LexisNexis® Legal Newsroom
Mealey's Health Law - Evidence Supported Convictions For Fraud, Kickback Charges, 5th Circuit Says

NEW ORLEANS - A Fifth Circuit U.S. Court of Appeals panel on Nov. 7 upheld convictions of a man and his son who were accused of health care fraud and paying kickbacks to obtain business for their partial hospitalization programs (PHPs), ruling that evidence presented by the government was sufficient...

Mealey's Health Law - Claim Seeking Coverage For Air Ambulance Transport Remanded To Plan Administrator

SACRAMENTO, Calif. - A California federal judge on Nov. 16 remanded an insured's claim seeking coverage for almost $500,000 incurred for the transport of her daughter from a hospital in Mexico to a hospital in Seattle by air ambulance because the plan administrator did not consider all of the available...

Mealey's Health Law - 5th Circuit Vacates $4M Restitution, Forfeiture Order Against Physician Assistant

NEW ORLEANS - A Fifth Circuit U.S. Court of Appeals panel on Nov. 30 overturned a federal judge in Texas' ruling ordering a physician's assistant found guilty of conspiracy to commit insurance fraud to pay $4 million in restitution and forfeiture, holding that the man should be required to reimburse...

Mealey's Health Law - GEICO's Insurance Fraud, RICO Claims Not Subject To Arbitration, Judge Says

CAMDEN, N.J. - A federal judge in New Jersey on Dec. 1 refused to dismiss a lawsuit brought by the Government Employees Insurance Co. (GEICO) over an alleged fraudulent billing scheme by doctors at two orthopedic firms, finding that the insurer's claims under the Racketeer Influenced and Corrupt...

Mealey's Health Law - Dave & Buster's $7.4M ERISA Settlement Denied By New York Federal Judge

NEW YORK - A New York federal judge, in an order filed Dec. 1, declined preliminary approval of a class settlement worth up to $7,425,000 offered by Dave & Buster's Inc. to end claims that the nationwide restaurant/entertainment chain violated the Employee Retirement Income Security Act by reducing...

Mealey's Health Law - Panel Says Plan Participant Could Recover Premiums If There Was A Plan Violation

ST. LOUIS - The Eighth Circuit U.S. Court of Appeals on Dec. 6 reversed and remanded a district court's dismissal of a health care plan participant's claim seeking to recover premiums paid under the plan after determining that a restitutionary claim for premiums under the Employee Retirement...

Mealey's Health Law - Federal Judge: Fusion Surgery Preauthorization Waived Insurer's Later Denial

LOS ANGELES - A health insurer waived the right to deny coverage for vertebrate fusion surgery as experimental when it preauthorized the procedure, albeit with a different device, a federal judge in California held Dec. 12, entering judgment for the plaintiff on her Employee Retirement Income Security...

Mealey's Health Law - Judge: Insurers Have No Statutory Duty To Pay No-Fault Benefits Claims

DETROIT - A federal judge in Michigan on Dec. 21 granted State Farm Mutual Automobile Insurance Co.'s motion to reconsider and dismissed a health medical practices counterclaims for fraud, civil conspiracy and declaratory relief, finding that pursuant to the Michigan Supreme Court's ruling in...

Mealey's Health Law - California Federal Judge Allows Intervention Into Contraceptive Mandate Suit

SAN FRANCISCO - A religious order has sufficient interests in the outcome of a suit challenging rules broadening the exemptions to the Patient Protection and Affordable Care Act (ACA) contraceptive mandate to permit intervention into the case, a federal judge in California held Dec. 29 (California, et...

Mealey's Health Law - Magistrate Judge Denies Gynecologist's Request For Grand Jury Instructions

BOSTON - A gynecologist accused of wrongfully providing a pharmaceutical drug sales representative access to patients' confidential health information cannot have access to instructions provided to two grand juries, a federal magistrate judge in Massachusetts ruled Jan. 3, holding that the information...

Mealey's Health Law - UnitedHealth, Insureds Battle Over Lactation Coverage Requirements In ACA

SAN FRANCISCO - Insureds create standards for lactation support services the Patient Protection and Affordable Care Act (ACA) does not impose in an attempt to save their suit, an insurance group told a California federal judge on Jan. 5 in support of its motion for summary judgment (Rachel Condry, et...

Mealey's Health Law - New York Federal Judge Dismisses Class Claims Over PBM's Pricing, Allows Amendment

NEW YORK - A New York federal judge on Jan. 5 dismissed Employee Retirement Income Security Act and Racketeer Influenced and Corrupt Organizations Act class claims against the largest pharmacy benefits manager (PBM) and a health insurance provider over prescription pricing, but gave the plaintiffs 21...

Mealey's Health Law - 3rd Circuit Vacates Order Saying GEICO Need Not Pay $2.1M In Pending Claims

PHILADELPHIA - A Third Circuit U.S. Court of Appeals panel on Jan. 10 reversed a federal judge in New Jersey's ruling that allowed the Government Employees Insurance Co. (GEICO) to withhold payment on $2.1 million in pending personal injury protection (PIP) claims submitted by a neurology and rehabilitation...

Mealey's Health Law - United States Says California Abortion Law Governing Licensed Speakers Fails

WASHINGTON, D.C. - Neither pregnancy counseling centers challenging a law requiring that they disclose the availability of abortion services nor the state of California advances the correct standard for analyzing the case, and the law at the heart the case partially fails when properly evaluated, the...

Mealey's Health Law - Aetna Will Pay $17 Million To End Privacy Class Suit By HIV Patients

PHILADELPHIA - Aetna Inc. and related entities (Aetna, collectively) have agreed to pay $17,161,200 to settle privacy claims by more than 13,400 class members whose HIV status was revealed by the insurer through an indiscreet mailing, according to a motion for preliminary approval of a class action settlement...

Mealey's Health Law - Judge Refuses To Remand Fraud Suit For Improper Service To Defendant Doctor

PHILADELPHIA - A federal judge in Pennsylvania on Jan. 12 denied a motion to remand filed by Aetna Inc. and Aetna Health Management LLC, finding that their attempt to provide service to a defendant doctor accused of conspiring to submit claims for an opioid-based pain medication for cancer patients was...

Mealey's Health Law - Judge Chops Fee Request For Tribe's $8 Million Win Over Blue Cross For Hidden Fees

BAY CITY, Mich. - A Michigan Indian tribe that won an $8.4 million award for Blue Cross Blue Shield's charging of hidden administrative fees for the tribe's employee benefit program had its request for attorney fees drastically reduced Jan. 17 by a federal judge, who slashed the fees by 75 percent...

Mealey's Health Law - 7th Circuit Upholds Fraud Sentences For Medical Office Manager, Billing Agent

CHICAGO - A federal judge in Illinois did not err when sentencing a home health care office manager and billing specialist following their convictions for health care fraud and conspiracy to commit health care fraud, a Seventh Circuit U.S. Court of Appeals panel ruled Jan. 19, holding that the reasoning...

Mealey's Health Law - 11th Circuit Upholds Couple's Conviction For $12M Insurance Fraud Scheme

ATLANTA - An 11th Circuit U.S. Court of Appeals panel on Jan. 23 refused to vacate a couple's convictions and sentences for a $12 million insurance fraud scheme that involved their clinics overcharging Universal Health Care Insurance Co. for treatment of patients with HIV, finding that the judge...

Mealey's Health Law - Judge Finds Vague ERISA Claims Don't Put Insurer On Notice Of Claims

ATLANTA - A hospital's general references to Employee Retirement Income Security Act plans is not sufficiently specific to put a health care insurer on notice of the claims against it, and requiring at least a summary of the number of plans in question would not hamper judicial efficiency, a federal...

Mealey's Health Law - Spine Center's ERISA Claims Survive Dismissal, Federal Judge Says

TRENTON, N.J. - A medical provider has a valid assignment of Employee Retirement Income Security Act benefits, and it is too early in its litigation against an insurer to determine if its claims seek duplicative recovery, a federal judge in New Jersey held Feb. 2 (University Spine Center v. Anthem Blue...

Mealey's Health Law - Doctor Pleads Guilty To Fraudulent Billing, Dispensing Controlled Substances

BOWLING GREEN, Ky. - A doctor pleaded guilty on Feb. 5 in Kentucky federal court to intentionally distributing and dispensing controlled substances outside the course of professional practice and submitting fraudulent bills to Medicare and Medicaid and agreed to serve eight years in prison (United States...

Mealey's Health Law - Surgeon Sentenced To 196 Months In Prison For Fraudulent Billing Scheme

NEW YORK - A surgeon who was found guilty of one count of health care fraud, three counts of making false statements related to health care matters and two counts of money laundering was sentenced by a federal judge in New York on Feb. 7 to 196 months in prison and ordered to pay $7.2 million in restitution...

Mealey's Health Law - Aetna Says California Investigation Based On 'Out Of Context' Comments

SACRAMENTO, Calif. - Lawyers took deposition comments from a medical claims reviewer out of context to create trial and media leverage, Aetna Inc. says in a Feb. 14 response to an announcement that California would investigate the insurer's claims processing.

Mealey's Health Law - Judge Rejects Indiana's Challenge To ACA Employer Mandate

INDIANAPOLIS - Res judicata and U.S. Supreme Court precedent require judgment in favor of the federal government in a state's and school district's attack on the Patient Protection and Affordable Care Act (ACA) employer mandate, a federal judge in Indiana held Feb. 14 (Indiana, et al. v. Internal...