LexisNexis® Legal Newsroom
Mealey's Health Law - Man's Conviction, Sentence For Insurance Fraud Upheld By Ohio Appeals Court

TOLEDO, Ohio - A trial court judge did not err when allowing a jury to hear evidence about an administrative hearing that concluded that a man should be terminated from his job for representing that he was married to obtain insurance benefits for his ex-wife because presentation of the information did...

Mealey's Health Law - Judge Orders Liquidation Of ACA Health Care Provider

TRENTON, N.J. - A New Jersey judge on Feb. 3 ordered a Patient Protection and Affordable Care Act (ACA) consumer-operated and oriented plan insurer's liquidation and appointed the state's insurance commissioner as liquidator (In the Matter of Freelancers Consumer Operated and Oriented Program...

Mealey's Health Law - Mental Health Facility Administrator Found Guilty For Kickback Scheme

SHREVEPORT, La. - A federal jury in Louisiana on Feb. 10 found a mental health care facility administrator guilty of organizing a kickback scheme that resulted in the submission of $6.7 million in fraudulent bills to Medicare, the U.S. Attorney's Office announced (United States of America v. Tom...

Mealey's Health Law - Judge: Claims Alleging Wrongful Antitrust, Monopolizing Conduct Are Related

ORLANDO, Fla. - Judgment was entered in favor of insurers on Feb. 15, one day after a Florida federal judge found that there is no further coverage owed to insureds for lawsuits alleging that they have intentionally engaged in wrongful antitrust and monopolizing conduct in an effort to dominate the health...

Mealey's Health Law - Magistrate Judge Recommends Entering Default Against Doctor, Clinics For Fraud

NEW YORK - A federal magistrate judge in New York on Feb. 13 recommended that a federal judge enter default judgment against a doctor and the clinics he owned for common-law fraud and violation of the Racketeer Influenced and Corrupt Organizations Act for his role involving the submission of fraudulent...

Mealey's Health Law - Claims In Bad Faith Suit Not Subject To ERISA Preemption, Magistrate Rules

NEWARK, N.J. - Remand of an insurance breach of contract and bad faith lawsuit to state court is proper because a third-party's claims are not preempted by the Employee Retirement Income Security Act (ERISA), a federal magistrate judge in New Jersey ruled Feb. 17 (North Jersey Brain & Spine Center...

Mealey's Health Law - Magistrate Judge: Fraud Defendants Should Pay $2.7M To GEICO Over Scheme

NEW YORK - A federal magistrate judge in New York on Feb. 22 recommended that a judge enter default judgment against defendants accused by the Government Employees Insurance Company (GEICO) and other insurers of fraud and unjust enrichment for submitting bills from clinics that were not owned by physicians...

Mealey's Health Law - U.S. Attorney: Medical Equipment Company Owner Found Guilty Of Fraud

McALLEN, Texas - U.S. Attorney Kenneth Magidson on Feb. 24 announced that the owner of a durable medical equipment (DME) company was found guilty by a federal jury in the Southern District of Texas for conspiracy to commit health care fraud, health care fraud, paying illegal kickbacks and other charges...

Mealey's Health Law - Home Health Agency Administrator Sentenced To 126 Months For Fraud

MIAMI - An administrator of a home health agency was sentenced to 126 months in prison by a federal judge in Florida on Feb. 24, after the defendant was found guilty for his role in a $2.5 million Medicare fraud scheme (United States of America v. Raciel Leon, et al., No. 16cr20476, S.D. Fla.).

Mealey's Health Law - Man Who Posed As Physician As Part Of Fraud Scheme Found Guilty

HOUSTON - A man who posed as a physician as part of a $1.3 million Medicare fraud scheme was found guilty on counts of conspiracy to commit health care fraud, health care fraud and conspiracy to pay health care kickbacks by a federal jury in Texas on March 3 (United States of America v. Nkiru Ibeabuchi...

Mealey's Health Law - Judge Refuses To Dismiss State Farm's Suit Alleging No-Fault Insurance Scheme

DETROIT - A federal judge in Michigan on March 6 denied a motion to dismiss filed by defendants accused by State Farm Mutual Automobile Insurance Co. of submitting false bills under Michigan's No-Fault Automobile Insurance Act for services that were either medically unnecessary or never provided...

Mealey's Health Law - 4th Circuit Reinstates Retaliation Claim In Suit Over Overbilling Clinics

RICHMOND, Va. - A federal judge in Virginia erred in finding that a physical therapist assistant's retaliation claim against his employer should be dismissed, finding that they were not subject to the False Claims Act's (FCA) first-to-file rule, a Fourth Circuit Court of Appeals ruled March 16...

Mealey's Health Law - Judge Finds Jurisdiction Lacking In Insolvent Insurer's Suit Over ACA Payments

ST. LOUIS - An insolvent insurer's suit against the government over its handling of the Patient Protection and Affordable Care Act (ACA) risk corridor and how it offset debts properly belongs before the U.S. Court of Federal Claims, a federal judge in Iowa said March 17 in finding that she lacked...

Mealey's Health Law - Drug Makers, Benefit Managers Hit With Class Suit Alleging Insulin Pricing Scheme

NEWARK, N.J. - Three drug makers and the three largest pharmacy benefit managers have engaged in a pricing scheme to drive up the cost of diabetes insulin - by more than 150 percent in the last five years - in violation of the Racketeer Influenced and Corrupt Organizations Act, the Employee Retirement...

Mealey's Health Law - Judge Nixes Class In Insureds' Suit Claiming Pharmacy Gouged On Generic Drugs

SAN FRANCISCO - The variety of contracts at issue and evidence that at least some of the contracted pharmacy benefit managers (PBMs) understood that a pharmacy's usual and customary rate did not include the rate offered for generic drugs in its membership program defeat a motion for class certification...

Mealey's Health Law - ERISA Not The Vehicle For Health Centers' Suits Against Insurers, 9th Circuit Says

SAN FRANCISCO - Health care centers designated to receive direct payment from a health plan administrator for medical services cannot file suit in federal court under the Employee Retirement Income Security Act because they lack both direct statutory authority and derivative authority through assignment...

Mealey's Health Law - Judge Dismisses ERISA Action Involving Proton Beam Therapy Coverage Denial

BIRMINGHAM, Ala. - A man's Employee Retirement Income Security Act (ERISA) suit impermissibly seeks equitable relief in the face of other available remedies, a federal magistrate judge in Alabama held March 23 (Jeffrey Woodruff v. Blue Cross and Blue Shield of Alabama, et al., 2017 U.S. Dist. LEXIS...

Mealey's Health Law - Judge Trims Some Claims Over Billing For Vein Procedures Due To Pleadings

CHICAGO - A federal judge in Illinois dismissed without prejudice claims from a man that his former employer falsely billed Medicare, Medicaid and other private insurers for endovascular laser therapy (EVLT) procedures that were not medically necessary or done with reused laser fibers, finding that the...

Mealey's Health Law - Judge Hands Insurer Mixed Results In Colorectal Cancer Test Coverage Case

GREENSBORO, N.C. - An insurer received mixed results in its challenge to claims that it failed to properly compensate the developer of a colorectal cancer screening test, with a federal judge in North Carolina dismissing some of the claims on March 27 but largely allowing Employee Retirement Income Security...

Mealey's Health Law - Washington Settles Class Suit Over Denial Of Hepatitis C Medication

SEATTLE - A Washington federal judge on April 10 issued an order granting final approval of a settlement under which the Washington State Health Care Authority (WHCA) has agreed to provide coverage for direct-acting antiviral medications for the treatment of hepatitis C (HCV) for Medicaid enrollees who...

Mealey's Health Law - Failed ACA Insurer Claims HHS Improperly Withholds Reinsurance Funds

COLUMBIA, S.C. - The government is improperly withholding payments from, and setting off debts owed by, a failed South Carolina Patient Protection and Affordable Care Act (ACA) co-operative insurer, illegally placing its own interests before those of policyholders and others entitled to priority, the...

Mealey's Health Law - Judge Affirms Ruling Finding Conflict Between Fraud Defendant And Attorney

BUFFALO, N.Y. - A federal judge in New York on May 12 upheld a magistrate judge's decision finding that an attorney representing a man accused of health care fraud should be removed as his counsel due to a conflict of interest because the government intends to call him as a witness (United States...

Mealey's Health Law - Class Action Over Cost Of EpiPens Filed In Minnesota Federal Court

MINNEAPOLIS - A putative class action brought pursuant to the Employee Retirement Income Security Act alleging that pharmacy benefits managers' violation of their fiduciary duty caused the price of a drug used to treat severe, life-threatening allergic reaction to skyrocket was filed June 2 in Minnesota...

Mealey's Health Law - 4th Circuit Panel Affirms Judgment For Michelin Plan On Injection Payment Rulings

RICHMOND, Va. - A Fourth Circuit U.S. Court of Appeals panel on June 13 affirmed the grant of summary judgment to defendants in a case where a plaintiff sued under the Employee Retirement Income Security Act seeking additional reimbursement for a series of steroid knee injections that an orthopedic surgeon...

Mealey's Health Law - Defense Expert Excluded In Case Alleging Illegal Kickbacks For Lab Work

CHARLESTON, S.C. - An expert for health care defendants accused of running kickback schemes cannot testify because his opinion draws on legal conclusions that should be left to the court to decide, is based on unsound methodology and would mislead a jury, a South Carolina federal judge held June 26 in...