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Mealey's Health Law - 3rd Circuit: Catalyst Theory Of Recovery Available In ERISA Fees Case

PHILADELPHIA - The Third Circuit U.S. Court of Appeals ruled May 8 that the "catalyst theory" of recovery of attorney fees is available under the Employee Retirement Income Security Act and that judicial action is not required under that theory in order to establish some degree of success on...

Mealey's Health Law - 4th Circuit Overturns Pretrial Evidentiary Rulings In Health Care Fraud Suit

RICHMOND, Va. - A federal judge in Virginia erred when granting three pretrial motions to exclude evidence filed by a dermatologist accused of health care fraud, a Fourth Circuit U.S. Court of Appeals panel ruled May 11, holding that the rulings restricted the latitude needed by the government to carry...

Mealey's Health Law - Restaurant Employees Allege Interference Under ERISA Related To ACA Compliance

NEW YORK - Nationwide restaurant/entertainment chain Dave & Buster's Inc. violated the Employee Retirement Income Security Act by reducing the hours of its work force in 2013 in order to avoid the costs associated with providing health insurance to its full-time employees in compliance with the...

Mealey's Health Law - Man Sentenced To 48 Months In Prison For Secondhand Drug Scheme

NEW YORK - A federal judge in New York on May 12 sentenced a man who pleaded guilty to two counts of health care fraud for his role in a scheme involving the sale of secondhand prescription drugs to 48 months in prison and ordered him to pay $2.9 million in restitution (United States of America v. Bladimir...

Mealey's Health Law - Panel: Lead Plaintiffs In Securities Suit Failed To Plead Loss Causation

ATLANTA - A federal district court judge did not err in dismissing a securities class action lawsuit because, despite having numerous opportunities to amend their complaint, the lead plaintiffs still failed to properly plead loss causation, a divided 11th Circuit U.S. Court of Appeals panel ruled May...

Mealey's Health Law - Plan Management Agreement Does Not Confer ERISA Standing, Divided 5th Circuit Rules

NEW ORLEANS - A plan management agreement between Humana Health Plan and a health plan's administrator, which provided that Humana would supply subrogation and recovery services, did not vest Humana with discretionary authority sufficient to make Humana a fiduciary with standing to bring claims under...

Mealey's Health Law - 7th Circuit Rejects Preliminary Injunction In ACA Opt-Out Challenge

CHICAGO - Notre Dame is not entitled to a preliminary injunction while it challenges the opt-out provision of the Patient Protection and Affordable Care Act (ACA)'s contraceptive mandate, a divided Seventh Circuit U.S. Court of Appeals held May 19 (University of Notre Dame v. Kathleen Sebelius, et...

Mealey's Health Law - Federal Judge Allows Most Cause-Of-Death Testimony In Medical Malpractice Case

MEMPHIS, Tenn. - A Tennessee federal judge on May 18 declined to strike or exclude testimony of three experts for a couple alleging medical malpractice in the death of their 11-year-old son but ruled that testimony by a fourth expert for the plaintiffs should be excluded from trial based on state law...

Mealey's Health Law - High Court Won't Review ERISA Preemption Ruling Involving Policy Cancellation

WASHINGTON, D.C. - The U.S. Supreme Court on May 26 declined to review the Eighth Circuit U.S. Court of Appeals ruling that a shareholder-owner's state law claims related to improper cancellation of her health care coverage were preempted by the Employee Retirement Income Security Act (CeCelia Catherine...

Mealey's Health Law - Top Court Rejects Maine's Challenge To ACA 'Maintenance Of Effort' Rule

WASHINGTON, D.C. - The U.S. Supreme Court on June 8 denied the State of Maine's petition challenging mandatory continued Medicaid coverage for older children under the Patient Protection and Affordable Care Act's maintenance of effort requirements, according to the docket (Mary C. Mayhew, in...

Mealey's Health Law - 1st Circuit Affirms Conviction, Sentencing Of Health Care Fraud Defendant

BOSTON - A First Circuit U.S. Court of Appeals panel on June 10 affirmed the conviction and sentencing of man found guilty for his role in a scheme of fraudulently billing Medicare for durable medical equipment (DME), finding that the judge presiding over the case did not err in any of his evidentiary...

Mealey's Health Law - Government Files Intervener Complaint In Suit Against Ambulance Service Company

JACKSONVILLE, Fla. - The federal government filed an intervener complaint in Florida federal court on June 12 in a False Claims Act (FCA) and Anti-Kickback Statute lawsuit brought against an ambulance service company accused of engaging in a 10-year scheme in which it fraudulently billed Medicare for...

Mealey's Health Law - Pediatric Hospital To Pay $12.9M To Settle False Claims Act Suit

WASHINGTON, D.C. - The U.S. Department of Justice on June 15 announced that Children's National Medical Center Inc., Children's Hospital and its affiliated entities (collectively CNMC) agreed to pay $12.9 million to resolve allegations in a False Claims Act (FCA) lawsuit that they submitted false...

Mealey's Health Law - DOJ: Florida Skilled Nursing Facility To Pay $17M Over Illegal Referrals

WASHINGTON, D.C. - The U.S. Department of Justice announced June 16 that a Florida-based skilled nursing facility, its former president and executive director and its subsidiaries have agreed to pay $17 million to resolve allegations that it violated the False Claims Act (FCA) and Anti-Kickback Statute...

Mealey's Health Law - High Court Affirms Availability Of Tax Credits In ACA Federal Exchange

WASHINGTON, D.C. - The Patient Protection and Affordable Care Act (ACA)'s structure suggests the availability of tax subsidies in the federal exchange, and Congress could not have intended the state insurance market "death spirals" likely to result from barring such subsidies, a divided...

Mealey's Health Law - Florida Panel Finds Discovery Order On Hospital Exceeded Statute's Scope

TALLAHASSEE, Fla. - A trial court erred in ordering a hospital to produce confidential contracts between it and 37 health insurers, a Florida appeals panel ruled June 22, finding that the scope of the law under which the order was issued did not extend to such documents (Shands Jacksonville Medical Center...

Mealey's Health Law - Judge Allows Expert Opinion On ACA Impact On Class Status, Decertifies Class

PHILADELPHIA - An expert may opine regarding, among other things, how Patient Protection and Affordable Care Act (ACA) medical loss ratio (MLR) regulations affect class ascertainability, a federal judge held June 30 in decertifying a class of indirect purchasers of Wellbutrin XL (In re: Wellbutrin XL...

Mealey's Health Law - High Court Will Determine Whether ERISA Preempts Health Care Database Law

WASHINGTON, D.C. - The U.S. Supreme Court on June 29 granted review of a divided Second Circuit U.S. Court of Appeals ruling that the Employee Retirement Income Security Act preempts Vermont's health care data collection law, which requires health care payers to report claims and health care-services...

Mealey's Health Law - 7th Circuit Denies Fees Under Common-Fund Doctrine In COBRA Case

CHICAGO - An attorney may not recover fees under the common-fund doctrine in addition to or in lieu of fees awarded under a fee-shifting statute like the Employee Retirement Income Security Act "in the absence of a contract," the Seventh Circuit U.S. Court of Appeals ruled July 1 (Darryl Pierce...

Mealey's Health Law - DOJ: Vascular Center To Pay $1.2M To esolve False Claims Act Suit

MIAMI - The U.S. Department of Justice announced July 2 that American Access Care Holdings (AAC) agreed to pay $1.2 million to resolve allegations that it violated the False Claims Act by billing Medicare for medically unnecessary percutaneous transluminal angioplasties (PTAs) and thrombectomies and...

Mealey's Health Law - Warner Chilcott Sales Director Pleads Guilty To Health Care Fraud For Fake Scripts

BOSTON - A former district sales manager for drug maker Warner Chilcott Sales U.S. LLC on July 7 pleaded guilty to one count of conspiracy to commit health care fraud for directing a scheme to have other sales representatives submit falsified authorizations for the osteoporosis drugs Actonel and Atelvia...

Mealey's Health Law - Pennsylvania Panel Affirms Conviction Of Pain Clinic Owner For Fraudulent Billing

PHILADELPHIA - A Pennsylvania Superior Court panel on July 7 affirmed the conviction of a pain clinic owner for conspiracy, theft and insurance fraud after finding that the evidence presented during his trial supported the verdict and that the trial court judge did not err when allowing the Commonwealth...

Mealey's Health Law - 11th Circuit Upholds Pharmacy Owner's 144-Month Sentence For Fraud

ATLANTA - An 11th Circuit U.S. Court of Appeals panel on July 15 found no error in a federal judge in Florida's decision to sentence a pharmacy owner to 144 months in prison, ruling that the judge did not err when finding that the defendant's fraudulent billing of prescription medication to Medicare...

Mealey's Health Law - 2nd Circuit: Health Care Providers Lack Standing To Assert Retaliation Claims

NEW YORK - Health care providers are not beneficiaries of their patients' health insurance plans and, therefore, do not have standing to assert anti-retaliation protections under the Employee Retirement Income Security Act, the Second Circuit U.S. Court of Appeals affirmed July 15 (Henry L. Rojas...

Mealey's Health Law - 3rd Circuit: Judge Did Not Err When Enhancing Sentencing For Fraud

PHILADELPHIA - A federal judge in Pennsylvania did not err when sentencing a woman to 96 months in prison for her role in an insurance fraud scheme that resulted in Medicare and other supplemental insurers paying approximately $1.8 million in false claims, a Third Circuit U.S. Court of Appeals panel...