6th Circuit Affirms Conviction Of Doctor In Medicare Fraud Case

CINCINNATI - In considering an issue of first impression regarding the admissibility of functional magnetic resonance imaging (fMRI) lie detection testing, a Sixth Circuit U.S. Court of Appeals panel on Sept. 7 affirmed the conviction of an owner of two companies providing follow-up psychiatric care...

Unsettled Case Law Leads 7th Circuit To Uphold Award In ERISA Dispute

CHICAGO - Citing the previously unsettled state of case law regarding the production of insurers' internal documents and a lack of bad faith in an insurer's handling requests for such documents, a Seventh Circuit U.S. Court of Appeals panel on Nov. 28 upheld a lower court's ruling that had...

Federal Judge Denies Class Certification To Insurance Agents' Fraud Lawsuit

LEXINGTON, Ky. - A Kentucky federal judge on May 22 denied class certification in a fraud lawsuit between insurance agents and an insurance agency regarding withheld commissions on sold Medicare Advantage plans (Harold David Cowden, et al. v. Parker & Associates Inc., et al., No. 09-323, E.D. Ky...

Chiropractors Sufficiently Alleged Breach, Bad Faith Under ERISA, Judge Rules

NEWARK, N.J. - Three chiropractors pursuing class claims against a health insurer's "bundling" of purportedly distinct claims survived dismissal on July 31, with a New Jersey federal judge finding that they had satisfied standing and pleading requirements under the Employee Retirement Income...

Federal Judge Grants Health Insurers Summary Judgment In Reimbursement Dispute

NEWARK, N.J. - A New Jersey federal judge on Aug. 1 granted summary judgment in favor of health insurers in a reimbursement dispute and denied the plaintiffs' motion for class certification (Premier Health Center, et al. v. UnitedHealth Group, et al., No. 11-425, D. N.J.; 2013 U.S. Dist. LEXIS 108041...

3rd Circuit Reverses Dismissal Of Dispute Against Health Insurer; Analysis Wrong

PHILADELPHIA - A Third Circuit U.S. Court of Appeals panel on Aug. 16 reversed a putative class action reimbursement dispute against a health insurer, saying the lower court improperly relied on the defendant's competing account of events when dismissing the claim (TRi3 Enterprises v. Aetna Inc....

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...

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...

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...

9th Circuit Vacates Injunctions In Medicare Secondary Payer Class Action Suit

SAN FRANCISCO - A Ninth Circuit U.S. Court of Appeals panel on Jan. 2 filed an amended opinion vacating injunctions entered by a lower court prohibiting the secretary of the U.S. Department of Health and Human Services (DHHS) from demanding "up front" reimbursement for secondary payments from...