BURLINGTON, Vt. - A Vermont federal judge on Aug. 8 dismissed without prejudice a qui tam action asserting that a mental health and substance abuse facility engaged in fraudulent and improper claims and refund practices and policies, saying that many of the claims were time-barred and that the plaintiff failed to plead other claims with required specificity (United States of America, ex rel. Thomas Joseph v. The Brattleboro Retreat, No. 13-55, D. Vt.; 2014 U.S. Dist. LEXIS 110154).
DENVER - A health plan participant's state law contract and tort claims against a health care provider were properly removed to federal court because a single claim for tortious interference with contract, which was related to the discount for services provided by the participant's health plan, was completely preempted by the Employee Retirement Income Security Act, the 10th Circuit U.S. Court of Appeals affirmed Aug. 6 (Richard Salzer v. SSM Health Care of Oklahoma Inc., No. 13-6099, 10th Cir.; 2014 U.S. App. LEXIS 15122).
CHICAGO - A federal district court did not abuse its discretion in awarding retirees more than $400,000 in attorney fees under the Employee Retirement Income Security Act following the retirees' settlement of their claims that their employer's successor unlawfully eliminated their health care benefits, the Seventh Circuit U.S. Court of Appeals affirmed Aug. 6 (Shirley Temme, et al. v. Bemis Company, Incorporated, No. 14-1085, 7th Cir.; 2014 U.S. App. LEXIS 15174).
PORTLAND, Ore - An Oregon federal judge on Aug. 8 granted partial summary judgment in favor of the plaintiffs in a case alleging that a health insurance company violated federal and state law by denying coverage for applied behavioral analysis (ABA) therapy for the treatment of autism-related spectrum disorder to children who have been diagnosed as autistic, saying that the exclusion is prohibited by the Employee Retirement Income Security Act (A.F., by and through his parents and guardians, Brenna Legaard and Scott Fournier, et al. v. Providence Health Plan, No. 13-776, D. Ore.; 2014 U.S. Dist. LEXIS 109507).
OKLAHOMA CITY - An Oklahoma federal judge on Aug. 6 dismissed a woman's challenge to the Patient Protection and Affordable Care Act (ACA), saying the woman lacked standing to challenge the suit, failed to establish that the court had jurisdiction to hear the case and failed to state a plausible claim for relief (Kimberly Willis v. U.S. Department of Health and Human Services, et al., No. 14-261, W.D. Okla.; 2014 U.S. Dist. LEXIS 108072).
SAN FRANCISCO - A panel of the Ninth Circuit U.S. Court of Appeals on Aug. 7 affirmed dismissal of two plaintiffs' claims challenging the Patient Protection and Affordable Care Act (ACA)'s individual mandate on privacy grounds, challenging a new Medicare payment advisory board as unconstitutional and challenging preemption of Arizona's Health Care Freedom Act as preempted by the ACA (Nick Coons, et al. v. Jacob L. Lew, et al., No. 13-15324, 9th Cir.).
DENVER - The son of a nursing home patient who allegedly died due to the negligence of the facility's personnel has presented a compelling need for discovery of an employee disciplinary document, a Colorado federal magistrate judge found Aug. 1, granting the plaintiff's motion to compel (Donald Bennett v. SSC Palisade Operating Co. LLC, No. 1:14-cv-00923, D. Colo.; 2014 U.S. Dist. LEXIS 105349).
CINCINNATI - The Sixth Circuit U.S. Court of Appeals on Aug. 4 affirmed that the Employee Retirement Income Security Act does not preempt a Michigan state law established to generate revenue necessary to fund the state's obligations under Medicaid (Self-Insurance Institute of America v. Rick Snyder, et al., No. 12-2264, 6th Cir.; 2014 U.S. App. LEXIS 14905).
KANSAS CITY, Kan. - A Kansas federal judge on Aug. 5 held that a state law prohibiting subrogation clauses in health insurance contracts is preempted by the Federal Employees Health Benefit Act (FEHBA) (Lee Ann Helfrich v. Blue Cross Blue Shield Association, et al., No. 13-2620, D. Kan.; 2014 U.S. Dist. LEXIS 107126).
NASHVILLE, Tenn. - Community Health Systems Inc. has agreed to pay $98 million to settle seven cases accusing the hospital chain of submitting false claims to Medicare and Medicaid, according to an Aug. 4 announcement by the U.S. Department of Justice.
KANSAS CITY, Kan. - A Kansas federal judge on July 31 granted a health insurer's motion for summary judgment in a wrongful denial of benefits case, saying the plan excluded coverage for treatments considered experimental or investigative and studies confirmed a lack of support for the treatment involved to treat abdominal cancers (Doug Burton, in his capacity as executor of the Estate of Marsha Burton v. Blue Cross and Blue Shield of Kansas, No. 13-2099, D. Kan.; 2014 U.S. Dist. LEXIS 104328).
GRAND RAPIDS, Mich. - A Michigan federal judge on July 30 dismissed a plaintiff's false Medicaid billing claims, but allowed a wrongful termination claim to continue (Susan K. Hendricks v. Bronson Methodist Hospital Inc., et al., No. 13-294, W.D. Mich.; 2014 U.S. Dist. LEXIS 103538).
DALLAS - A Texas federal judge on July 30 granted a health care provider's motion to remand a reimbursement suit to state court, saying the Employee Retirement Income Security Act did not preempt the plaintiff's claims (Methodist Hospitals of Dallas v. Aetna Health, No. 13-4992, N.D. Texas; 2014 U.S. Dist. LEXIS 104291).
SACRAMENTO, Calif. - A California appeals court on July 29 held that a health care provider must actually contract for the right to preserve its right to recover its customary billing rates through a Hospital Lien Act (HLA) lien or it forfeits the right to recover the customary billing rate for emergency room services from third-party tortfeasors (Dameron Hospital Association v. AAA Northern California, et al., No. C070475, Calif. App., 3rd. Dist.; 2014 Cal. App. LEXIS 684).
PHILADELPHIA - A panel of the Third Circuit U.S. Court of Appeals on July 29 held that the Medicare as a Secondary Payer Act (MSP Act) authorizes the government to seek reimbursement from a settlement a plaintiff receives from a tortfeasor because the funds came from a "primary plan" and that the plaintiff cannot invoke a New Jersey state law to avoid her reimbursement obligations (Cecelia A. Taransky v. Secretary of the U.S. Department of Health and Human Services, et al., No. 13-3483, 3rd Cir.; 2014 U.S. App. LEXIS 14408).
WASHINGTON, D.C. - A plaintiff challenging the individual mandate of the Patient Protection and Affordable Care Act (ACA) cannot do so by arguing that the requirement is a revenue measure that should have originated in the U.S. House of Representatives, a unanimous federal appeals court ruled July 29 (Matt Sissel v. United States Department of Health and Human Services, et al., No. 13-5202, D.C. Cir.).
GREENBELT, Md. - A health insurance company on July 25 sued multiple ambulatory service centers in a Maryland federal court for allegedly conspiring to submit fraudulent bills for services provided to patients covered by the plaintiff (Connecticut General Life Insurance Co., et al. v. Advanced Surgery Center of Bethesda, et al., No. 14-2376, D. Md.).
WASHINGTON, D.C. - A woman's action alleging wrongful denial of reduced-cost medical care under the Patient Protection and Affordable Care Act (ACA) ignores that she was granted Medicaid coverage after an appeal, a District of Columbia federal court judge held July 22 (Stephanie Mykonos v. United States of America, et al., No. 13-1845, D. D.C.; 2014 U.S. Dist. LEXIS 98926).
WASHINGTON, D.C. - A resolution seeking authority to initiate a suit against President Barack Obama and various department head for the alleged failure to faithfully construe the Patient Protection and Affordable Care Act (ACA) passed through the U.S. House of Representatives Rules Committee on July 24.
OKLAHOMA CITY - Parties in a religious employers' challenge to the Patient Protection and Affordable Care Act (ACA) contraceptive mandate briefed the 10th Circuit U.S. Court of Appeals on July 22 on the impact of the U.S. Supreme Court's ruling in Hobby Lobby (Southerrn Nazarene University, et al. v. Sylvia Mathews Burewell, et al., No. 14-6026, 10th Cir.).
MOBILE, Ala. - A physician group and two clinics that are part of the Alabama-based Infirmary Health System Inc. (IHS) on July 21 agreed to pay $24 million to resolve a lawsuit brought by the federal government accusing the defendants of violating the False Claims Act by paying or receiving financial inducements in connection with claims to the Medicare program, according to a docket entry in Alabama federal court (United States of America, ex rel. Heesch v. Diagnostic Physicians Group P.C., et al., No. 11-0364-KD-B, S.D. Ala.).
RICHMOND, Va. - Patient Protection and Affordable Care Act (ACA) language governing whether individuals who enroll through the federal exchange are entitled to tax credits is ambiguous enough to defer to the Internal Revenue Service's interpretation, a Fourth Circuit U.S. Court of Appeals panel held July 22 (David King, et al. v. Kathleen Sebelius, et al., No. 14-1158, 4th Cir.).
FRESNO, Calif. - A California appeals court in an unpublished July 21 decision affirmed summary judgment in favor of a health care service plan in a suit brought by a hospital over reimbursement rates and agreed with the lower court that amendment would be futile because the trial court correctly concluded that the hospital failed to provide any evidence of a mutual mistake of fact and, therefore, amending the complaint would have been an idle act (Doctors Medical Center of Modesto Inc. v. Kaiser Foundation Health Plan Inc., No. F066017, Calif. App., 5th Div.; 2014 Cal. App. Unpub. LEXIS 5086).
GREEN BAY, Wis. - A U.S. senator lacks standing to challenge Patient Protection and Affordable Care Act (ACA) regulations governing insurance for congressional members and staffers, a Wisconsin federal judge held July 21 (Senator Ron Johnson, et al. v. U.S. Office of Personnel Management, et al., No. 14-09, E.D. Wis.).
WASHINGTON, D.C. - Patient Protection and Affordable Care Act (ACA) premium tax credits are available only for individuals who enrolled through state exchanges and not the federal exchange, a District of Columbia U.S. Circuit Court of Appeals panel majority held July 22. The dissent argued that the suit is a "not-so-veiled attempt to gut" the ACA (Jacqueline Halbig, et al. v. Sylvia Mathews Burwell, et al., No. 14-5018, D.C. Cir.).