LexisNexis® Legal Newsroom
    Mealey's Health Law - Ill. Federal Judge Leaves 1 Claim In Medicare, Medicaid False Billing Suit

    PEORIA, Ill. - An Illinois federal judge on Jan. 31 partially granted a defendant's motion to dismiss a suit alleging that the health care provider submitted false claims pursuant to Medicare and Medicaid, leaving only a state law claim (United States of America, ex rel. Gail McGinnis v. OSF Healthcare System, et al., No. 11-1392, C.D. Ill.; 2014 U.S. Dist. LEXIS 12600).

    Mealey's Health Law - Nevada Federal Judge Approves Distribution Of Settlement Funds As Cy Pres Award

    LAS VEGAS - A Nevada federal judge on Jan. 31 granted the plaintiffs' motion for a cy pres distribution of $31,680.47 in unclaimed funds remaining from the settlement of a class action case accusing an insurance company of overcharging copayments for medical treatment (Mary Forsyth, et al. v. Humana Inc., et al., No.90-249, D. Nev.; 2014 U.S. Dist. LEXIS 1324).

    Mealey's Health Law - Divided 2nd Circuit: ERISA Preempts Vermont's State Database Law

    PHILADELPHIA - A divided Second Circuit U.S. Court of Appeals on Feb. 4 reversed a finding that the Employee Retirement Income Security Act did not preempt a Vermont state law requiring health insurers to provide information for the state's health care database (Liberty Mutual Insurance Co. v. Susan L. Donegan, in her capacity as the commissioner of the Vermont Department of Financial Regulation, No. 12-4881, 2nd Cir.; 2014 U.S. App. LEXIS 2088).

    Mealey's Health Law - Official Is Granted Summary Judgment In Dispute Over Medicare Reimbursement

    BAY CITY, Mich. - A Michigan federal judge on Jan. 30 granted summary judgment in favor of the secretary of the Health and Human Services in a dispute over Medicare reimbursement related to residents' services, saying that the secretary's interpretation of the regulations at issue is reasonable (Covenant Medical Center Inc. v. Kathleen Sebelius, No. 12-12901, E.D. Mich.; 2014 U.S. Dist. LEXIS 11289).

    Mealey's Health Law - Injunction Denied In Suit Over Termination Of Provider Agreement

    COLUMBUS, Ohio - An Ohio federal judge on Jan. 29 denied a mail order pharmacy's motion for a temporary restraining order and preliminary injunction in its case seeking to keep a pharmacy services administrative organization (PSAO) from terminating its pharmacy provider participation agreement, saying the plaintiff failed to demonstrate a likelihood of success on the merits (Med-Care Diabetic & Medical Supplies Inc. v. Strategic Health Alliance II Inc. d/b/a AccessHealth, No. 14-82, S.D. Ohio; 2014 U.S. Dist. LEXIS 10881).

    Mealey's Health Law - N.J. Federal Judge Dismisses Reimbursement Suit, Says Anti-Assignment Clause Valid

    TRENTON, N.J. - A New Jersey federal judge in a Jan. 30 unpublished opinion granted a motion to dismiss brought by defendants in a health care reimbursement dispute, saying the patient's health care plan contained a valid anti-assignment of benefits provision that precluded the plaintiff provider from bringing the suit (Dr. Brian M. Torpey v. Blue Cross Blue Shield of Texas, at al., No. 12-7618, D. N.J.; 2014 U.S. Dist. LEXIS 11412).

    Mealey's Health Law - La. Supreme Court Reverses $330M Verdict For Risperdal Medicaid Law Violations

    NEW ORLEANS - In a 4-3 vote, the Louisiana Supreme Court on Jan. 28 reversed a verdict of more than $330.6 million against Janssen Pharmaceutical Inc. and parent company Johnson & Johnson, finding that the state attorney general failed to prove that misrepresenting the safety of the atypical antipsychotic drug Risperdal violated the state's Medicaid fraud law (James D. "Buddy" Caldwell, ex rel. State of Louisiana v. Janssen Pharmaceutical, Inc., et al., Nos. 2012-C-2447 and 2012-C-2466, La. Sup.).

    Mealey's Health Law - N.Y. Federal Judge Declines To Remand Reimbursement Suit; ERISA Preempts Claims

    BROOKLYN, N.Y. - A New York federal judge on Jan. 27 declined to remand a health care reimbursement suit to state court, saying that the Employee Retirement Income Security Act preempted claims against one of the defendants (Enigma Management Corp. v. Multiplan Inc., et al., No. 13-5524, E.D. N.Y.; 2014 U.S. Dist. LEXIS 9738).

    Mealey's Health Law - Hospital System's Acquisition Of Physician Group Must Be Undone, Federal Judge Rules

    BOISE, Idaho - A federal judge in Idaho on Jan. 24 ordered the divestiture of a consummated merger between Idaho's largest health system and the state's largest independent, multispecialty physician group, finding that the acquisition was anticompetitive (Saint Alphonsus Medical Center - Nampa, Inc., et al. v. St. Luke's Health System, Ltd., No. 12-560, D. Idaho; Federal Trade Commission, et al. v. St. Luke's Health System, Ltd., et al., No. 13-116, D. Idaho; 2014 U.S. Dist. LEXIS 9264).

    Mealey's Health Law - Ky. Appeals Court: Arbitration Provision Not Applicable In Reimbursement Suit

    FRANKFORT, Ky. - A Kentucky appeals court in a Jan. 24 unpublished opinion affirmed an order denying a motion to compel arbitration between a Medicaid managed care organization (MCO) and a health care provider (Kentucky Spirit Health Plan Inc., et al. v. PremierTox Inc., et al., No. 2012-CA-001457-MR, Ky. App.; 2014 Ky. App. Unpub. LEXIS 57).

    Mealey's Health Law - Wash. Federal Judge Grants Injunction, Class Status In Denial Of Benefits Case

    SEATTLE - A Washington federal judge on Jan. 24 granted a preliminary injunction and class certification in a case challenging the denial of benefits for the treatment of autism (K.M., et al. v. Regence BlueShield, et al., No. 13-1214, W.D. Wash.; 2014 U.S. Dist. LEXIS 9156).

    Mealey's Health Law - Alabama High Court: Networks Do Not Have To Contract With Health Care Provider

    MONTGOMERY, Ala. - A divided Alabama Supreme Court on Jan. 24 held that a trial court erred in submitting a claim for intentional interference with business relationship to a jury in a health care network dispute, saying the defendants had no obligation to do business with the plaintiff health care provider (Alabama Psychiatric Services, et al. v. A Center for Eating Disorders, No. 1110703, Ala. Sup.; 2014 Ala. LEXIS 9).

    Mealey's Health Law - Arizona Appeals Court Affirms Denial Of Prescription Drug Coverage

    PHOENIX - An Arizona state appeals court in a Jan. 23 unpublished opinion affirmed that a health insurance company properly denied benefits for a prescription drug because the plan and state law expressly prohibited coverage for drugs not included in the plan's formulary (Deanna M. Cancino v. Arizona Health Cost Containment Administration, et al., No. 13-130, Ariz. App., Div. 1; 2014 Ariz. App. Unpub. LEXIS 84).

    Mealey's Health Law - Miss. Federal Judge Leaves Breach Of Contract Claim In Denial Of Benefits Suit

    HATTIESBURG, Miss. - A Mississippi federal judge on Jan. 22 denied a health insurance company's motion for summary judgment on a plaintiff's breach of contract claim in a dispute over denial of benefits but granted the motion as to the plaintiff's remaining claims (Larry R. Mixon v. The Golden Rule Insurance Co., No. 12-234, S.D. Miss.; 2014 U.S. Dist. LEXIS 7760).

    Mealey's Health Law - Mo. Federal Judge Grants Injunction, Halts Law Regulating Insurance Exchanges

    JEFFERSON CITY, Mo. - A Missouri federal judge on Jan. 23 granted a motion for preliminary injunction, enjoining the enforcement of Missouri's Health Insurance Market Innovation Act (HIMIA) as it applies to entities and individuals certified under federal law to provide services or perform functions pursuant to the Patient Protection and Affordable Care Act (PPACA) (St. Louis Effort for Aids, et al. v. John Huff, director of the Missouri Department of Insurance, Financial Institutions and Professional Registration, No. 13-4246, W.D. Mo.; 2014 U.S. Dist. LEXIS 8187).

    Mealey's Health Law - Supreme Court Blocks Enforcement Of Birth Control Mandate

    WASHINGTON, D.C. - The U.S. Supreme Court on Jan 24 enjoined the federal government from enforcing the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) against an order of Catholic nuns pending final disposition of an appeal by the 10th Circuit U.S. Court of Appeals (Little Sisters of the Poor Home for the Aged, et al. v. Kathleen Sebelius, et al., No. 13A691, U.S. Sup.).

    N.Y. Federal Judge Declines To Reinstate Injunction Pending Appeal Of Dismissal

    ROCHESTER, N.Y. - A New York federal judge on Jan. 16 denied a motion by a nursing home operator to reinstate a preliminary injunction pending its appeal of a decision dismissing its suit challenging the termination of its Medicare and Medicaid provider agreement (Blossom South v. Kathleen Sebelius, et al., No. 13-6474, W.D. N.Y.; 2014 U.S. Dist. LEXIS 6474).

    N.J. Federal Judge Remands Reimbursement Dispute; No Federal Jurisdiction Exists

    NEWARK, N.J. - In an unpublished opinion, a New Jersey federal judge on Jan. 21 granted a plaintiffs' motion to remand its health care reimbursement suit, saying neither complete preemption nor an embedded federal question of jurisdiction existed (MHA d/b/a Meadowlands Hospital Medical Center v. UnitedHealth Group Inc., et al., No. 13-6130, D. N.J.; 2014 U.S. Dist. LEXIS 7035).

    Federal Magistrate Declines To Transfer Denial Of Benefits Case To Other Court

    MILWAUKEE - A Wisconsin federal magistrate judge on Jan. 15 denied a defendant's motion to transfer a wrongful denial of benefits case to another federal court (Ryan M. Redmond v. Sirius International Insurance Corp., No. 12-587, E.D. Wis.; 2014 U.S. Dist. LEXIS 5089).

    Podiatrist Admits Lying To Grand Jury Investigating Orthofix Health Care Fraud

    BOSTON - A Virginia podiatrist on Jan. 15 pleaded guilty to lying to a federal grand jury during an investigation into health care fraud and kickbacks related to bone growth stimulators sold by Orthofix Holdings Inc. (United States of America v. Ilene Terrell, No. 1:13-10180, D. Mass.).

    Judge: Act Authorizes Tax Credits For Insurance Bought On Federal Exchanges

    WASHINGTON, D.C. - A District of Columbia federal judge on Jan. 15 granted summary judgment in favor of the federal government in a suit challenging an Internal Revenue Service regulation imposed under the Patient Protection and Affordable Care Act (PPACA) that extends eligibility for premium assistance subsidies to people who purchase health insurance through exchanges established by the PPACA (Jacqueline Halbig, et al. v. Kathleen Sebelius, et al., No. 13-623, D. D.C.).

    Arkansas Federal Judge Affirms Decision Disallowing Medicare Payments

    LITTLE ROCK, Ark. - An Arkansas federal judge on Jan. 10 granted summary judgment in favor of the federal government in a challenge to a final decision of the secretary of the U.S. Department of Health and Human Service (DHHS) to disallow Medicare payments to a diagnostic audiological testing facility when the tests were not ordered by physicians (Doctors Testing Centers v. U.S. Department of Health and Human Services, et al., No. 11-857, E.D. Ark.; 2014 U.S. Dist. LEXIS 3781).

    Michigan Federal Judge Grants Injunction In Birth Control Case

    DETROIT - A Michigan federal judge on Jan. 13 granted a preliminary injunction in favor of five religious organizations challenging the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) (The Ave Marie Foundation, et al. v. Kathleen Sebelius, et al., No. 13-15198, E.D. Mich.; 2014 U.S. Dist. LEXIS 3516).

    9th Circuit Reverses Injunction In California Medi-Cal Dispute

    SAN FRANCISCO - A Ninth Circuit U.S. Court of Appeals panel on Jan. 9 reversed a decision affirming a preliminary injunction prohibiting the California Department of Health Care Service (DHCS) from implementing Medicaid reimbursement rate reductions, saying the lower court erroneously interpreted the statute governing the reimbursements (Santa Rosa Memorial Hospital, et al. v. Toby Douglas, No. 09-17633, 9th Cir.; 2014 U.S. App. LEXIS 449).

    8th Circuit Affirms Dismissal Of Medicare False Billings Case

    ST. LOUIS - An Eighth Circuit U.S. Court of Appeals panel on Jan. 9 affirmed the dismissal of a Medicare false claims billing case, saying the plaintiff failed to plead fraud with the sufficient particularity required (United States of America, ex rel. Michael Dunn v. North Memorial Health Care, et al., No. 13-1099, 8th Cir.; 2014 U.S. App. LEXIS 413).