http://www.lexisnexis.com/mealeys/news.aspx Headline Managed Care Liability Legal News from LexisNexis® en-us http://www.lexisnexis.com/mealeys/images/lexismealeyslogo.gif 130 29 http://www.lexisnexis.com/mealeys/news.aspx Copyright 2013 http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%201%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' PITTSBURGH - A Pennsylvania federal judge on May 8 granted a motion to reconsider the dismissal of claims brought by a private, nonprofit college, two for-profit entities and the owners of those entities who are challenging the "birth control" mandate contained in the Patient Protection and Affordable Care Act (PPACA), saying that the claims are now ripe for review. The judge then went on to partially grant and partially deny the defendants' motion to dismiss (Geneva College, et al. v. Kathleen Sebelius, et al., No. 12-207, W.D. Pa.; 2013 U.S. Dist. LEXIS 65685; See 5/1/13, Page 4). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%202%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' BROOKLYN, N.Y. - A New York federal judge on April 24 partially granted the federal government's emergency motion to halt proceedings in a challenge to a provision in the Patient Protection and Affordable Care Act (PPACA) mandating that all health plans provide preventive services for free, including those for birth control (The Roman Catholic Archdiocese of New York, et al. v. Kathleen Sebelius, No. 12-2542, E.D. N.Y.; See 12/19/12, Page 5). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%203%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' WASHINGTON, D.C. - A District of Columbia Circuit U.S. Court of Appeals panel on May 3 granted the federal government's motion for voluntary dismissal of interlocutory appeal in a case challenging the grant of a preliminary injunction in favor of a for-profit Christian publishing company seeking to halt the implementation of the contraception mandate contained in the Patient Protection and Affordable Care Act (PPACA) (Tyndale House Publishers Inc., et al. v. Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, et al., No. 13-5018, D.C. Cir.; See 12/5/12, Page 6). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%204%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' WASHINGTON, D.C. - Plaintiffs challenging the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) on April 30 asked the District of Columbia Circuit U.S. Court of Appeals to reverse a lower court decision denying their motion for preliminary injunction for their violation of the Religious Freedom Restoration Act (RFRA) claim (Francis A. Gilardi, et al. v. United States Department of Health and Human Services, et al., No. 13-5069, D.C. Cir.; See 4/3/13, Page 4). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%205%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' FORT LAUDERDALE, Fla. - A Florida federal judge on May 7 dismissed a putative class action case against a health insurer and a third-party administrator accused of inflating medical loss ratios to avoid paying rebates for excessive premiums to subscribers as mandated by the Patient Protection and Affordable Care Act (PPACA) for lack of standing and ordered arbitration for claims against a second third-party administrator (MRI Scan Center v. National Imaging Associates Inc., et al., No. 13-60051, S.D. Fla.). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%206%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' SAN JOSE, Calif. - A California appeals court panel held in a May 9 unpublished opinion that a hospital has no duty to inform patients admitted to the emergency room that emergency room physicians do not accept a particular health care plan and to take action to prevent emergency room physicians from "balance billing" (Maria Leon, et al. v. Watsonville Hospital Corp., No. H037288, Calif. App., 6th Dist.; 2013 Cal. App. Unpub. LEXIS 3297). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%207%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' DALLAS - A Texas federal judge on May 2 granted health care providers' motion to amend their complaint against insurance companies in a reimbursement dispute, saying that defendant the plaintiffs sought to add was a necessary party to the action (Paragon Office Services, et al. v. Aetna Inc., et al., No. 11-1898, N.D. Texas; 2013 U.S. Dist. LEXIS 62804; See 7/5/12, Page 11). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%208%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' LOS ANGELES - A California federal judge on April 29 dismissed a federal false advertising claim from a reimbursement dispute between medical providers and health insurers and declined to exercise supplemental jurisdiction over the remaining state claims (Los Angeles County Medical Association, et al. V. Aetna Health of California Inc., et al., No. 12-11020, C.D. Calif.). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%209%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' NEW ORLEANS - A divided en banc Fifth Circuit U.S. Court of Appeals on May 7 held that the Employee Retirement Income Security Act permits health plan fiduciaries to seek reimbursement for medical benefits the plan paid on behalf of a participant from a special needs trust funded by a third-party tortfeasor settlement (ACS Recovery Services, Inc., et al. v. Larry Griffin, et al., No. 11-40446, 5th Cir.; 2013 U.S. App. LEXIS 9324; See 8/15/12, Page 18). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2010%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' LAFAYETTE, La. - A Louisiana federal judge on May 1 denied a plaintiff's motion to remand her wrongful denial of prescription benefits case to state court (Amelia Simon v. Express Scripts Inc., et al., No. 13-187, W.D. La.; 2013 U.S. Dist. LEXIS 63132). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2011%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' FLINT, Mich. - A federal judge in Michigan on May 3 declined to dismiss on statute of limitations grounds an employer's claim that Blue Cross and Blue Shield of Michigan (BCBS) violated the Employee Retirement Income Security Act by charging hidden fees that were not included in the parties' administrative service contract (ASC) (East Jordan Plastics, Inc., et al. v. Blue Cross and Blue Shield of Michigan, No. 12-cv-15621, E.D. Mich.; 2013 U.S. Dist. LEXIS 63475). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2012%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' PHILADELPHIA - A federal judge properly imposed a $10 per day penalty on a former employer under the Comprehensive Omnibus Budget Reconciliation Act of 1986 (COBRA) because the former employer was 293 days late in providing notice to its employee of her rights, even though the former employer mistakenly continued the employee's coverage after the termination of her employment, the Third Circuit U.S. Court of Appeals ruled April 10 in an unpublished opinion (Sarah Fama v. Design Assistance Corporation, et al., Nos. 12-2414, 12-2474, 3rd Cir.; 2013 U.S. App. LEXIS 7225). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2013%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' SACRAMENTO, Calif. - A California appeals court on May 2 held that federal law does not prohibit the application of California's two-visit rule to psychology services provided by federally qualified health centers (FQHCs) to Medi-Cal patients (Mendocino Community Health Clinic, et al. v. State Department of Health Care Services, No. C067826, Calif. App., 3rd Dist.; 2013 Cal. App. LEXIS 350). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2014%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' NEW ORLEANS - The Fifth Circuit U.S. Court of Appeals on May 1 affirmed a federal trial court order denying judicial review of a challenge to the U.S. Department of Health and Human Services (HHS) Medicare Part D rule allowing prescription drug plans (PDPs) to establish preferred pharmacy networks. The appeals court found that the limited exception to the requirement of exhausting the administrative appeals process does not apply in the instant case (Southwest Pharmacy Solutions Inc. v. Centers for Medicare and Medicaid Services, et al., No. 12-40097, 5th Cir.; 2013 U.S. App. LEXIS 8923). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2015%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' BOSTON - A Massachusetts federal judge on May 9 dismissed a Medicare payment dispute, saying that the plaintiff home health agency failed to exhaust administrative remedies and that, therefore, the court lacked jurisdiction to hear the case (MJG Management Associates Inc. v. NHIC Corp., et al., No. 12-11414, D. Mass.; 2013 U.S. Dist. LEXIS 66238). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2016%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' MIAMI - A federal judge in the U.S. District Court for the Southern District of Florida on April 30 affirmed a U.S. Department of Health and Human Services (HHS) ruling that an outpatient rehabilitation facility's Medicare billing privileges were properly revoked because the facility was not properly staffed with qualified medical professionals (CompRehab Wellness Group Inc. v. Kathleen Sebelius, Secretary of Health and Human Services, No. 1:11cv23377, S.D. Fla.; 2013 U.S. Dist. LEXIS 61567). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2017%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' CHICAGO - An Illinois federal judge on May 6 partially granted a defendant's motion for an order directing the federal government to file a bill of particulars in its case against him for Medicare fraud (United States of America v. Robert Kolbusz, No. 12-782, N.D. Ill.; 2013 U.S. Dist. LEXIS 64043). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2018%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' NEWARK, N.J. - A New Jersey orthopedic surgeon on May 3 sued a health insurer in federal court for allegedly failing to pay the proper reimbursement rate for out-of-network services he provided to a patient insured by the defendant (Dr. Christopher Johnson v. Blue Cross Blue Shield of Oklahoma, et al., No. 13-2875, D. N.J.). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2019%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' COVINGTON, Ky. - A Kentucky woman on April 30 sued her health insurer and its agent in federal court for allegedly failing to pay the proper amount for her mammogram (Julie A. Lester v. Business Benefits Inc., et al., No. 13-69, E.D. Ky.) http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2020%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' President Obama signed the Patient Protection and Affordable Care Act (PPACA), as amended by the Health Care and Education Reconciliation Act, on March 23, 2010. One of the main requirements of the act is that most Americans without insurance obtain coverage or face a penalty. Other provisions will stop insurance companies from dropping or denying care to people with pre-existing conditions and expand the federal-state Medicaid insurance program for the poor to cover people with incomes up to 133 percent of the federal poverty level and to cover childless adults for the first time, starting in 2014. The act also requires most employers to provide birth control coverage as part of their employee health plans or be subject to fines and penalties. http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%201%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' PITTSBURGH - A Pennsylvania federal judge on April 19 granted a motion for a preliminary injunction in a case brought by a private, nonprofit college, two for-profit entities and the owners of those entities who are challenging the "birth control" mandate contained in the Patient Protection and Affordable Care Act (PPACA) (Geneva College, et al. v. Kathleen Sebelius, et al., No. 12-207, W.D. Pa.; 2013 U.S. Dist. LEXIS 56087; See 3/20/13, Page 6). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%202%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' BROOKLYN, N.Y. - A New York federal judge on April 12 granted the federal government's motion to dismiss a challenge to the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA), saying the claims are not ripe for review (Priests for Life v. Kathleen Sebelius, et al., No. 12-753, E.D. N.Y.; 2013 U.S. Dist. LEXIS 55082). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%203%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' DALLAS - A Texas federal judge on April 9 granted a motion to dismiss a challenge to the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA), finding that the case was not ripe for judicial consideration (The Criswell College v. Kathleen Sebelius, et al., No. 12-44090, N.D. Texas; 2013 U.S. Dist. LEXIS 56694). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%204%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' WASHINGTON, D.C. - A District of Columbia U.S. Circuit Court of Appeals panel on April 17 denied an emergency motion for injunction pending the appeal of the dismissal of a challenge of changes to Medicare arising from the Patient Protection and Affordable Act (PPACA) (Association of American Physicians & Surgeons Inc., et al. v. Kathleen G. Sebelius, et al., No. 13-5003, D.C. Cir.; See 4/3/13, Page 8). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%205%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' ST. LOUIS - The federal government on April 10 asked the Eighth Circuit U.S. Court of Appeals to affirm a lower court's decision denying a preliminary injunction in a suit challenging the "birth control" mandate contained in the Patient Protection and Affordable Care Act (PPACA) (Annex Medical Inc., et al. v. Kathleen Sebelius, et al., No. 13-1118, 8th Cir.; See 3/20/13, Page 9). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%206%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' WASHINGTON, D.C. - The federal government on April 17 urged the District of Columbia Circuit U.S. Court of Appeals to affirm the dismissal of a case challenging a provision in the Patient Protection and Affordable Care Act (PPACA) mandating that all health plans provide preventive services for free, including those for birth control (Roman Catholic Archbishop of Washington, et al. v. Kathleen Sebelius, et al., No. 13-5091, D.C. Cir.; See 4/17/13, Page 5). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%207%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' DETROIT - A Michigan appeals panel on April 18 partially affirmed and partially reversed class certification of five classes in a suit alleging that a health insurer failed to properly reimburse chiropractors (Michigan Association of Chiropractors, et al. v. Blue Care Network of Michigan Inc., No. 304783, Mich. App.; 2013 Mich. App. LEXIS 724). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%208%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' DETROIT - A Michigan appeals panel on April 18 partially affirmed and partially reversed class certification in a suit alleging that a health insurer failed to properly reimburse chiropractors (Michigan Association of Chiropractors, et al. v. Blue Cross Blue Shield, No. 304763, Mich. App.; 2013 Mich. App. LEXIS 721). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%209%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' NEWARK, N.J. - A New Jersey federal judge on April 15 recused himself from a class action multidistrict litigation case involving a dispute over out-of-network reimbursement rates, saying he had a disqualifying interest in the case (In Re: Aetna UCR Litigation, Master File No. 07-3541, MDL 2020, D. N.J.; 2013 U.S. Dist. LEXIS 54864; See 2/16/13, Page 17). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2010%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' NEWARK, N.J. - A New Jersey federal judge on April 15 declined to recuse himself from a case in which health plan participants are suing a health care insurer for using flawed data to calculate the reimbursement rate for out-of-network providers and vacating his decision denying class certification (Darlery Franco v. Connecticut General Life Insurance Co., et al., No. 07-6039, D. N.J.; 2013 U.S. Dist. LEXIS 54867; See 2/20/13, Page 10). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2011%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' ATLANTA - A plan insurer's calculation of benefits due to a participant for his out-of-network surgery was not wrong under the plan terms, and the insurer did not violate the Employee Retirement Income Security Act by failing to provide documents on which the insurer relied to calculate and verify the benefits due, the 11th Circuit affirmed April 22 (Brian Fox v. Blue Cross and Blue Shield of Florida Inc., No. 12-14569, 11th Cir.; 2013 U.S. App. LEXIS 7906). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2012%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' NEWARK, N.J. - A New Jersey federal judge on April 17 dismissed claims against four health care payers in a reimbursement dispute, saying that either the defendants were not subject to the Employee Retirement Income Security Act or were not proper parties; he left claims against seven other defendants, saying that the plaintiff exhausted administrative remedies before filing suit (Sportscare of America v. Multiplan Inc., et al., No. 10-4414, D. N.J.; 2013 U.S. Dist. LEXIS 54947). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2013%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' MEMPHIS, Tenn. - A health insurance plan administrator's denial of benefits was not arbitrary and capricious, even though the administrator gave three different reasons for the denial at different times in the administrative process, because substantial evidence supported one of the three proffered reasons, a federal judge in Tennessee ruled April 23 (Joseph M. Morrison, et al. v. Regions Financial Corporation, et al., No. 10-2843, W.D. Tenn.; 2013 U.S. Dist. LEXIS 57921; See 12/1/10, Page 18). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2014%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' NEW YORK - A New York federal judge on April 19 dismissed a health care copayment dispute, finding that the plaintiff lacked standing to bring her claims (Marianne Gates v. United Healthcare Insurance Co., et al., No. 11-3487, S.D. N.Y.; 2013 U.S. Dist. LEXIS 56619). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2015%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' WAUSAU, Wis. - A Wisconsin appeals court on April 2 partially affirmed and partially reversed a dispute seeking payment for medical bills from a health care provider after the provider failed to obtain precertification for a patient's surgeries (David R. Evers v Orthopedic Clinic of Appleton Inc., et al., No. 2011AP2551, Wis. App., 3rd Dist.; 2013 Wisc. App. LEXIS 281). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2016%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' AUSTIN, Texas - The Texas Supreme Court on April 19 held that health care providers could not assert a prompt-pay violation against a health maintenance organization because it had contracts only with the HMO's network and not the HMO (Christus Health Gulf Coast, et al. v. Aetna Inc., et al., No. 11-483, Texas Sup.; 2013 Tex. LEXIS 296). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2017%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' OKLAHOMA CITY - An Oklahoma federal judge on April 18 denied a motion to dismiss a breach of contract claim related to the payment for prescription drugs, saying that the court had personal jurisdiction over the out-of-state defendants and that the plaintiff sufficiently supported its claims (Pharmacy Providers of Oklahoma Inc. v. Q Pharmacy Inc., et al., No. 12-1405, W.D. Okla.; 2013 U.S. Dist. LEXIS 55567). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2018%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' SAN DIEGO - A hospital system failed to allege that a managed care organization and its related entities conspired with a labor union to exclude competition in the markets for emergency and acute care hospital services, a federal judge in California tentatively ruled April 4 (Prime Healthcare Services, Inc. v. Service Employees International Union, et al., No. 11-2652, S.D. Calif.; 2013 U.S. Dist. LEXIS 49189). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2019%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' JONESBORO, Ark. - An Arkansas federal judge on April 18 denied a health insurer's motion to dismiss a wrongful rescission of a health insurance policy, saying the plaintiff pleaded a plausible claim for breach of contract (William Masterson v. Starr Indemnity & Liability Co., No. 13-79, E.D. Ark.; 2013 U.S. Dist. LEXIS 55641). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2020%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' SAN FRANCISCO - A Ninth Circuit U.S. Court of Appeals panel on April 19 affirmed that a private Medicare Advantage Organization (MAO) plan cannot sue a plan participant's survivors for reimbursement of expenses paid out of the proceeds of an automobile insurance policy (Guillermina Parra, et al. v. PacifiCare of Arizona Inc., No.11-16069, 9th Cir.; 2013 U.S. App. LEXIS 7861). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2021%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' CINCINNATI - A Sixth Circuit U.S. Court of Appeals panel on April 24 dismissed as moot an appeal challenging an order granting a temporary injunction in a Medicaid provider dispute and affirmed the lower court decision denying the defendant's bond motion (Appalachian Regional Healthcare Inc., et al. v. Coventry Health and Life Insurance Co., et al., No. 12-5779, 6th Cir.; 2013 U.S. App. LEXIS 8286; See 4/3/13, Page 18). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2022%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' CINCINNATI - A Sixth Circuit U.S. Court of Appeals panel on April 22 affirmed that the U.S. Department of Health and Human Services secretary's decision to omit waiver-expansion population patients from the Medicaid fraction provision in the disproportionate share hospital (DSH) adjustment calculation was based on a permissible construction of the DSH statute (Adventist Health System/Sunbelt Inc. v. Kathleen Sebelius, No. 11-5990, 6th Cir.; 2013 U.S. App. LEXIS 7907). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2023%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' WASHINGTON, D.C. - The U.S. Supreme Court on April 22 denied a writ of certiorari to the Indiana Family and Social Services Administration's appeal of a federal appeals court decision requiring the state Medicaid agency to cover all "medically necessary" dental care. The Seventh Circuit U.S. Court of Appeals on Sept. 26 affirmed a federal court order granting a class of Medicaid plaintiffs from Indiana preliminary injunctive relief in their challenge of the state's cap on "medically necessary" dental care under the state's Medicaid program (Sandra M. Bontrager, et al., v. Indiana Family and Social Services Administration, et al., No. 12-1037, U.S. Sup.). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2024%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' OAKLAND, Calif. - A California federal judge on April 26 declined to dismiss a federal and state False Claims Act case brought against a nonprofit health center for alleged Medicaid violations (United States of America, et al. v. Northeast Medical Services Inc., No. 10-1904, N.D. Calif.; 2013 U.S. Dist. LEXIS 60126). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2025%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' BEAUFORT, S.C. - A health insurance provider properly reimbursed its insured for the actual amount paid to a medical provider after adjustments were made by Medicare, a South Carolina federal judge ruled April 24, granting summary judgment to the insurer on bad faith and breach of contract claims against it (Dennis Barker v. Washington National Insurance Co., No. 9:12-cv-01901, D. S.C.; 2013 U.S. Dist. LEXIS 58437). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2026%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' RICHMOND, Va. - The Fourth Circuit U.S. Court of Appeals on April 23 affirmed a federal jury conviction of a Maryland cardiologist for health care fraud, saying there was sufficient evidence that he willfully made false statements and submitted fraudulent bills to Medicare, Medicaid and private insurers for medically unnecessary cardiac stent procedures (United States of America v. John R. McLean, No. 11-5130, 4th Cir.; 2013 U.S. App. LEXIS 8160). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2027%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' RICHMOND, Va. - The Virginia Court of Appeals on April 16 affirmed a trial court order granting summary judgment to the Virginia Department of Medical Assistance Services (DMAS) ordering the Family Redirection Institute Inc. (FRI) to reimburse the state Medicaid program for payments made to FRI for services by unqualified mental health care professionals (Family at Redirection Institute Inc. v. Commonwealth of Virginia Department of Medical Assistance Services, No. 1274-12-2, Va. App.; 2013 Va. App. LEXIS 116). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2028%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' LITTLE ROCK, Ark. - An Arkansas resident filed a class action lawsuit on March 21 in an Arkansas federal court, alleging that agreements between Blue Cross Blue Shield Association (BCBSA) and its licensees divide and allocate health insurance markets throughout the United States in violation of the Sherman Act (Linda L. Mills v. Usable Mutual Insurance Co., et al., No. 13-165, E.D. Ark.). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2029%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' GREENVILLE, S.C. - A South Carolina hospital sued a health insurer in federal court on April 29, alleging that it failed to pay benefits for services provided to the defendant's insured (Greenville Hospital System v. United Healthcare Insurance Co., No. 13-1145, D. S.C.). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2030%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' NEWARK, N.J. - A health care provider that received an assignment of benefits from one of its patients sued a health insurance company on April 11 in a New Jersey federal court for allegedly wrongfully denying benefits (North Jersey Brain & Spine Center v. Anthem Blue Cross Life and Health Insurance Co., No. 13-2312, D. N.J.). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2031%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' President Obama signed the Patient Protection and Affordable Care Act (PPACA), as amended by the Health Care and Education Reconciliation Act, on March 23, 2010. One of the main requirements of the act is that most Americans without insurance obtain coverage or face a penalty. Other provisions will stop insurance companies from dropping or denying care to people with pre-existing conditions and expand the federal-state Medicaid insurance program for the poor to cover people with incomes up to 133 percent of the federal poverty level and to cover childless adults for the first time, starting in 2014. The act also requires most employers to provide birth control coverage as part of their employee health plans or be subject to fines and penalties. http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%201%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' RICHMOND, Va. - The federal government on April 4 asked the Fourth Circuit U.S. Court of Appeals to find that the Anti-Injunction Act (AIA) bars a pre-enforcement challenge to the employer responsibility provision contained in the Patient Protection and Affordable Care Act (PPACA) (Liberty University, et al. v. Jacob J. Lew, et al., No. 10-2347, 4th Cir.; See 12/5/12, Page 4). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%202%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' WASHINGTON, D.C. - Plaintiffs challenging a provision in the Patient Protection and Affordable Care Act (PPACA) mandating that all health plans provide preventive services for free, including those for birth control, asked the District of Columbia Circuit U.S. Court of Appeals on April 4 to reverse the dismissal of their case and remand it to the lower court with an order to hold the case in abeyance (Roman Catholic Archbishop of Washington, et al. v. Kathleen Sebelius, et al., No. 13-5091, D.C. Cir.; See 2/6/13, Page 12). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%203%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' DETROIT - A Michigan federal judge on April 3 denied an emergency motion for a temporary injunction brought by a business owner and his company to halt the implementation of the "birth control" mandate contained in the Patient Protection and Affordable Care Act (PPACA) (MK Chambers Co., et al. v. Department of Health and Human Services, et al., No. 13-11379, E.D. Mich.; 2013 U.S. Dist. LEXIS 47887). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%204%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' SOUTH BEND, Ind. - An Indiana federal judge on April 1 granted a construction company's motion for a preliminary injunction in its case challenging a provision in the Patient Protection and Affordable Care Act (PPACA) mandating that all health plans provide preventive services for free, including those for birth control after the defendants indicated that they no longer opposed the motion (Tonn and Blank Construction v. v. Kathleen Sebelius, et al., No. 12-325, N.D. Ind.; See 1/23/13, Page 10). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%205%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' PHILADELPHIA - Plaintiffs challenging the "birth control mandate" contained in the Patient Protection and Affordable Care Act (PPACA) asked the Third Circuit U.S. Court of Appeals on March 15 to reverse the denial of a preliminary injunction halting the implementation of the mandate against their business (Conestoga Wood Specialties Corp., et al. v. Secretary of the US. Department of Health and Human Services, et al., No. 13-1144, 3rd Cir.; See 2/20/13, Page 4). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%206%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' WASHINGTON, D.C. - The U.S. Supreme Court on April 16 ruled that a health plan administrator's claim for reimbursement against a plan participant under Employee Retirement Income Security Act Section 502(a)(3) based on an equitable lien by agreement is governed by the terms of the plan and is not subject to equitable limitations (U.S. Airways, Inc. v. James McCutchen, et al., No. 11-1285, U.S. Sup.; See 12/19/12, Page 15). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%207%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' LAFAYETTE, La. - A Louisiana federal judge on April 4 granted a motion to remand in a class action health care reimbursement case, saying that one of the defendants was not fraudulently joined and that the plaintiffs met an exception to the Class Action Fairness Act (CAFA) (Opelousas General Trust Authority v. Multiplan Inc., et al., No. 12-1830, W.D. La.; 2013 U.S. Dist. LEXIS 49824). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%208%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' NEW YORK - A New York federal judge on March 26 denied two hospitals' motion to remand a reimbursement suit to state court, saying the Employee Retirement Income Security Act preempted the claims and denied one of the defendant's motion to sever claims (Beth Israel Medical Center, et al. v. Mark Goodman, in his capacity as Fund Manager of Local 272 Welfare Fund, et al., No. 12-1689, S.D. N.Y.; 2013 U.S. Dist. LEXIS 44546). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%209%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' GREEN BAY, Wis. - A Wisconsin federal judge on April 10 held that a plaintiff in a health care payment determination case failed to join the beneficiary as a necessary party to the action (VHC Inc. as trustee for SBV Health Plan v. University of Wisconsin Hospitals and Clinics, No. 13-92, E.D. Wis.; 2013 U.S. Dist. LEXIS 51635). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2010%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' DETROIT - A health insurer arbitrarily and capriciously denied coverage for applied behavioral analysis (ABA) therapy for autism based on the plan's exclusion for experimental treatment under the Employee Retirement Income Security Act, a federal judge in Michigan ruled March 30 (Michael Potter v. Blue Cross Blue Shield of Michigan, No. 10-14981, E.D. Mich.; See 8/3/11, Page 9). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2011%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' SEATTLE - A health plan administrator did not breach its fiduciary duties under the Employee Retirement Income Security Act by failing to modify its coverage certificates to reflect a court order that it provide mental health treatment because the administrator informed its members of the changes to its coverages of neurodevelopmental therapy mandated by the court's order, a federal judge in Washington ruled April 8 (Z.D., et al. v. Group Health Cooperative, et al., No. 2:11-cv-01119, W.D. Wash.; 2013 U.S. Dist. LEXIS 50402; See 11/14/12, Page 15). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2012%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' BISMARCK, N.D. - The North Dakota Supreme Court on April 4 affirmed summary judgment in favor of health care providers in a suit in which plaintiffs were seeking reimbursement for expenses and liabilities incurred in pursuing a federal court action to get health insurance companies to pay for medical services provided by the hospitals (Arthur M. Hayden, et al. v. Medcenter One Inc., et al., No. 20120337, N.D. Sup.; 2013 N.D. LEXIS 47). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2013%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' LAFAYETTE, La. - A Louisiana federal judge on April 11 granted summary judgment in favor of a health insurance company in a wrongful denial of benefits case, agreeing with the insurer that the plan excluded coverage for bariatric surgery and complications arising from the surgery (Amy Macip v. Louisiana Service & Indemnity Co., No. 10-1678, W.D. La.; 2013 U.S. Dist. LEXIS 53342). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2014%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' LAS VEGAS - A Nevada state court jury on April 9 ordered two health insurers to pay $500 million in punitive damages to three plaintiffs who claim that the defendants' actions contributed to them or a spouse becoming infected with hepatitis C during colonoscopies, a source told Mealey Publications (Helen Meyer v. Health Plan of Nevada, et al., No. A583799, Bonnie Brunson, et al. v. Health Care Plan of Nevada, No. A608344, Nev. Dist., Clark Co.). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2015%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' WASHINGTON, D.C. - The U.S. Supreme Court on April 15 denied a petition for writ of certiorari filed by GlaxoSmithKine PLC (GSK), leaving stand a decision allowing a Medicare Advantage provider to seek reimbursement from GSK under Medicare law for the costs of treating insurance customers who were injured by GSK's Avandia diabetes drug (GlaxoSmithKline, et al. v. Humana Medical Plans, et al., No. 12-690, U.S. Sup.; See 7/18/12, Page 14). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2016%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' SAN FRANCISCO - A California federal judge on March 28 granted summary judgment in favor of the defendants accused of engaging in a conspiracy to inflate the amount that Virginia's Medicaid program paid for brand-name prescription drugs, saying that the claims were barred by the statute of limitations (The Commonwealth of Virginia v. McKesson Corp., et al., No. 11-2782, N.D. Calif.; 2013 U.S. Dist. LEXIS 46999). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2017%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' SAN FRANCISCO - A Ninth Circuit U.S. Court of Appeals panel on April 4 affirmed in part and reversed in part the dismissal of two federally funded health care clinics' actions alleging that the California Department of Health Care Services incorrectly calculated payments for Medicaid-covered pharmacy services provided to "dual-eligible" Medicare beneficiaries who also receive Medicaid (North East Medical Services Inc., et al. v. State of California, et al., Nos. 11-16795, 11-16796, 9th Cir.; 2013 U.S. App. LEXIS 6808). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2018%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' OKLAHOMA CITY - An Oklahoma federal judge on April 4 remanded to the U.S. Department of Health and Human Services a Medicare reimbursement case, finding that an appeals board erred in determining that a contractor administering the program established the reimbursement codes at issue (Oklahoma Procure Management v. Kathleen Sebelius, secretary of the United States department of Health and Human Services, No. 12-680, W.D. Okla.; 2013 U.S. Dist. LEXIS 48829). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2019%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' CHICAGO - An Illinois federal judge on April 12 granted a defense motion to dismiss a Medicare dispute for lack of jurisdiction (Columbus Park Nursing and Rehabilitation Center v. Kathleen Sebelius, No. 10-4317, N.D. Ill.; 2013 U.S. Dist. LEXIS 52774). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2020%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' NASHVILLE, Tenn. - A Tennessee federal judge on April 5 dismissed a qui tam action brought by a state resident who accused local medical clinics of offering illegal inducements to Medicare beneficiaries to secure patronage, saying that the relator obtained his information from public records (United States of America, ex rel. Marc Osheroff v. HealthSpring Inc., et al., No. 10-1015, M.D. Tenn.; 2013 U.S. Dist. LEXIS 49526). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2021%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' BROOKLYN, N.Y. - A federal judge in the U.S. District Court for the Eastern District of New York on April 3 partially granted a motion to dismiss a federal and New York state False Claims Act (FCA) suit against Americare Inc. and partially denied the motion, saying that the plaintiff was able to sufficiently assert that the corporate defendants may have altered medical records to justify unnecessary home health services under Medicare (United States of America, ex rel. Patricia Mooney, v. Americare Inc., et al., No. 06cv1806, E.D. N.Y.; 2013 U.S. Dist. LEXIS 48398). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2022%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' BIRMINGHAM, Ala. - A board-certified orthopedic surgeon who practiced in Alabama until recently filed a class action lawsuit on April 4 in an Alabama federal court, alleging that agreements between Blue Cross Blue Shield Association (BCBSA) and its licensees divide and allocate health insurance markets throughout the United States in violation of the Sherman Act (Gilbert Reid Melson II v. Blue Cross and Blue Shield of Alabama, et al., No. 13-625, N.D. Ala.). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=17-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2023%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' President Obama signed the Patient Protection and Affordable Care Act (PPACA), as amended by the Health Care and Education Reconciliation Act, on March 23, 2010. One of the main requirements of the act is that most Americans without insurance obtain coverage or face a penalty. Other provisions will stop insurance companies from dropping or denying care to people with pre-existing conditions and expand the federal-state Medicaid insurance program for the poor to cover people with incomes up to 133 percent of the federal poverty level and to cover childless adults for the first time, starting in 2014. The act also requires most employers to provide birth control coverage as part of their employee health plans or be subject to fines and penalties.