrative Fee Case

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...

Mealey's Health Law - Florida Jury Returns Defense Verdict In Medical Malpractice Suit

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.).

Mealey's Health Law - New York Cardiologist Sentenced To 3 Years In Prison, Pay $2M In Restitution

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...

Mealey's Health Law - Surgeon's Opinion Permitted In Nursing Home Neglect Lawsuit

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...

Mealey's Health Law - 3rd Circuit: Relator Wasn't Original Source In Drug Whistle-Blower Case

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...

Mealey's Health Law - Government Challenges Merits, Standing In Anti-Abortion Group's Mandate Case

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...

Mealey's Health Law - Jury Finds Hospital President, 3 Others Guilty In Medicare Fraud Scheme

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...

Mealey's Health Law - Illinois Dermatologist Found Guilty Of Defrauding Medicare Of More Than $2.6M

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.).