Immigration Plan Won't Include Health Care Benefits

" Stephen W. Yale-Loehr , who teaches immigration law at Cornell, said he believed the president had the legal authority to decide whether the immigrants included in his executive actions qualified for federal health benefits. “Just as the president has broad discretion to decide whether to...

Mealey's Health Law - Iowa Appeals Court Affirms Denial Of Health Benefits As Excluded Under Policy

DES MOINES, Iowa - A panel of the Iowa Court of Appeals on Nov. 13 affirmed that a health care insurer properly denied coverage for sensory integration therapy and hyperbaric oxygen therapy used in the treatment of cerebral palsy as not covered under the policy (Ryan Gjerde, et al. v. UnitedHealthcare...

Mealey's Health Law - Reimbursement Action Seeks Legal, Not Equitable Relief, 2nd Circuit Rules

NEW YORK - A multiemployer welfare fund was not entitled to reimbursement from another insurer for benefits paid on behalf of a plan beneficiary who was covered by both insurers because the claims were not "appropriate equitable relief" under the Employee Retirement Income Security Act, the...

Mealey's Health Law - Health Insurer: Endo Paid Impax $112M To Delay Selling Generic Opana ER

BATON ROUGE, La. - Blue Cross Blue Shield of Louisiana on Nov. 17 filed a class action complaint in federal court, alleging that Endo Health Solutions Inc. paid a competitor at least $112 million to delay a generic drug until Endo could market a new, crush-resistant formula (Louisiana Health Service...

Mealey's Health Law - Federal Judge Grants Injunction To Privately Held For-Profit After Hobby Lobby

DETROIT - The government may not enforce the Patient Protection and Affordable Care Act (ACA) contraceptive mandate against a privately held for-profit company, a Michigan federal judge held Nov. 17 (M & N Plastics Inc., et al. v. Sylvia Burwell, et al., No. 13-14754, E.D. Mich.).

Mealey's Health Law - Judge Enjoins ACA Birth Control Mandate, Excludes Future Regulations

OKLAHOMA CITY - An Oklahoma federal judge on Nov. 19 enjoined application of the Patient Protection and Affordable Care Act (ACA) contraceptive mandate against Hobby Lobby Stores Inc. but limited his judgment to the regulation as it existed at the time of the Supreme Court's ruling on the issue ...

Mealey's Health Law - Government Tells 8th Circuit That Hobby Lobby Endorsed Accommodation

CEDAR RAPIDS, Iowa - The government on Nov. 18 responded to two religious schools' argument that Hobby Lobby was not an implicit endorsement of the Patient Protection and Affordable Care Act (ACA) accommodation allowing religious objectors to avoid paying for contraceptive insurance coverage as a...

Mealey's Health Law - U.S. House Files Suit Over Implementation Of ACA Employer Mandate, Funding

WASHINGTON, D.C. - The U.S. House of Representatives on Nov. 21 filed suit in the District of Columbia federal court against Sylvia Burwell, the U.S. Department of Health and Human Services (HHS) and others over implementation of the Patient Protection and Affordable Care Act (ACA) (United States House...

Mealey's Health Law - FDA Issues ACA-Mandated Nutritional Labeling Rules

WASHINGTON, D.C. - Restaurants, retail food establishments and vending machines with more than 20 locations will need additional nutritional labeling under rules finalized by the U.S. Food and Drug Administration on Nov. 25 in compliance with the Patient Protection and Affordable Care Act (ACA).

Mealey's Health Law - Louisiana Appeals Court: Plaintiffs Have Private Right Of Action Under Billing Act

GRETNA, La. - A Louisiana appeals court on Nov. 25 vacated a trial court's decision granting a hospital summary judgment and denying class certification in a wrongful billing suit, saying a recent state Supreme Court decision established that the plaintiffs had a private right of action under the...

Mealey's Health Law - 11th Circuit Applies Clear- Repudiation Rule To Termination Of ERISA Benefits

ATLANTA - A disability plan participant's cause of action under the Employee Retirement Income Security Act based on the termination of his benefits accrued when the participant had reason to know that the claims administrator clearly repudiated his claim for benefits, the 11th Circuit U.S. Court...

Mealey's Health Law - 1st Circuit: 'First-To-File' Rule Bars 2nd Medicare False Claims Act Suit

BOSTON - A panel of the First Circuit U.S. Court of Appeals on Dec. 1 affirmed that the "first-to-file" rule barred a False Claims Act (FCA) suit alleging that a pharmaceutical company defrauded federal Medicaid and Medicare programs (United States, ex rel. Ven-A-Care of The Florida Keys Inc...

Mealey's Health Law - 11th Circuit: Standing Lacking In ACA Employer Mandate Implementation Challenge

MIAMI - An orthodontics company lacks standing to challenge the delay in implementing the Patient Protection and Affordable Care Act (ACA)'s employer mandate, a divided 11th Circuit U.S. Court of Appeals panel held Dec. 2 (Kawa Orthodontics LLP v. Secretary, U.S. Department of the Treasury, et al...

DLA Piper: Binding Arbitration in Managed Care Contracts - 6 Tips to Tailor Your Dispute Resolution Provisions

By Stephen L. Goff and John Barnes The Affordable Care Act is moving millions of previously uninsured patients into commercial managed care health plans. As the healthcare system grapples with complexity of this shift, the size of disputes between healthcare providers and managed care payers, in terms...

DLA Piper: Government Turns Up the Heat With the False Claims Act – 5 Action Steps for Healthcare Providers

By Savaria B. Harris and Mitka T. Baker Forbes magazine has dubbed 2014 “The Year of the Whistleblower.” For healthcare providers, this designation has translated into millions of dollars in fines and penalties and the initiation of criminal investigations. Just last month, the Health...

Mealey's Health Law - Federal Judge Expands Injunction To Cover ACA Insurers, Administrators

OKLAHOMA CITY - A federal judge in Oklahoma on Dec. 3 modified an order enjoining the implementation of the Patient Protection and Affordable Care Act (ACA) contraceptive mandate, expanding it to prevent the government from interfering with insurers or third-party administrators (The Catholic Benefits...

Mealey's Health Law - 9th Circuit Rules On Permissible Offsets To Disability Benefits

SAN FRANCISCO - A long-term disability plan governed by the Employee Retirement Income Security Act properly offset a firefighters' workers' compensation settlement, but remand is necessary to determine the amount of salary continuation benefits that the plan can properly offset under the plan...

Mealey's Health Law - 10th Circuit: Denial Under Plan Proper Despite Award Of Social Security Benefits

DENVER - A disability insurer did not act arbitrarily or capriciously by terminating benefits under the any-reasonable-occupation disability standard of a plan governed by the Employee Retirement Income Security Act, despite a contrary determination by the Social Security Administration (SSA) under the...

Mealey's Health Law - Claims Over Fraudulent Billing Of Medicare Claims For Hospice Benefits Continue

BIRMINGHAM, Ala. - A federal judge in Alabama on Dec. 4 declined to dismiss False Claims Act (FCA) claims brought against the operator of 60 hospice facilities for allegedly submitting fraudulent claims to Medicare for people who were not eligible to receive hospice benefits, saying genuine issues of...

Mealey's Health Law - Connecticut Federal Judge Dismisses Medicare Case; Plaintiffs Have No Standing

NEW HAVEN, Conn. - A federal judge in Connecticut on Dec. 8 dismissed a class action lawsuit over the denial of Medicare benefits, holding that Medicare patients do not have standing to sue if Medicare denies a health care claim, but then Medicaid ends up paying the claim (Carolyn Hull v. Sylvia Burwell...

Mealey's Health Law - Nursing Assistant Sentenced To 150 Months For Role In Medicare Fraud Scheme

MIAMI - A nursing assistant was sentenced by a federal judge in Florida on Dec. 8 to 150 months in prison and ordered to pay $18.2 million in restitution for participating in a $200 million scheme to fraudulently bill Medicare for mental health services (United States v. Rodolfo Santaya, No. 14-cr-20052...

Mealey's Health Law - Parties In Pro-Life Group's Birth-Control Mandate Challenge Brief Court On Priests

WASHINGTON, D.C. - A pro-life employer and the government filed supplemental briefs on Dec. 10 in the District of Columbia federal court on the impact of a recent District of Columbia Circuit U.S. Court of Appeals ruling on the Patient Protection and Affordable Care Act (ACA) contraceptive mandate (March...

Mealey's Health Law - Solicitor General View Sought Regarding ERISA Preemption Of State Database Law

WASHINGTON, D.C. - The U.S. Supreme Court on Dec. 15 invited the solicitor general to weigh in on whether the court should grant 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 as applied...

Mealey's Health Law - Petition Denied; Law Prohibiting Use Of Abortion- Inducing Drugs Enjoined

WASHINGTON, D.C. - In denying a petition for writ of certiorari, the U.S. Supreme Court on Dec. 15 left standing a Ninth Circuit U.S. Court of Appeals decision reversing a lower court's decision denying Planned Parenthood of Arizona's motion for a preliminary injunction and remanding the case...

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...