1st Circuit Affirms Dismissal Of Claims Against HMOs In Medicare Dispute

BOSTON - A First Circuit U.S. Court of Appeals panel on Sept. 7 affirmed the dismissal of a Medicare fee reimbursement suit, saying that the health maintenance organization defendants could compensate the plaintiff doctors in a manner of their choosing and that no antitrust violations occurred ( Carlos...

Health Insurer's Antitrust Claims Against Physicians May Continue, Federal Judge Rules

SAN JUAN, Puerto Rico - Humana Health of Puerto Rico Inc., a health insurer, sufficiently alleged that eight physicians violated federal and state antitrust laws by price-fixing, a federal judge in Puerto Rico ruled Sept. 17 in denying the physicians' motion to dismiss (Humana Health of Puerto Rico...

Blue Cross, Hospitals Ordered To Produce Documents In Federal Antitrust Suit

DETROIT - A Michigan federal magistrate judge on Oct. 1 ordered Blue Cross Blue Shield of Michigan and two nonparty hospitals to produce documents to the U.S. Department of Justice and the state in an action seeking to enjoin Blue Cross from including "most favored nation" (MFN) clauses in...

Provider's Misrepresentation Claims Not ERISA Preempted, Calif. Federal Judge Says

SAN DIEGO - A health-care provider's claims against insurers alleging that the insurers misappropriated his name and made misrepresentations to his patients by holding him out as a contracted provider, which negatively impacted his ability to recover additional amounts owed under his contracts with...

Wyeth, Officers To Pay $57M To Settle Securities Class Action Claims

NEW YORK - Wyeth Inc. and several of its executive officers have agreed to pay more than $67 million to settle claims that they misrepresented the safety and approvability of the drug Pristiq in violation of federal securities laws, according to a motion for settlement filed Nov. 9 in New York federal...

Antitrust Defendant Waived Right To Arbitrate Claim, 3rd Circuit Rules

PHILADELPHIA - A pharmacy benefit manager (PBM) waived its right to arbitrate antitrust claims against it by litigating the merits for 10 months, including its motion to dismiss, before filing a motion to compel arbitration, the Third Circuit U.S. Court of Appeals ruled Nov. 15, reversing a trial court...

High Court Hears Arguments On State-Action Doctrine In Hospital Merger Case

WASHINGTON, D.C. - The U.S. Supreme Court on Nov. 26 heard oral arguments regarding whether the state-action doctrine applied to immunize a merger between two Georgia hospitals from the Federal Trade Commission's challenge that the transaction substantially lessened competition or tended to create...

Michigan Federal Judge Declines To Dismiss Health Insurance Antitrust Case

DETROIT - A Michigan federal judge on Nov. 30 declined to dismiss a class action lawsuit alleging that a health insurance company's conduct of incorporating "most favored nation" (MFN) clauses into its contracts with hospitals results in antitrust violations; the judge said the plaintiffs...

Preliminary Approval Of Settlement In Out-Of-Network Reimbursement MDL Sought

NEWARK, N.J. - Parties involved in a multidistrict litigation case in which defendants are accused of manipulating the rates for which they reimburse out-of-network medical providers filed a joint motion on Dec. 7 asking a New Jersey federal judge to preliminarily approve a settlement valued up to $120...

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...

U.S. Supreme Court: Hospital Merger Is Not Immune From Antitrust Scrutiny

WASHINGTON, D.C. - The U.S. Supreme Court on Feb. 19 ruled that the state-action doctrine does not immunize the merger between two Georgia hospitals from the Federal Trade Commission's challenge that the transaction substantially lessened competition in the market for hospital services or tended...

DOJ, Michigan Move To Dismiss Antitrust Suit Against Blue Cross Over MFN Clauses

DETROIT - Following the Michigan Legislature's passage of bills prohibiting the use of "most favored nation" (MFN) clauses, the United States, Michigan and Blue Cross Blue Shield of Michigan on March 25 filed a joint motion to dismiss allegations that Blue Cross violated federal and state...

County Mental Health Board Is Immune From Antitrust Suit, Federal Judge Rules

ROCKFORD, Ill. - An action alleging that a community mental health board established by McHenry County, Ill., violated federal antitrust law by demanding recoupment of fees paid from an organization that the board found engaged in improper billing practices is barred by the state-action immunity doctrine...

Health Insurance Purchasers May Drop $4.8M Settlement Of Antitrust Litigation

PITTSBURGH - A federal judge in Pennsylvania on May 7 permitted purchasers of health insurance from Highmark Inc. to withdraw their motion for preliminary approval of their settlement with Highmark of their antitrust claims, where the purchasers argued that Highmark failed to disclose information that...

FTC Entitled To TRO In Merger Case, Georgia Federal Judge Rules

ALBANY, Ga. - A federal judge in Georgia on May 15 granted the Federal Trade Commission's motion to temporarily enjoin Phoebe Putney Health System Inc. from taking any further steps to consolidate Georgia hospitals and from making any price changes to existing contracts following the U.S. Supreme...

FTC, Hospitals Agree To Preliminary Injunction Halting Merger

ALBANY, Ga. - A federal judge in Georgia on June 5 approved the terms of a preliminary injunction agreed to by the Federal Trade Commission and Putney Health System Inc., enjoining the further integration of Georgia hospitals (Federal Trade Commission, et al. v. Phoebe Putney Health System Inc., et al...

Antitrust, Some ERISA Claims Dismissed From Wellpoint Reimbursement MDL

LOS ANGELES - A federal judge in California on July 19 dismissed antitrust and other claims alleging that WellPoint Inc. and other companies conspired to use a flawed database to set the rates for which out-of-network medical services (ONS) are reimbursed (In re: WellPoint Inc. Out-Of-Network "UCR"...

California Federal Judge Partially Grants Arbitration In Drug Trade Secret Suit

SAN FRANCISCO - A California federal judge on July 22 granted in part and denied in part a motion to compel arbitration in a class action lawsuit, alleging that a pharmacy benefit management company (PBM) and its related entities made unauthorized disclosures of customer information (Uptown Drug Company...

FTC Settles Charges That Georgia Hospital Merger Is Anti-Competitive

WASHINGTON, D.C. - The Federal Trade Commission and the Hospital Authority of Albany-Dougherty County and Phoebe Putney Health System Inc. on Aug. 22 settled FTC charges that the acquisition of Palmyra Park Hospital harmed competition in six Georgia counties (In the Matter of Phoebe Putney Health System...

Ill. Federal Judge Dismisses Antitrust Claims Against Health Insurer, Hospital

EAST ST. LOUIS, Ill. - An Illinois federal judge on Aug. 26 dismissed antitrust claims brought by an outpatient surgery center against a health insurance company and a corporation owning multiple hospitals in Illinois, holding that the plaintiff failed to properly show a relevant market (Marion Healthcare...

Ohio Federal Judge Grants In Part Motions To Compel Against Non-Party

DAYTON, Ohio - Non-party Community Insurance Co., doing business as Anthem Blue Cross and Blue Shield (Anthem), must produce certain documents regarding its deliberations not to contract with a medical center in the medical center's lawsuit claiming that it was denied contracts with managed care...

Judge: Provider Neither Competitor Not Consumer Of Insurer; Unfair Claim Fails

SACRAMENTO, Calif. - Claims that a health insurer misrepresented its power to authorize and provide coverage for treatment form the basis for a California unfair competition law (UCL) unlawful-prong claim, but because the provider is neither a consumer nor a competitor, its unfair-prong claim fails,...

Federal Judge Rules On Expert Testimony, Access In Merger Trial

BOISE, Idaho - The federal judge in Idaho overseeing the trial involving an antitrust challenge to a consummated merger between a hospital system and a physician group on Oct. 18 refused to exclude certain expert testimony regarding the impact of unwinding the merger and ruled that the Associated Press'...

Appeals Court Affirms Case Dismissal, Orders Transfer To Insurance Department

TRENTON, N.J. - A New Jersey appeals court in a Nov. 4 unpublished opinion affirmed the dismissal of chiropractors' challenge to a health insurer's policy provision limiting reimbursement of diagnostic imaging services but ordered the case transferred to the state insurance department for review...

California Federal Judge Remands Reimbursement Suit, Finds No Preemption Exists

SAN JOSE, Calif. - A California federal judge on Dec. 16 remanded a reimbursement dispute to state court, holding that the Employee Retirement Income Security Act did not preempt the state law claims (Bay Area Surgical Management v. United Healthcare Insurance Co., et al., No. 13-2512, N.D. Calif.; 2013...