Mealey's Health Law - Judge: Government's Loss Of Evidence Warrants Dismissal Of Fraud Indictment

SALT LAKE CITY - The government's loss of computer data from a women's health care clinic operated by a woman accused of defrauding Medicare by coaching illegal aliens to apply for benefits under the Baby Your Baby (BYB) program warrants the dismissal of her indictment, a federal judge in Utah...

Mealey's Health Law - 4th Circuit Affirms Verdict, Sentencing In Health Care Fraud Case

RICHMOND, Va. - A Fourth Circuit U.S. Court of Appeals panel on Dec. 19 upheld a jury's verdict finding a dermatologist guilty of 13 counts of health care fraud and affirmed a judge's sentencing of the defendant, holding that the evidence presented during the trial supported the jury's decision...

Mealey's Health Law - Preliminary Injunction Halts Recoupment Of Medicaid Funds To Pediatric Hospitals

WASHINGTON, D.C. - A federal judge in the District of Columbia on Dec. 29 granted a preliminary injunction to enjoin the U.S. Department of Health and Human Services (HHS) from recouping any federal disproportionate-share hospital (DSH) funds provided to two pediatric teaching and research hospitals...

Mealey's Health Law - Decision Reverses Injunction Enjoining Termination Of Provider Agreement

BATON ROUGE, La. - In a Dec. 29 unpublished opinion, a Louisiana appeals court reversed a summary judgment opinion granting a permanent injunction to halt the termination of a health care clinic's Medicaid provider agreement, saying the plaintiff failed to meet its required prima facie showing of...

Mealey's Health Law - 3rd Circuit Affirms Sentence Given To Doctor Who Violated Medicare, Medicaid

PHILADELPHIA - A panel of the Third Circuit U.S. Court of Appeals on Dec. 31 affirmed the sentence given to a radiologist who pleaded guilty to illegally paying physicians to refer their patients to his facility so he could obtain more reimbursement from Medicare and Medicaid (United States of America...

Mealey's Health Law - Physical Injury Not Needed For Medical-Monitoring Claim, Nevada High Court Rules

CARSON CITY, Nev. - Members of a health maintenance organization who seek medical monitoring for potential exposure to blood-borne diseases may maintain negligence claims against the HMO, the Nevada Supreme Court ruled Dec. 31, finding in a case of first impression under Nevada law that "a plaintiff...

Mealey's Health Law - Federal Judge Allows Home-Care Group's Challenge To ACA

WASHINGTON, D.C. - A home-care association with at least one member denied reimbursement from Medicare has standing to challenge Patient Protection and Affordable Care Act (ACA) rules and need not exhaust administrative remedies first given the unlikelihood of success, a District of Columbia federal...

Mealey's Health Law - Federal Judge Dismisses 1 Claim From Health Care Reimbursement Suit

TAMPA, Fla. - A Florida federal judge on Jan. 12 partially dismissed a complaint alleging that a health insurance company wrongfully declined to reimburse two health care providers for services, dismissing a fraud claim and granting the plaintiff leave to amend the complaint to assert claims under the...

Mealey's Health Law - Owners Of Mental Health Clinic Sentenced For Medicare Fraud Scheme

HOUSTON - Two physician owners of a mental health clinic were sentenced to 148 months and 120 months, respectively, in prison for their roles in a $97 million Medicare fraud scheme, according to docket entries entered Jan. 12 in Texas federal court (United States of America v. Mansour Sanjar, et al....

Mealey's Health Law - State Of Oregon Wins Dismissal Of Copyright Infringement Claims

PORTLAND, Ore. - Allegations by Oracle America Inc. that the State of Oregon infringed its copyrighted software were rejected Jan. 13 by an Oregon federal judge, on the basis of sovereign immunity (Oracle America Inc. v. The Oregon Health Insurance Exchange Corporation, et al., No. 14-1279, D. Ore.;...

Mealey's Health Law - Pharmacy Employee Sentenced To 13 Months For Scheme To Defraud Benefits Programs

BALTIMORE - A pharmacy employee was sentenced by a federal judge in Maryland on Jan. 15 to 13 months in prison and ordered to pay $102,066.25 in restitution for his role in a scheme to defraud Medicare, Medicaid and the Federal Employees Health Benefits Program by submitting false prescriptions for refills...

Mealey's Health Law - Osteopathic Physician Pleads Guilty To Committing Health Care Fraud

HARTFORD, Conn. - An osteopathic physician on Jan. 16 pleaded guilty in Connecticut federal court to one count of committing health care fraud and agreed to pay the government $270,528 to resolve federal civil claims arising from his conduct (United States of America v. David Lester Johnston, No. 14...

Mealey's Health Law - Michigan Doctor Sentenced To 15 Months For Role In Health Care Fraud

DETROIT - A doctor was sentenced to 15 months in prison and ordered to pay $1.3 million in restitution by a federal judge in Michigan on Jan. 14 for her role in a $2.1 million home health care fraud scheme, the U.S. Department of Justice announced (United States of America v. Paula Williamson, No. 13...

Mealey's Health Law - Federal Judge Dismisses Self-Funded Employee Plan's Subrogation Suit

PRESCOTT, Ariz. - An Arizona federal judge on Jan. 16 dismissed a self-funded employee welfare benefit plan's subrogation lawsuit against the estate of a plan participant regarding settlement proceeds in an underlying wrongful death action because the participant's children did not incur health...

Mealey's Health Law - 1st Circuit Approves Class Certification In Nexium Pay-For-Delay Lawsuit

BOSTON - The presence of a few uninjured members in a class does not prevent certification, the First Circuit U.S. Court of Appeals ruled Jan. 21, affirming the certification of the class of indirect purchasers of Nexium in a pay-for-delay lawsuit over the heartburn drug (In re Nexium Antitrust Litigation...

Mealey's Health Law - Supreme Court Won't Hear Prejudgment Case Involving Subsidies

WASHINGTON, D.C. - The U.S. Supreme Court on Jan. 26 denied a petition from the State of Oklahoma seeking a writ of certiorari before judgment in its challenge to the availability of subsidies in Patient Protection and Affordable Care Act (ACA) insurance exchanges (State of Oklahoma, ex rel. Scott Pruitt...

Mealey's Health Law - ACA's Experimental, Consumer-Owned Insurer Funded With $146M Fails

WEST DES MOINES, Iowa - The Iowa insurance commissioner will liquidate CoOportunity Health Inc., a consumer-owned health insurance company started with $146 million in Patient Protection and Affordable Care Act (ACA) funds, it announced Jan. 23 (State of Iowa, et al. v. CoOpportunity Health Inc., No...

Mealey's Health Law - 2nd Circuit Reverses Dismissal Of Due Process Claim In Medicare Dispute

NEW YORK - The Second Circuit U.S. Court of Appeals on Jan. 22 reversed the dismissal of a due process claim in a class action Medicare payment dispute, saying the lower court erred in concluding that the plaintiffs lacked a property interest in being treated as "inpatients." The court affirmed...

Mealey's Health Law - 2nd Circuit Remands Medical Reimbursement Claims To District Court

NEW YORK - A federal judge erred by finding that a health care provider settled its claims under the Employee Retirement Income Security Act for services rendered with a self-funded employee benefit plan based on the plan's "one-sided representation," the Second Circuit U.S. Court of Appeals...

Mealey's Health Law - HHS Seeks Dismissal Of House's Suit Over ACA Implementation

WASHINGTON, D.C. - The House of Representatives lacks standing to challenge implementation of the Patient Protection and Affordable Care Act (ACA)'s employer mandate in court, the U.S. Department of Health and Human Services (HHS) told a federal judge in the District of Columbia on Jan. 26 (United...

Mealey's Health Law - Tennessee Federal Judge Dismisses Medicare False Claims Act Case

NASHVILLE, Tenn. - A Tennessee federal judge on Jan. 23 dismissed a Medicare False Claims Act case, saying the plaintiff failed to plead the claims with the specificity required (Kathleen McFeeters v. Northwest Hospital, et al., No. 13-467, M.D. Tenn.; 2015 U.S. Dist. LEXIS 8523).

Mealey's Health Law - Medicare Suit Dismissed For Failure To Exhaust Administrative Remedies

AKRON, Ohio - An Ohio federal judge on Jan. 26 dismissed a Medicare reimbursement dispute, finding that the plaintiffs failed to exhaust administrative remedies as required under the Medicare Act (Ohio State Chiropractic Association, et al. v. Humana Health Plan Inc., No. 14-2313, N.D. Ohio; 2015 U.S...

Mealey's Health Law - Hospital's Reimbursement Action Not Preempted By ERISA, Calif. Federal Judge Rules

SAN JOSE, Calif. - A federal judge in California on Jan. 26 remanded to state court a hospital's lawsuit seeking reimbursement for charges for treatment of a participant in a health plan governed by the Employee Retirement Income Security Act, holding that the hospital's state unfair competition...

Mealey's Health Law - Judge: Government's Evidence Supported Guilty Verdict In Health Care Fraud Suit

DETROIT - A federal judge in Michigan on Jan. 27 denied a defendant's motion for acquittal and new trial, ruling that the government presented sufficient evidence to support the jury's finding that the man conspired to commit health care fraud (United States of America v. Vinod Patel, No. 11...

Mealey's Health Law - Report: Even After ACA, Cost Remains Barrier To Insurance

WASHINGTON, D.C. - Cost remains a barrier to obtaining medical insurance, with nearly one-third of uninsured but Patient Protection and Affordable Care Act (ACA)-eligible adults citing it as the reason they remain uninsured, according to a Henry J. Kaiser Family Foundation report issued Jan. 29.