LexisNexis® Legal Newsroom
    Federal Judge Grants Health Insurers Summary Judgment In Reimbursement Dispute

    NEWARK, N.J. - A New Jersey federal judge on Aug. 1 granted summary judgment in favor of health insurers in a reimbursement dispute and denied the plaintiffs' motion for class certification (Premier Health Center, et al. v. UnitedHealth Group, et al., No. 11-425, D. N.J.; 2013 U.S. Dist. LEXIS 108041).

    Texas Medicare Claim Dismissed For Lack Of Subject Matter Jurisdiction

    HOUSTON - A federal judge in Texas on July 31 dismissed a Medicare Act claim against Specialty Select Hospital Houston (Select), saying the Medicare beneficiary plaintiff failed to state a claim upon which relief may be granted. The judge concluded that the beneficiary has not completed the administrative review process and that the court, therefore, lacks jurisdiction because a final administrative decision has not been made (Catalina Blanco v. Select Specialty Hospital, Houston L.P., No. H-13-1591, S.D. Texas, Houston Div.; 2013 U.S. Dist. LEXIS 107525).

    Chiropractors Sufficiently Alleged Breach, Bad Faith Under ERISA, Judge Rules

    NEWARK, N.J. - Three chiropractors pursuing class claims against a health insurer's "bundling" of purportedly distinct claims survived dismissal on July 31, with a New Jersey federal judge finding that they had satisfied standing and pleading requirements under the Employee Retirement Income Security Act (ERISA) and state law (Alphonse A. DeMaria, D.C., et al. v. Horizon Healthcare Services Inc., et al., No. 11-7298, D. N.J.; 2013 U.S. Dist. LEXIS 107422).

    Federal Judge Partially Dismisses Qui Tam Suit Against Tennessee Facility

    CHATTANOOGA, Tenn. - A federal judge in Tennessee on July 29 partially granted and partially denied a motion to dismiss a qui tam lawsuit filed against Chattanooga-Hamilton County Hospital Authority, doing business as Erlanger Medical Center (Erlanger). The judge concluded that the false claims against the hospital authority are not allowed under the public disclosure bar of the Patient Protection and Affordable Care Act (PPACA) (United States of America, ex rel. Lisa K. Stratienko v. Chattanooga-Hamilton County Hospital Authority, d/b/a Erlanger Medical Center, No. 1:10cv322, E.D. Tenn.; 2013 U.S. Dist. LEXIS 105584).

    1 Claim Remains In Breach Of Health Insurance Contract Dispute

    OKLAHOMA CITY - An Oklahoma federal judge on July 29 partially granted summary judgment in favor of a health care provider in a breach of contract dispute, leaving only the plaintiff's claim that she is a third-party beneficiary seeking to enforce restrictions on permitted billing of members for services that are not covered (Elizabeth Cates v. Integris Health Inc., No. 12-763, W.D. Okla.; 2013 U.S. Dist. LEXIS 105437).

    Arizona Federal Judge Grants Defense Summary Judgment In Medicaid Dispute

    PRESCOTT, Ariz. - An Arizona federal judge on July 26 granted summary judgment in favor of the defendants in a class action lawsuit alleging that the secretary of Health and Human Services wrongfully granted approval to the State of Texas to permit heightened and mandatory copayments in a Medicaid demonstration project (Flint Wood, et al. v. Thomas Betlach, et al., No. 12-8098, D. Ariz.; 2013 U.S. Dist. LEXIS 105027).

    7th Circuit Affirms Dismissal Of Lawsuit Challenging Copayments

    CHICAGO - A panel of the Seventh Circuit U.S. Court of Appeals on July 26 affirmed the dismissal of a proposed class action lawsuit alleging that six health insurance companies violated Wisconsin state law by requiring copayments for chiropractic care, saying that although the insurance companies were proper defendants, the practice of requiring chiropractic copayments is not a fiduciary act under the Employee Retirement Income Security Act (Cynthia Larson, et al. v. United Healthcare Insurance Co., et al., No. 12-1256, 7th Cir.; 2013 U.S. App. LEXIS 15272).

    California Federal Judge Partially Grants Arbitration In Drug Trade Secret Suit

    SAN FRANCISCO - A California federal judge on July 22 granted in part and denied in part a motion to compel arbitration in a class action lawsuit, alleging that a pharmacy benefit management company (PBM) and its related entities made unauthorized disclosures of customer information (Uptown Drug Company Inc. v. CVS Caremark Corp., et al., No. 12-6559, N.D. Calif.; 2013 U.S. Dist. LEXIS 102265).

    Florida Federal Judge Dismisses Health Care Insurance Reimbursement Suit

    MIAMI - A Florida federal judge on July 22 dismissed a reimbursement suit brought by a provider of health care against a health insurance company for failure to state a claim (Hialeah Physicians Care v. Connecticut General Life Insurance Co., No. 13-21895, S.D. Fla.; 2013 U.S. Dist. LEXIS 102007).

    Antitrust, Some ERISA Claims Dismissed From Wellpoint Reimbursement MDL

    LOS ANGELES - A federal judge in California on July 19 dismissed antitrust and other claims alleging that WellPoint Inc. and other companies conspired to use a flawed database to set the rates for which out-of-network medical services (ONS) are reimbursed (In re: WellPoint Inc. Out-Of-Network "UCR" Rates Litigation, MDL No. 2:09-ml-02074, C.D. Calif.).

    Federal Judge Reverses Decision, Grants Preliminary Injunction In Health Act Case

    OKLAHOMA CITY - Following instructions from the 10th Circuit U.S. Court of Appeals, an Oklahoma federal judge on July 19 reversed a previous decision and granted a preliminary injunction in favor of the arts and craft company Hobby Lobby Stores Inc. and its owners, halting the implementation of a mandate contained in the Patient Protection and Affordable Care Act (PPACA) related to the provision of birth control as it relates to the plaintiffs (Hobby Lobby Stores Inc., et al. v. Kathleen Sebelius, et al., No. 12-1000, W.D. Okla.).

    Blue Cross Violates Fiduciary Duty By Setting, Imposing Fee, 6th Circuit Rules

    CINCINNATI - Blue Cross Blue Shield of Michigan (BCBSM) violated its fiduciary duties under the Employee Retirement Income Security Act by discretionarily setting and billing a self-funded benefits fund for a cost-transfer subsidy fee to satisfy its obligation to the State of Michigan, the Sixth Circuit U.S. Court of Appeals ruled July 18 in affirming summary judgment to the fund (Pipefitters Local 636 Insurance Fund, et al. v. Blue Cross and Blue Shield of Michigan, No. 12-2265, 6th Cir.; 2013 U.S. App. LEXIS 14517).

    Wisconsin Federal Judge Declines To Dismiss Medicaid Dispute

    MADISON, Wis. - A federal judge in Wisconsin on July 17 declined to dismiss a suit alleging that Wisconsin officials violated the plaintiffs' federal Medicaid rights by failing to furnish medical assistance under a program for childless adults, saying that the plaintiffs have a private right of action (Charles Wagner, et al. v. Wisconsin Department of Health Services, et al., No. 12-463, 2013 U.S. Dist. LEXIS 99629).

    High Court Denies Stay Pending Filing Of Certiorari In Medicaid Case

    WASHINGTON, D.C. - The U.S. Supreme Court on July 22 denied an application for a stay in a case in which the Ninth Circuit U.S. Court of Appeals vacated preliminary injunctions prohibiting the California Department of Health Care Services and its director from implementing Medi-Cal reimbursement reductions authorized by the California Legislature and approved by the secretary of the Department of Health and Human Services (Managed Pharmacy Care, et al. v. Kathleen Sebelius, et al., No. 13A13, U.S. Sup.).

    N.Y. Federal Judge Grants Health Insurer Judgment In Denial Of Benefits Case

    NEW YORK - A New York federal judge on July 17 granted summary judgment in favor of a health insurer in a wrongful denial of benefits suit, saying the denial of benefits was not arbitrary and capricious (Daniel Z. Stern v. Oxford Health Plans Inc., No. 12-2379, E.D. N.Y.; 2013 U.S. Dist. LEXIS 99962).

    Allocation Burden Was Properly Placed On Insured, Pennsylvania Majority Affirms

    HARRISBURG, Pa. - A majority of the Pennsylvania Superior Court found July 18 that a lower court properly placed the allocation burden on an insured in a professional liability coverage dispute over settlement and defense costs stemming from an underlying managed care multidistrict litigation (Executive Risk Indemnity Inc. v. CIGNA Corp., No. 1117 EDA 2012, Pa. Super.; 2013 Pa. Super. LEXIS 1662).

    Florida Appeals Panel Revives Couple's Claims Against Health Care Company

    MIAMI - The Third District Florida Court of Appeal on July 17 reversed a trial court decision dismissing claims against a health care provider, ruling that the plaintiffs' claims were not for medical malpractice (Angel Acosta, et al. v. HealthSpring of Florida Inc., No. 3D12-1340, Fla. App., 3rd Dist.; 2013 Fla. App. LEXIS 11358).

    D.C. Federal Judge Grants Summary Judgment To DHHS In Medicaid Reimbursement Suit

    WASHINGTON, D.C. - A federal judge in the U.S. District Court for the District of Columbia on July 15 granted summary judgment to the U.S. Department of Health and Human Services (DHHS) in a dispute regarding a "hold-harmless" provision for reimbursement under the "Disproportionate Share Hospital" (DSH) adjustments hospitals receive under the Medicare and Medicaid statutes (University of Kansas Hospital Authority, et al. v. Kathleen Sebelius, Secretary, U.S. Department of Health and Human Services, No. 11-cv-1382, D. D.C.; 2013 U.S. Dist. LEXIS 98183).

    5th Circuit Affirms Merger Not 'Sale' For Purposes Of Depreciation Under Medicare

    NEW ORLEANS - A panel of the Fifth Circuit U.S. Court of Appeals on July 12 affirmed the denial of a request for a loss payment made by a Medicare provider following a merger, finding that the merger was not a bona fide sale as required by the Medicare statute (Memorial Hermann Hospital v. Kathleen Sebelius, secretary of the Department of Health and Human Services, No. 12-20654, 5th Cir.; 2013 U.S. App. LEXIS 14232).

    Michigan Federal Judge Denies Preliminary Injunction In Birth Control Suit

    DETROIT - A Michigan federal judge on July 11 denied a motion for a temporary restraining order and preliminary injunction in a challenge to the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) brought by a management company owned by practicing Catholics (Mersino Management Co., et al. v. Kathleen Sebelius, et al., No. 13-11296, E.D. Mich.; 2013 U.S. Dist. LEXIS 96588).

    4th Circuit Affirms Dismissal Of Challenge To Health Care Reform Act

    RICHMOND, Va. - In a case remanded from the U.S. Supreme Court, a Fourth Circuit U.S. Court of Appeals panel on July 11 affirmed the dismissal of a case challenging the individual and employer mandates contained in the Patient Protection and Affordable Care Act (PPACA) (Liberty University, et al. v. Jacob J. Lew, et al., No. 10-2347, 4th Cir.; 2013 U.S. App. LEXIS 14052).

    9th Circuit Says N.J. Violated Medicaid When Changing Payment System

    PHILADELPHIA - In partially affirming and partially reversing a lower court, a panel of the Ninth Circuit U.S. Court of Appeals on July 9 held that New Jersey's requirement that Medicaid wraparound payments be contingent on prior managed care organization (MCO) payments violated the federal Medicaid statute's requirements that federally qualified health centers (FQHCs) timely receive full wraparound payment for all Medicaid-eligible claims (New Jersey Primary Care Association Inc. v. State of New Jersey Department of Human Services, et al., No. 12-3220, 3rd. Cir.; 2013 U.S. App. LEXIS 13881).

    9th Circuit Holds California Law Eliminating Coverage Violates Medicaid Act

    SAN FRANCISCO - In reversing a lower court, a Ninth Circuit U.S. Court of Appeals panel on July 5 held that California legislation eliminating coverage for certain health care services, including adult dental, podiatry, optometry and chiropractic services, conflicted with the Medicaid Act and, therefore, was invalid (California Association of Rural Health Clinics, et al. v. Toby Douglas, et al., Nos. 10-17574, 10-17622, 9th Cir.; 2013 U.S. App. LEXIS 13651).

    7th Circuit Affirms Dismissal Of Prescription Drug Headline Fraud Case

    CHICAGO - A panel of the Seventh Circuit U.S. Court of Appeals on July 8 affirmed the dismissal of a class action complaint alleging that a prescription drug manufacturer and pharmacy engaged in a scheme to defraud insurers (United Food and Commercial Unions and Employers Midwest Health Benefits Fund v. Walgreen Co., et al., No. 12-2077, 7th Cir.).

    Colorado Federal Judge Defers Ruling On Motions In Birth Control Case

    DENVER - A Colorado federal judge on July 3 deferred a motion for a preliminary injunction or a temporary restraining order pending a ruling on the motion for a preliminary injunction in a case brought by the owner of for-profit senior care assisted living centers and skilled nursing centers in a suit challenging the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA), pending a ruling by the 10th Circuit U.S. Court of Appeals in a similar case (Stephen W. Briscoe, et al. v. Kathleen Sebelius, et al., No. 13-285, D. Colo.; 2013 U.S. Dist. LEXIS 93607).