LexisNexis® Legal Newsroom
Mealey's Health Law - DOJ: Neurosurgeon Sentenced To 235 Months In Prison For Fraud Scheme

DETROIT - The U.S. Department of Justice announced that a federal judge in Michigan on Jan. 9 sentenced a neurosurgeon to 235 months in prison for his role in a $2.8 million Medicare fraud scheme that involved the doctor billing public and private insurers for spinal fusions that he never performed ...

Mealey's Health Law - Supreme Court Won't Review 6th Circuit ERISA Preemption Ruling

WASHINGTON, D.C. - The U.S. Supreme Court on Jan. 9 let stand a Sixth Circuit U.S. Court of Appeals' ruling that affirmed the dismissal of claims that the Michigan Health Insurance Claims Assessment Act is preempted by the Employee Retirement Income Security Act (Self-Insurance Institute of America...

Mealey's Health Law - Michigan Tribe, Blue Cross Settle ERISA Plan Administration Claims

DETROIT - Michigan's Little River Band of Ottawa Indians and Blue Cross Blue Shield have settled the tribe's claims that Blue Cross breached its fiduciary duty and violated the Employee Retirement Income Security Act (ERISA) in administering the tribe's health care plan for employees, according...

Mealey's Health Law - Holistic Doctor's Expert Unqualified To Testify, Judge Finds

ALBUQUERQUE, N.M. - A federal judge in New Mexico on Jan. 11 granted the federal government's motion to exclude the testimony of an expert designated to discuss the medical necessity of tests administered by a holistic doctor who is accused of fraudulently billing Medicare and other insurers, after...

Mealey's Health Law - Blue Shield's Insurance Renewal Calls Found Not To Violate TCPA

SANTA ANA, Calif. - Single calls placed to each health insurance customer about policy renewals were not telemarketing or advertising, a California federal judge ruled Jan. 13, granting summary judgment to the insurance provider in a Telephone Consumer Protection Act (TCPA) class complaint (Shannon Smith...

Mealey's Health Law - Plaintiff's Claims Are Preempted By ERISA, Illinois Federal Judge Says

CHICAGO - An Illinois federal judge on Jan. 12 denied a plaintiff's motion to remand after determining that her state law claims arising out of the disclosure of medical records without consent are preempted by the Employment Retirement Income Security Act (Jane Doe v. Aetna Inc., et al., No. 16...

Mealey's Health Law - California Women Files Class Action Over Denial Of Breastfeeding Support

OAKLAND, Calif. - A California woman on Jan. 13 filed a class action complaint in federal court alleging that she and other women have been wrongfully denied access to and coverage for a vital women's preventive service - breastfeeding support, supplies and counseling - for which coverage is mandated...

Mealey's Health Law - Judge Affirms Earlier Ruling That Fraud Scheme Netted $2.9M In Losses

NEW YORK - A federal judge in New York, who was ordered by the Second Circuit U.S. Court of Appeals to provide more detailed findings on the intended loss of an insurance fraud scheme that involved the redistribution of drugs originally provided to HIV and AIDS patients, on Jan. 17 affirmed his earlier...

Mealey's Health Law - Texas Federal Judge Dismisses Gender Identity Discrimination Claims

DALLAS - A Texas federal judge on Jan. 13 dismissed claims alleging gender identity discrimination under Section 1557 of the Patient Protection and Affordable Care Act (ACA) against an insurer and an employer because the plaintiff failed to cite any controlling precedent that recognizes a cause of action...

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...