NEWARK, N.J. - A New Jersey federal judge on Feb. 27 granted partial summary judgment in favor of an insurer in a health care benefits reimbursement dispute, dismissing the claims asserted by the plaintiff but denying the defendant's motion for recovery for its counterclaim and request for attorney fees (New Jersey Back Institute ASO Juan Rodriguez v. Horizon Blue Cross Blue Shield Insurance Co., No. 12-4985, D. N.J.; 2014 U.S. Dist. LEXIS 25639).
ST. LOUIS - The federal government on Feb. 27 filed a brief with the Eighth Circuit U.S. Court of Appeals, urging the court to affirm the denial of a preliminary injunction in a case brought by a Missouri family challenging the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) (Paul Wieland, et al. v. U.S. Department of Health and Human Services, No. 13-3528, 8th Cir.).
RICHMOND, Va. - A Fourth Circuit U.S. Court of Appeals panel on Feb. 21 held that a relator who sued his former employer for allegedly filing false Medicare and Medicaid claims failed to allege that the defendants made a false statement or that they acted with the necessary scienter. The appeals court also affirmed that the lower court did not abuse its discretion in denying the relator's request to file a third amended complaint (United States ex rel. Barry Rostholder v. Omnicare Inc., et al., No. 12-2431, 4th Cir.; 2015 U.S. App. LEXIS 3269).
CHICAGO - A divided Seventh Circuit U.S. Court of Appeals panel on Feb. 21 affirmed a decision denying the University of Notre Dame's motion for a preliminary injunction in its case challenging the birth control mandate contained in the Patient Protection and Affordable Care Act (University of Notre Dame v. Kathleen Sebelius, et al., No. 13-3853, 7th Cir.; 2014 U.S. App. LEXIS 3326).
HARRISBURG, Pa. - A divided Commonwealth Court of Pennsylvania on Feb. 19 reversed a decision ordering the disclosure of the rates managed care organizations (MCOs) paid to subcontractors and the rates the subcontractors paid to the providers of Medicaid dental services (Dental Benefit Providers Inc., et al. v. James Eiseman Jr., et al., Nos. 945 C.D. 2013, 957 C.D. 2013, 958 C.D. 2013, Pa. Comm.; 2014 Pa. Commw. LEXIS 113).
ATLANTA - In an unpublished per curiam opinion, a panel of the 11th Circuit U.S. Court of Appeals on Feb. 20 affirmed the dismissal of a class action complaint brought by a group of medical associations and medical providers against multiple health insurers for allegedly wrongfully reducing payments for out-of-network services provided to the insureds' members, agreeing that the claims were "released claims" barred by settlement agreements in a similar case (The American Medical Association, et al. v. Connecticut General Life Insurance Co., et al., No. 13-10916, 11th Cir.; 1014 U.S. App. LEXIS 3088).
LOS ANGELES - In reversing a lower court decision, a California appeals panel on Feb. 19 held that emergency room physicians alleged sufficient facts to reflect the existence of a claim for negligent delegation asserted against health maintenance organizations for allegedly knowing that their independent practice associations (IPAs) were unable to pay the physicians for providing statutorily required services (Centinela Freeman Emergency Medical Associates, et al. v. Health Net of California Inc., et al., No. B238867, Calif. App., 2nd. Dist., Div. 3; 2014 Cal. App. LEXIS 158).
HARRISBURG, Pa. - A Pennsylvania federal judge on Feb. 19 partially dismissed a dispute related to the payment of health care benefits for the treatment of autism, dismissing claims for legal damages and breach of contract but leaving a claim for equitable remedies (Patrick C. Jarman v. Capital Blue Cross, et al., No. 13-932, M.D. Pa.; 2014 U.S. Dist. LEXIS 20464).
WASHINGTON, D.C. - The U.S. Supreme Court on Feb. 24 denied a petition for writ of certiorari, leaving in place a Ninth Circuit U.S. Court of Appeals decision affirming that Arizona cannot bar state Medicaid patients from obtaining covered family planning services from health care providers who also perform elective abortions (Tom Betlach, et al. v. Planned Parenthood of Arizona Inc., No. 13-621, U.S. Sup.).
MADISON, Wis. - A Wisconsin federal judge on Feb. 18 dismissed a Medicare false claims suit but gave the plaintiff permission to amend her suit (United States of America ex rel. Jodi Miller v. SSM Health Care Corp., et al., No. 12-885, W.D. Wis.; 2014 U.S. Dist. LEXIS 19722).
HOUSTON - A Texas federal judge on Feb. 13 dismissed a class action lawsuit related to the denial of health care benefits based on a plan's subrogation provisions, saying that some claims were preempted by federal law and that the plan administrator acted in accordance with plan terms in denying benefits (Joe Hollingshead v. Aetna Health Inc., No. 13-231, S.D. Texas; 2014 U.S. Dist. LEXIS 18770).
SAN JUAN, Puerto Rico - A Puerto Rico federal judge on Feb. 13 dismissed a Medicare dispute, saying the court lacked jurisdiction because the plaintiff had yet to receive a "final decision" from Medicare's Departmental Appeals Board (DAB) (Centro Radiologico Rolon Inc., et al. v. United States of America, et al., No. 12-2051, D. P.R.; 2014 U.S. Dist. LEXIS 19112).
FORT WORTH, Texas - A federal Texas judge on Feb. 12 remanded a prompt-pay case to state court, saying that the Employee Retirement Income Security Act did not preempt the claims (Texas Health Resources v. Aetna Health Inc., No. 13-1013, N.D. Texas; 2014 U.S. Dist. LEXIS 17939).
ATLANTA - An 11th Circuit U.S. Court of Appeals panel on Feb. 14 affirmed that the Employee Retirement Income Security Act preempted several provisions of Georgia's state code related to prompt payment of health care claims (America's Health Insurance Plans v. Ralph T. Hudgens, in his Official Capacity as Georgia Insurance and Safety Fire Commissioner, No. 13-10349, 11th Cir.; 2014 U.S. App. LEXIS 2771).
ROCK ISLAND, Ill. - A federal judge in Illinois on Feb. 5 ruled that where a health plan governed by the Employee Retirement Income Security Act requires a plan participant to reimburse the plan for benefits received from a third-party recovery, the participant was not relieved of his reimbursement obligation by the plan's failure to follow procedures in a document other than the plan's governing document (Plumbers and Pipefitters Local No. 25 Welfare Fund, et al. v. Wes Sedam, No. 12-4114, C.D. Ill.; 2014 U.S. Dist. LEXIS 14436).
NEW YORK - In a Feb. 7 unpublished opinion, a panel of the Second Circuit U.S. Court of Appeals affirmed with a modification a lower court's decision to grant a preliminary injunction to keep a health insurance company group from terminating approximately 2,200 physicians from its Medicare Advantage program (Fairfield County Medical Association, et al. v. United Healthcare of New England, et al., No.13-4608, 2nd Cir.; 2014 U.S. App. LEXIS 2319).
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).
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).
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).
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).
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).
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).
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.).
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).
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).