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<title>LexisNexis&#174; Mealey's&#8482; Managed Care Liability Legal News</title>

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<description>Headline Managed Care Liability Legal News from LexisNexis&#174;</description>

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<copyright>Copyright 2009</copyright>

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<link>http://www.mealeysonline.com/mealey/ppv/articleSearch.do?searchTerm=%22%2013-21 Mealeys Man. Care Liab. Rep. 1%20(2009)%20%22&amp;pageLimit=10&amp;pageNumber=0&amp;publication=All+Mealey+Publications%3BMEALEY%3BMEALEY&amp;relativeDateValue=NONE&amp;fromDate=&amp;toDate=&amp;loc=mealeysrss</link>
<title>Federal Judge Grants PBM Summary Judgment In Reimbursement Case</title>
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<![CDATA[MONTGOMERY, Ala. - An Alabama federal judge on Oct. 29 granted summary judgment in favor of a pharmacy benefit manager (PBM) in a reimbursement dispute, saying that contracts between the parties permitted the PBM to amend the documents governing the updating of reimbursement methods (Pearson's Pharmacy Inc., et al. v. Express Scripts Inc., No. 06-73, M.D. Ala.; 2009 U.S. Dist. LEXIS 100915; See 6/20/07, Page 9). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-21 Mealey's Man. Care Liab. Rep. 1 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Plaintiffs File Briefs Opposing Dismissal Of Data Manipulation Case</title>
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<![CDATA[NEWARK, N.J. - Plaintiffs alleging that insurance companies and a database company manipulate the rates for which they reimburse out-of-network medical providers for services filed separate briefs on Oct. 28 in a New Jersey federal court opposing dismissal of their class action complaint (In re: Aetna UCR Litigation, MDL No. 2020, Master File No. 07-3541, D. N.J.; See 10/7/09, Page 5). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-21 Mealey's Man. Care Liab. Rep. 2 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>1st Circuit Panel Finds Remand Of Health Insurance Fraud Class Is Premature</title>
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<![CDATA[BOSTON - A federal judge's finding that removal jurisdiction under the Class Action Fairness Act (CAFA) does not attach if the complaint does not specifically define the putative class was premature, the First Circuit U.S. Court of Appeals ruled Oct. 22 (College of Dental Surgeons of Puerto Rico v. Connecticut General Life Insurance Company, et al., No. 09-2201, 1st Cir.; 2009 U.S. App. LEXIS 23299). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-21 Mealey's Man. Care Liab. Rep. 3 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>ERISA Doesn't Bar Provider's Reimbursement Claim Against Plan, 9th Circuit Says</title>
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<![CDATA[SAN FRANCISCO - The Employee Retirement Income Security Act does not preempt a medical service provider's claim that a welfare plan failed to reimburse the provider pursuant to the contractually set rates for services, a divided Ninth Circuit U.S. Court of Appeals affirmed Sept. 14 in an unpublished opinion (Board of Trustees of the Laborers Health and Welfare Trust Fund for Northern California v. Doctors Medical Center of Modesto, et al., No. 07-16710, 9th Cir.; 2009 U.S. App. LEXIS 20615; See 9/19/07, Page 11). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-21 Mealey's Man. Care Liab. Rep. 4 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>U.S. Supreme Court Grants Certiorari In FEHBA Case</title>
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<![CDATA[WASHINGTON, D.C. - The U.S. Supreme Court on Oct. 13 granted certiorari to determine whether the Federal Employees Health Benefits Act (FEHBA) completely preempts state court suits challenging enrollment and health benefits determinations made under FEHBA in a case in which a health plan administrator allegedly wrongfully removed a child from his mother's health care insurance (Health Care Service Corp. v. Juli A. Pollitt, et al., No. 09-38, U.S. Sup.). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-21 Mealey's Man. Care Liab. Rep. 5 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Louisiana Federal Judge Grants Summary Judgment In Denial Of Benefits Case</title>
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<![CDATA[NEW ORLEANS - A Louisiana federal judge on Oct. 20 granted summary judgment in favor of a plaintiff in a wrongful denial of benefits case, finding that a plan administrator's interpretation of "investigational" procedures was not a fair reading of the plan's medical policy (James F. Welch v. HMO Louisiana/Blue Cross, No. 08-4576, E.D. La.; 2009 U.S. Dist. LEXIS 97159). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-21 Mealey's Man. Care Liab. Rep. 6 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<link>http://www.mealeysonline.com/mealey/ppv/articleSearch.do?searchTerm=%22%2013-21 Mealeys Man. Care Liab. Rep. 7%20(2009)%20%22&amp;pageLimit=10&amp;pageNumber=0&amp;publication=All+Mealey+Publications%3BMEALEY%3BMEALEY&amp;relativeDateValue=NONE&amp;fromDate=&amp;toDate=&amp;loc=mealeysrss</link>
<title>Wisconsin Federal Judge Dismisses Wrongful Denial Of Benefits Case</title>
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<![CDATA[MILWAUKEE - A Wisconsin federal judge on Oct. 26 dismissed a wrongful denial of benefits case, saying that the plaintiff's health insurance policy did not provide for the benefits he sought and that he was not entitled to extracontractual relief (Jeffrey Smith v. Medical Benefit Administrators Group Inc., No. 09-538, E.D. Wis.; 2009 U.S. Dist. LEXIS 99322). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-21 Mealey's Man. Care Liab. Rep. 7 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>11th Circuit Finds Policy Term Not Ambiguous, Affirms Judgment</title>
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<![CDATA[ATLANTA - In affirming a lower court's decision, an 11th Circuit U.S. Court of Appeals Court panel in an Oct. 23 per curiam opinion held that the term "actual charges incurred" in a supplemental health insurance policy was not ambiguous and referred to the amount actually accepted by a hospital as payment in full and not the amount charged (Philadelphia American Life Insurance Co. v. Charles Buckles, No. 09-12533, 11th Cir.; 2009 U.S. App. LEXIS 23406). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-21 Mealey's Man. Care Liab. Rep. 8 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<link>http://www.mealeysonline.com/mealey/ppv/articleSearch.do?searchTerm=%22%2013-21 Mealeys Man. Care Liab. Rep. 9%20(2009)%20%22&amp;pageLimit=10&amp;pageNumber=0&amp;publication=All+Mealey+Publications%3BMEALEY%3BMEALEY&amp;relativeDateValue=NONE&amp;fromDate=&amp;toDate=&amp;loc=mealeysrss</link>
<title>Massachusetts Federal Judge Grants, Denies Attorney Fees In Drug-Pricing Case</title>
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<![CDATA[BOSTON - A federal Massachusetts judge on Oct. 20 partially granted and partially denied a motion for attorneys' fees and costs brought by an objector to the fees and costs sought by class counsel in a fraudulent drug-pricing case (New England Carpenters Health Benefits Fund, et al. v. First Databank Inc., et al., No. 05-11148, D. Mass.; 2009 U.S. Dist. LEXIS 97364; See 4/1/09, Page 5). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-21 Mealey's Man. Care Liab. Rep. 9 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Houses Introduces Health Care Reform Bill</title>
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<![CDATA[WASHINGTON, D.C. - House Speaker Nancy Pelosi of California on Oct. 29 announced the introduction of a health care bill aimed at expanding coverage to most Americans and overhauling the health insurance industry. 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-21 Mealey's Man. Care Liab. Rep. 10 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Plaintiffs Seek To Enforce Injunction Stopping Rate Reduction; Defendants Oppose</title>
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<![CDATA[LOS ANGELES - Plaintiffs seeking to stop the State of California from reducing reimbursement rates paid under the Medicaid program on Oct. 11 filed motions in two cases to enforce injunctions against implementing the reductions, while the state on Oct. 26 filed separate briefs opposing the reductions (Independent Living Center of Southern California, et al. v. David Maxwell-Jolly, director of Department of Health Services of the State of California, et al., No. 08-3315, Independent Living Center of Southern California Inc., et al. v. David Maxwell-Jolly director of Department of Health Services of the State of California, et al., No. 09-382 C.D. Calif.; See 9/2/09, Page 17). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-21 Mealey's Man. Care Liab. Rep. 11 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Father, Daughter Sue Insurer For Wrongly Denying Benefits</title>
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<![CDATA[LOS ANGELES - A California father and daughter on Oct. 13 sued their health insurer in federal court for allegedly wrongfully denying benefits for treatment of the girl's eating disorder at an inpatient facility (Ken Lancaster, et al. v. Blue Cross of California, No. 09-1184, C.D. Calif.). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-21 Mealey's Man. Care Liab. Rep. 12 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Illinois Man Sues Former Employer, Insurer For Failure To Pay Benefits</title>
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<![CDATA[CHICAGO - An Illinois man on Oct. 14 sued his former employer and health insurer in federal court for allegedly failing to pay benefits and failing to secure his rights under the Consolidated Omnibus Budget Reconciliation Act (COBRA) (Wynn Kanten v. OP Therapy Inc., et al., No. 09-6475, N. D. Ill.). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-21 Mealey's Man. Care Liab. Rep. 13 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Health Insurer Sues Auto Insurer In Federal Court To Recover Benefits Paid</title>
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<![CDATA[BATON ROUGE, La. - A Medicare Advantage health insurer on Oct. 19 sued an automobile insurer in Louisiana federal court to recover payments paid on behalf of one of its insureds that it says the automobile insurer should have paid pursuant to the Medicare Secondary Payer law (Humana Insurance Co. v. State Farm Mutual Automobile Insurance Co., No. 09-902, M.D. La.). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-21 Mealey's Man. Care Liab. Rep. 14 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>1st Circuit Declines To Hear Appeal En Banc</title>
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<![CDATA[BOSTON - The First Circuit U.S. Court of Appeals on Oct. 21 denied a request by Maine Attorney General Janet T. Mills to have heard en banc the appeal of an order granting a preliminary injunction to stop enforcement of the state's Prescription Privacy Law (IMS Health Inc., et al. v. Janet T. Mills, as attorney general for the state of Maine, No. 08-1248, 1st. Cir.; See 10/21/09, Page 10). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-21 Mealey's Man. Care Liab. Rep. 15 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Federal Judge Denies Motion To Reconsider</title>
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<![CDATA[SEATTLE - U.S. Judge Robert S. Lasnik of the Western District of Washington on Oct. 20 denied a motion to reconsider his decision granting the dismissal of a class action case alleging that an insurance company misrepresented the amounts preferred providers could charge (Kimberly Young, et al. v. Regence Blueshield, et al., No. 07-2008RSL, W.D. Wash.; See 8/19/19, Page 13). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-21 Mealey's Man. Care Liab. Rep. 16 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Companies Sued For Deceptive Marketing Of Discount Medical Plans</title>
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<![CDATA[BOSTON - Massachusetts Attorney General Martha Coakley on Oct. 13 filed a lawsuit against four companies, alleging that they were involved in deceptively marketing and selling a medical discount plan to hundreds of state residents. 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-21 Mealey's Man. Care Liab. Rep. 17 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>UnitedHealth Names Executive VP, General Counsel</title>
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<![CDATA[MINNEAPOLIS - UnitedHealth Group on Oct. 28 announced that the company has appointed Christopher J. Walsh and Mitchell Zamoff to the position of executive vice president and general counsel, effective immediately.? Zamoff and Walsh have shared the duties on an interim basis for UnitedHealth Group since January. 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-21 Mealey's Man. Care Liab. Rep. 18 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Hawaii Federal Judge Certifies Question To State Supreme Court</title>
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<![CDATA[HONOLULU - A Hawaii federal judge on Oct. 2 certified a question to the state Supreme Court, seeking to clear up a solvency question in a managed care Medicaid contract dispute (G. Parent and next friend of K v. State of Hawaii, Department of Human Service, et al., Nos. 08-551, 09-44, D. Hawaii; 2009 U.S. Dist. LEXIS 92504; See 5/20/09, Page 12). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-20 Mealey's Man. Care Liab. Rep. 1 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Federal Judge Dismisses Reimbursement Case; Few Factual Allegations Pleaded</title>
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<![CDATA[NEWARK, N.J. - A New Jersey federal judge on Oct. 7, in an unpublished opinion, dismissed a proposed class action lawsuit accusing a health insurer of making wrongful reimbursement for out-of-network medical services, finding that the complaint failed to assert substantial factual allegations. The judge gave the plaintiff the opportunity to replead the complaint (Cathleen McDonough v. Horizon Blue Cross Blue Shield of New Jersey, No. 09-571, D. N.J.; 2009 U.S. Dist. LEXIS 93642; See 2/18/09, Page 22). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-20 Mealey's Man. Care Liab. Rep. 2 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Health Plan To Federal Court: Amended Complaint Still Fails Under ERISA</title>
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<![CDATA[FORT LAUDERDALE, Fla. - A hospital's amended complaint asserting reimbursement claims should be dismissed because the claims are still barred by the Employee Retirement Income Security Act, the health plan argues in an Oct. 2 motion filed in Florida federal court (Florida Pediatric Critical Care v. Vista Healthplan of South Florida Inc., No. 09-60867, S.D. Fla.; See 9/16/09, Page 5). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-20 Mealey's Man. Care Liab. Rep. 3 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>$274M Pricing Verdicts Against 3 Major Drug Companies Vacated By Ala. High Court</title>
<description>
<![CDATA[MONTGOMERY, Ala. - The Alabama Supreme Court on Oct. 16 vacated $274 million in two prescription drug average wholesale price verdicts and entered judgment in favor of AstraZeneca LP, Novartis Pharmaceuticals Corp. and GlaxoSmithKline plc (GSK), finding that they did not defraud the state Medicaid program and cause it to pay higher-than-needed reimbursement to health care providers (AstraZeneca LP, et al. v. State of Alabama, Nos. 1071439 and 1071704, SmithKline Beecham Corporation, et al. v. State of Alabama, No. 1071704, and Novartis Pharmaceuticals Corporation v. Alabama, No. 1071759, Ala. Cir., Montgomery Co.) 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-20 Mealey's Man. Care Liab. Rep. 4 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>1st Circuit Urged To Affirm Preliminary Injunction Stopping Drug Data Law</title>
<description>
<![CDATA[BOSTON - A federal appeals court should affirm a preliminary injunction ruling to stop enforcement of Maine's Prescription Privacy Law because the law violates the First Amendment, due process clause and commerce clause, a health plan argues in an Oct. 5 brief (IMS Health Inc., et al. v. Janet T. Mills, as attorney general for the state of Maine, No. 08-1248, 1st. Cir.; See 9/16/09, Page 16). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-20 Mealey's Man. Care Liab. Rep. 5 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Magistrate Judge Finds Health Plan Entitled To Partial Payment Recovery</title>
<description>
<![CDATA[PORTLAND, Ore. - An Oregon federal magistrate judge on Oct. 13 held that a health plan can recover $50,000 paid in third-party liability by an auto insurance company but could not recover $50,000 paid by the auto insurance company in underinsured motorist coverage (Providence Health Plan v. Linda L. Charriere, No. CV-08-872-HU, D. Ore.; 2009 U.S. Dist. LEXIS 95013). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-20 Mealey's Man. Care Liab. Rep. 6 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Supreme Court Seeks Government's View On San Francisco's Health Care Law</title>
<description>
<![CDATA[WASHINGTON, D.C. - The U.S. Supreme Court on Oct. 5 invited the solicitor general to file a brief expressing the government's view on whether the court should review the Ninth Circuit U.S. Court of Appeals ruling holding that San Francisco's requirements that employers make a minimum level of health care expenditures for their employees are not preempted by the Employee Retirement Income Security Act (Golden Gate Restaurant Association v. City and County of San Francisco, et al., No. 08-1515, U.S. Sup.; See 7/8/09, Page 17). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-20 Mealey's Man. Care Liab. Rep. 7 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Tennessee Federal Judge Declines To Dismiss Failure To Pay Premiums Suit</title>
<description>
<![CDATA[KNOXVILLE, Tenn. - A Tennessee federal judge on Sept. 30 declined to dismiss a complaint by plaintiffs seeking recourse against their former employer for failing to pay premiums, which led to the cancellation of their health care coverage (Vickie Munsey, et al. v. Tactical Armor Products Inc., et al., No. 07-445, E.D. Tenn.; 2009 U.S. Dist. LEXIS 92096). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-20 Mealey's Man. Care Liab. Rep. 8 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Nebraska Federal Judge Denies Summary Judgment In Denial Of Benefits Case</title>
<description>
<![CDATA[OMAHA, Neb. - A Nebraska federal judge on Oct. 1 held that because the term "medical" in a health insurance policy was ambiguous, summary judgment in favor of a health insurer in a wrongful denial of benefits case based on a pre-existing condition was not proper (Daniel F. Erker v. American Community Mutual Insurance Co., No. 08-237, D. Neb.; 2009 U.S. Dist. LEXIS 91894). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-20 Mealey's Man. Care Liab. Rep. 9 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Judge Won't Transfer Case Seeking Reimbursement From Excess Insurer</title>
<description>
<![CDATA[TRENTON, N.J. - After finding that the desirability of Texas federal court as the proper venue is diminished by the burden and hardship that it would impose upon an employer, a New Jersey federal judge on Oct. 9 rejected a health insurance company's request to transfer venue (Middle Department Inspection Agency v. United RE AG, No. 09-1496, D. N.J.; 2009 U.S. Dist. LEXIS 94591). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-20 Mealey's Man. Care Liab. Rep. 10 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<link>http://www.mealeysonline.com/mealey/ppv/articleSearch.do?searchTerm=%22%2013-20 Mealeys Man. Care Liab. Rep. 11%20(2009)%20%22&amp;pageLimit=10&amp;pageNumber=0&amp;publication=All+Mealey+Publications%3BMEALEY%3BMEALEY&amp;relativeDateValue=NONE&amp;fromDate=&amp;toDate=&amp;loc=mealeysrss</link>
<title>Federal Judge Won't Reconsider Plan's Rate Dispute</title>
<description>
<![CDATA[SEATTLE - A federal judge on Aug. 10 rejected a request to reconsider a decision to dismiss class action allegations that an insurance company misrepresented the amounts preferred providers could charge (Kimberly Young, et al. v. Regence Blueshield, et al., No. 07-2008RSL, W.D. Wash.; See 8/19/09, Page 14). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-20 Mealey's Man. Care Liab. Rep. 11 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Worker: Motion Premature In Denial Of Benefits Case</title>
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<![CDATA[EAST ST. LOUIS, Ill. - A federal judge should deny a motion for summary judgment in a case where a health plan administrator denied benefits because the motion is premature, a worker argues in a Sept. 30 response (Cynthia Whitcher v. Meritain Health Inc., et al., No. 08-634, S.D. Ill.; See 8/10/09, Page 15). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-20 Mealey's Man. Care Liab. Rep. 12 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Objectors To Class Settlement Appeal $70M Fee Award In Drug-Pricing Case</title>
<description>
<![CDATA[BOSTON - After a federal Massachusetts judge approved $70 million in attorney fees following a $350 million settlement in a class action fraudulent drug-pricing case, class members opposing the settlement filed notices of appeal (New England Carpenters Health Benefits Fund, et al. v. First Databank Inc., et al., No. 05-11148, D. Mass.; 2009 U.S. Dist. LEXIS 68419; See 8/19/09, Page 4). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-20 Mealey's Man. Care Liab. Rep. 13 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>3rd Circuit Vacates Arbitration Order In PBM Antitrust Case</title>
<description>
<![CDATA[PHILADELPHIA - A panel of the Third Circuit U.S. Court of Appeals on Sept. 24 vacated a multidistrict litigation judge's order vacating an arbitration order issued by the transferor judge in an antitrust case, finding that a transferee judge has no authority to vacate an order of a transferor court (In re: Pharmacy Benefit Managers Antitrust Litigation, Bellevue Drug Co., et al. v. Caremark, No. 07-1151, 3rd Cir.; 2009 U.S. App. LEXIS 21125; See 2/7/07, Page 18). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-19 Mealey's Man. Care Liab. Rep. 1 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Aetna Moves To Dismiss All Claims Against It In Data Manipulation MDL</title>
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<![CDATA[NEWARK, N.J. - Aetna companies on Sept. 9 moved to dismiss all cases against them in the recently formed multidistrict litigation in which the plaintiffs have alleged that the insurers manipulate the rates for which they reimburse out-of-network medical providers for services (In re: Aetna UCR Litigation, MDL No. 2020, Master File No. 07-3541, D. N.J.; See 4/15/09, Page 4). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-19 Mealey's Man. Care Liab. Rep. 2 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>New Jersey Federal Judge Grants, Denies Dismissal Of Claims</title>
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<![CDATA[NEWARK, N.J. - A New Jersey federal judge on Sept. 30 partially granted and partially denied an insurer's motion to dismiss a reimbursement suit, holding that the provider had standing to bring claims but that the plaintiff had not established that the defendant was a fiduciary owing any duty to the health plan's beneficiaries (Glen Ridge SurgiCenter v. Horizon Blue Cross Blue Shield of New Jersey, No. 08-6160, D. N.J.; 2009 U.S. Dist. LEXIS 90600). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-19 Mealey's Man. Care Liab. Rep. 3 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Texas Federal Judge Declines Remand In Reimbursement Dispute</title>
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<![CDATA[HOUSTON - A Texas federal judge on Sept. 29 declined to remand a case alleging that an insurance company wrongly stopped reimbursing claims, finding that federal question jurisdiction existed under the Employee Retirement Income Security Act because the plaintiff had received assignments of benefits from the patients treated (Quality Dialysis One, et al. v. Aetna Life Insurance Co., et al., No. 08-1121, S.D. Texas; 2009 U.S. Dist. LEXIS 89672). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-19 Mealey's Man. Care Liab. Rep. 4 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Divided Montana Supreme Court Affirms Disapproval Of Insurance Exclusions</title>
<description>
<![CDATA[HELENA, Mont. - In a divided opinion, the Montana Supreme Court on Sept. 24 affirmed that a health insurance company's exclusions in its forms violated state law by improperly attempting to exercise subrogation rights, thus the state's insurance commissioner properly disapproved the forms (Blue Cross and Blue Shield of Montana Inc. v. Montana State Auditor, et al., No. 09-0060, Mont. Sup.; 2009 Mont. LEXIS 466). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-19 Mealey's Man. Care Liab. Rep. 5 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Louisiana Federal Judge Dismisses Reimbursement Case; Jurisdiction Lacking</title>
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<![CDATA[NEW ORLEANS - A Louisiana federal judge on Sept. 30 dismissed a reimbursement dispute, holding that the court did not have jurisdiction over the defendants, none of whom had sufficient contacts with the state (Choice Healthcare Inc., et al. v. Kaiser Foundation Health Plan of Colorado, et al., No. 09-12, E.D. La.; 2009 U.S. Dist. LEXIS 90741). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-19 Mealey's Man. Care Liab. Rep. 6 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>California Federal Judge Denies Venue Transfer In Denial Of Benefits Case</title>
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<![CDATA[LOS ANGELES - A California federal judge on Sept. 10 declined to dismiss a wrongful denial of benefits case, holding that jurisdiction was proper in the state even though the insurer was based in Texas because the defendant had availed itself of the privilege of conducting business in California (Tamara L. Hajjar v. Blue Cross and Blue Shield of Texas, No. 09-362, C.D. Calif.; 2009 U.S. Dist. LEXIS 84835). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-19 Mealey's Man. Care Liab. Rep. 7 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Kansas Federal Judge: Insurer Properly Removed Denial Of Benefits Case</title>
<description>
<![CDATA[KANSAS CITY, Kan. - A Kansas federal judge on Sept. 24 held that a health insurer properly removed a wrongful denial of benefits case because the plan at issue qualifies as an employee benefits welfare plan under the Employee Retirement Income Security Act even though it was not specifically designated as such (Rita Shultz v. Blue Cross and Blue Shield of Kansas Inc., No. 09-1220, D. Kan.; 2009 U.S. Dist. LEXIS 88281). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-19 Mealey's Man. Care Liab. Rep. 8 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>California Appeals Court Affirms Insurer Within Bounds To Terminate Contract</title>
<description>
<![CDATA[LOS ANGELES - A California state appeals court on Sept. 29 in an unpublished opinion affirmed that a dermatologist group was not entitled to common0law fair procedures following the termination of its contract for breaching terms of the agreement (California Dermatology Center Inc., et al. v. United Healthcare Services Inc., et al., No. B207028 Calif. App., 2nd Dist.; 2009 Cal. App. Unpub. LEXIS 7801). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-19 Mealey's Man. Care Liab. Rep. 9 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Plaintiffs Ask Judge To Reconsider Order Denying Class Certification</title>
<description>
<![CDATA[AUGUSTA, Ga. - Plaintiffs suing a preferred provider organization and discount insurer in a Georgia federal court for misappropriation asked the judge on Sept. 8 to reconsider his Aug. 24 order denying their case class certification (William Andrew Rivell, M.D., et al. v. Private Healthcare Systems Inc., et al., No. 06-176, S.D. Ga.; See 8/5/09, Page 13). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-19 Mealey's Man. Care Liab. Rep. 10 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>California Federal Judge Enters Default Judgment For Failure To Pay Bills</title>
<description>
<![CDATA[SACRAMENTO, Calif. - A California federal judge on Sept. 11 entered default judgment in favor of a hospital seeking payment from four people it treated who did not pay their hospital bills (Dameron Hospital Association v. Premera Blue Cross, et al., No. 07-1818, E.D. Calif.; 2009 U.S. Dist. LEXIS 83277). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-19 Mealey's Man. Care Liab. Rep. 11 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>6th Circuit Affirms Benefits Wrongly Denied; Medical Center Entitled To Award</title>
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<![CDATA[CINCINNATI - A Sixth Circuit U.S. Court of Appeals panel on Sept. 22 affirmed that a health plan administrator wrongly denied benefits and that the medical center providing the health care services was entitled to an award of benefits, but the court reversed a finding that the plaintiff was entitled to attorney fees (Shelby County Health Care Corp. v. The Majestic Start Casino, LLC Group Health Benefit Plan, Nos. 08-6078/6419; 6th Cir.). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-19 Mealey's Man. Care Liab. Rep. 12 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Ohio Federal Judge Denies Attorney Fees, Motion To Vacate</title>
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<![CDATA[CLEVELAND - An Ohio federal judge on Sept. 23 denied a defense motion for attorney fees and the plaintiff's motions to file a brief instanter and to vacate a judgment dismissing her denial of benefits case, saying that fees were not warranted and that the plaintiff's attorney had no good reason for failing to file a brief opposing summary judgment (Meredith Solomon v. Medical Mutual Of Ohio, No. 09-3, N.D. Ohio; 2009 U.S. Dist. LEXIS 87480; See 9/2/09, Page 13). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-19 Mealey's Man. Care Liab. Rep. 13 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>New Jersey Federal Judge Dismisses 2 Defendants In Denial Of Benefits Case</title>
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<![CDATA[NEWARK, N.J. - A New Jersey federal judge on Sept. 21 in an unpublished opinion dismissed claims against two insurance companies in a wrongful denial of benefits case, finding that the defendants did not owe the plaintiff any duty and had made no representations to her about the coverage upon which she relied (Michelle Sander v. HR Trust Services, et al., No. 08-1383, D. N.J.; 2009 U.S. Dist. LEXIS 86194). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-19 Mealey's Man. Care Liab. Rep. 14 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Progress Being Made On Health Care Reform Legislation</title>
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<![CDATA[WASHINGTON, D.C. - Progress is being made to clear the way for debates to begin on landmark health care reform legislation. 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-19 Mealey's Man. Care Liab. Rep. 15 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Bills To Repeal Antitrust Exemption For Health Insurers Introduced</title>
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<![CDATA[WASHINGTON, D.C. - Bills titled "Health Insurance Industry Antitrust Enforcement Act of 2009" were introduced Sept. 17 in the U.S. House of Representatives and U.S. Senate that would partially repeal the exemption for health insurance issuers and medical malpractice insurance issuers from federal antitrust laws. 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-19 Mealey's Man. Care Liab. Rep. 16 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Texas EMS Company Owners Convicted Of Health Fraud</title>
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<![CDATA[BEAUMONT, Texas - The owners of Priority One EMS in Jasper, Texas, were convicted Sept. 11 of one charge of conspiracy to commit health fraud and 20 counts of mail fraud arising out of allegations that they made false claims for reimbursement for ambulance services for dialysis patients who were not bed-confined or otherwise qualified for ambulance transportation (United States v. Claudette Read, et ux., No. 1:09-cr-00040, E.D. Texas). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-19 Mealey's Man. Care Liab. Rep. 17 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Texas Man Sues Insurer In Federal Court, Says Coverage Wrongfully Rescinded</title>
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<![CDATA[HOUSTON - A Texas man on Sept. 15 sued his insurer in federal court for allegedly wrongfully rescinding his health insurance after learning that he had cancer of the esophagus (Stephen K. Smith v. Blue Cross Blue Shield of Texas, No. 09-3008, S. D. Texas). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-19 Mealey's Man. Care Liab. Rep. 18 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Florida Man Sues Insurer, Says Benefits Wrongly Denied</title>
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<![CDATA[TAMPA, Fla. - A Florida man on Sept. 21 sued his health insurer in federal court for allegedly failing to pay for his surgery and failing to provide a written explanation as to why his benefits were denied (Scott Harding v. Blue Cross and Blue Shield of Georgia, No. 09-1919, M.D. Fla.). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-19 Mealey's Man. Care Liab. Rep. 19 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Supreme Court Denies Certiorari In Reimbursement Case</title>
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<![CDATA[WASHINGTON, D.C. - The U.S. Supreme Court on Oct. 5 denied a petition for writ of certiorari, leaving in place a decision granting judgment in favor of a health insurer in a reimbursement dispute (George Schoedinger, M.D., et al. v. United Healthcare of the Midwest, No. 09-80, U.S. Sup.; See 5/6/09, Page 27). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-19 Mealey's Man. Care Liab. Rep. 20 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Hewitt: Few Changes Expected To Benefits Plans</title>
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<![CDATA[LINCOLNSHIRE, Ill. - With the possibility of health care reform coming soon, most U.S. employers are taking a "wait and see" approach and forgoing significant overhauls to their benefits plans in 2010, according to information released by Hewitt Associates on Sept. 30. 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-19 Mealey's Man. Care Liab. Rep. 21 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>New Jersey Hospital To Pay $8.3 Million For Medicare Fraud</title>
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<![CDATA[WASHINGTON, D.C. - The University of Medicine and Dentistry of New Jersey (UMDNJ) agreed to pay the government $8.3 million to settle allegations that it illegally paid kickbacks to cardiologists and caused the submission of false claims to Medicare, the U.S. Justice Department announced Sept. 30. 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-19 Mealey's Man. Care Liab. Rep. 22 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Indiana, Alabama Hospitals To Settle False Claims Act Allegations</title>
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<![CDATA[WASHINGTON, D.C. - Six hospitals in Indiana and Alabama have agreed to pay the United States more than $8 million to settle allegations that the health care facilities submitted false claims to Medicare, the U.S. Department of Justice announced Sept. 29. 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=13-19 Mealey's Man. Care Liab. Rep. 23 (2009)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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