LexisNexis® Legal Newsroom
    Colorado Federal Judge Grants Injunction In Health Care Act Case

    DENVER - A Colorado federal judge on Sept. 17 enjoined the federal government from enforcing the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) against a mortgage company and its owners, who had argued that adhering to the mandate would violate their religious beliefs (W.L. Armstrong, et al. v. Kathleen Sebelius, et al., No. 13-563, D. Colo.; 2013 U.S. Dist. LEXIS 132841).

    6th Circuit Affirms Denial Of Preliminary Injunction In Health Care Act Case

    CINCINNATI - A Sixth Circuit U.S. Court of Appeals panel on Sept. 17 affirmed the denial of a preliminary injunction sought by the owners of for-profit, secular corporations in a challenge to the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) and ordered the individual plaintiffs dismissed for lack of standing (Autocam Corp., et al. v. Kathleen Sebelius, et al., No. 12-2673, 6th Cir.; 2013 U.S. App. LEXIS 19152).

    Louisiana Federal Judge Remands Reimbursement Suit, Says Jurisdiction Lacking

    NEW ORLEANS - A Louisiana federal judge on Sept. 16 remanded a health care reimbursement suit to state court, finding that the court lacked subject matter jurisdiction (Omega Hospital v. Louisiana Health Service & Indemnity Co., et al., No. 13-21, E.D. La.; 2013 U.S. Dist. LEXIS 131988).

    Michigan Federal Judge Denies Injunction In Health Care Act Suit

    DETROIT - A Michigan federal judge on Sept. 13 denied a motion by a business owner and his company for a preliminary injunction halting the implementation of the "birth control" mandate contained in the Patient Protection and Affordable Care Act (PPACA) case (MK Chambers Co., et al. v. Department of Health and Human Services, et al., No. 13-11379, E.D. Mich.; 2013 U.S. Dist. LEXIS 130880).

    Health Plan May Seek Attorney Fees In ERISA Action, 2nd Circuit Rules

    NEW YORK - A health plan may seek attorney fees under the Employee Retirement Income Security Act because a restitution claim against it was dismissed on summary judgment, the Second Circuit U.S. Court of Appeals ruled Sept. 10 (Nicholas Scarangella v. Scarangella & Sons, Inc., et al., No. 12-2750-cv, 2nd Cir.; 2013 U.S. App. LEXIS 18761).

    Judge Declines To Dismiss Health Care Suit; Issues On Alter-Ego Liability Exist

    CHICAGO - An Illinois federal judge on Sept. 10 denied a motion to dismiss a health care insurance suit alleging breach of contract and violation of the Consolidated Omnibus Budget Reconciliation Act (COBRA) but granted the plaintiff's motion to strike an affidavit the defendants filed in support of their dismissal motion (Victoria Weiland v. AssureCare Inc., et al., No. 12-1947, N.D. Ill.; 2013 U.S. Dist. LEXIS 128750).

    Massachusetts High Court Affirms Exclusion Of Medical Cost Data

    BOSTON - The Supreme Judicial Court of Massachusetts affirmed the exclusion of evidence that a defendant sought to submit in a health care reimbursement suit from a database company, saying that the trial judge did not abuse his discretion in excluding evidence that could not be fully verified (NE Physical Therapy Plus Inc. v. Liberty Mutual Insurance Co., No. SJC-11284, Mass. Sup. Jud. Ct.; 2013 Mass. LEXIS 706).

    Terminated Employee's Denial Of Benefits, Fiduciary Duty Claims Fail, 7th Circuit Rules

    CHICAGO - A plan sponsor did not wrongfully deny health insurance benefits or breach its fiduciary duties under the Employee Retirement Income Security Act to a former employee whose employment was terminated because his work-related injuries prevented him from returning to work where the plan terms did not promise post-employment benefits, the Seventh Circuit U.S. Court of Appeals ruled Sept. 6 (James Brooks v. Pactiv Corporation, et al., No. 12-1155, 7th Cir.; 2013 U.S. App. LEXIS 18651).

    6th Circuit Affirms Imposition Of Monetary Penalty In Medicare Case

    CINCINNATI - In an unpublished opinion, a panel of the Sixth Circuit U.S. Court of Appeals on Sept. 6 affirmed the imposition of a civil monetary penalty (CMP) against a skilled nursing facility for failing to comply with participation requirements set by the Centers for Medicare and Medicaid Services (CMS) (Life Care Center of Bardstown v. Secretary of United States Department of Health and Human Services, No. 12-4420, 6th Cir.; U.S. App. LEXIS 18657).

    New Jersey Appeals Court Affirms Termination Of Medicaid Beneficiaries

    NEWARK, N.J. - In an unpublished, consolidated opinion, a New Jersey appeals court on Sept. 9 affirmed four financial agency decisions of the New Jersey Department of Human Services (DHS), Division of Medical Assistance and Health Services (DMAHS) terminating appellants from the New Jersey Family Care Medicaid Program (NJFC) (B.D. v. New Jersey Department of Human Services, Division of Medical Assistance and Health Services, No. A-2456-11T3; M.M., et al. v. New Jersey Department of Human Services, Division of Medical Assistance and Health Services, No. A-4744-11T2; T.J. v. New Jersey Department of Human Services, Division of Medical Assistance and Health Services; No. A-5761-11T1, G.G. v. New Jersey Department of Human Services, Division of Medical Assistance and Health Services, No. A-0109-12T1, N.J. Sup. Ct., App. Div.).

    Colorado Federal Judge Grants Injunction In Birth Control Mandate Suit

    DENVER - A Colorado federal judge on Sept. 6 granted a motion for a preliminary injunction to stop the implementation of the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) against an owner of for-profit senior care assisted living centers and skilled nursing centers (Stephen W. Briscoe, et al. v. Kathleen Sebelius, et al., No. 13-285, D. Colo.; 2013 U.S. Dist. LEXIS 127510).

    Puerto Rico Federal Judge Retains Jurisdiction In Dentists' Reimbursement Suit

    SAN JUAN, Puerto Rico - A Puerto Rico federal judge on Sept. 6 held that federal jurisdiction remains in a reimbursement suit brought by dentists and their employers against multiple health insurers following the denial of class certification under the Class Action Fairness Act (CAFA) (College of Dental Surgeons of Puerto Rico v. Triple S Management Inc., No. 09-1209, D. Puerto Rico; 2013 U.S. Dist. LEXIS 127747).

    9th Circuit Vacates Injunction In Medicare Suit, Orders Court To Consider Merits

    SAN FRANCISCO - A panel of the Ninth Circuit U.S. Court of Appeals on Sept. 4 vacated an injunction prohibiting the secretary of the U.S. Department of Health and Human Services (DHHS) from demanding "up front" reimbursement for secondary payments from beneficiaries who have appealed a Medicare reimbursement determination and remanded the class action case with instructions for the lower court to consider the merits of the plaintiffs' due process claim (Patricia Haro, et al. v. Kathleen Sebelius, No. 11-16606, 9th Cir.; 2013 U.S. App. LEXIS 18353).

    D.C. Federal Judge Grants Government Summary Judgment In Medicare Dispute

    WASHINGTON, D.C. - A District of Columbia federal judge on Sept. 5 granted summary judgment in favor of the government in a Medicare dispute, saying that the secretary of the U.S. Department of Health and Human Service (DHHS) did not act arbitrarily or capriciously in denying reimbursements for costs associated with off-site resident training (Borgess Medical Center, et al. v. Kathleen Sebelius, No. 12-144, D. D.C.; 2013 U.S. Dist. LEXIS 126442).

    Arizona Appeals Court Finds State's Subrogation Law Not Preempted

    PHOENIX - In a matter of first impression, an Arizona appeals court on Sept. 5 held that the Federal Employee Health Benefits Act (FEHBA) does not preempt Arizona state law forbidding subrogation in personal injury cases (Matthew Kobold v. The Aetna Life Insurance Co., No. 12-0315, Ariz. App., Div. 1; 2013 Ariz. App. LEXIS 187).

    8th Circuit: Medicare Doesn't Require Written Reports For Surgical Pathology Slides

    MINNEAPOLIS - The Eighth Circuit U.S. Court of Appeals on Sept. 4 affirmed the dismissal of a qui tam lawsuit filed against the Mayo Foundation under the federal False Claims Act (FCA), saying the Mayo Foundation and its related entities filed false and fraudulent claims for reimbursement to the Centers for Medicare and Medicaid Services when the Mayo Foundation and its related entities failed to submit written reports for each permanent surgical pathology slide it created for each patient treated (United States of America, ex rel. David Ketroser, et al., v. Mayo Foundation, et al., No. 12-3206, 8th Cir.; 2013 LEXIS 18330).

    Missouri Federal Judge Denies Summary Judgment In Medicare False Claims Suit

    ST. LOUIS - A Missouri federal on Aug. 30 denied summary judgment motions made by the parties in a Medicare false claims billing case, finding that a jury could reach a decision in favor of either party (United States of America ex rel. Health Dimensions Rehabilitation Inc. v. RehabCare Group Inc., et al., No. 12-848, E.D. Mo.; 2013 U.S. Dist. LEXIS 123204).

    Texas Federal Judge Allows Intervention In Health Care Act Suit

    HOUSTON - A Texas federal judge on Aug. 30 granted a motion to intervene in a case challenging the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) made by a graduate theological seminary (East Texas Baptist University, et al. v. Kathleen Sebelius, et al., No. 12-3009, S.D. Texas; 2013 U.S. Dist. LEXIS 124347).

    Michigan Federal Judge Denies Remand In Denial Of Benefits Suit; ERISA Applies

    KALAMAZOO, Mich. - A Michigan federal judge on Aug. 28 denied a motion to remand a wrongful denial of health care benefits suit to state court and granted the defendant's motion to dismiss, while allowing the plaintiff to amend the complaint (Anne Florence Andrea-Pearson v. Grand Valley Health Plan Inc., No. 12-1223, W.D. Mich.; 2013 U.S. Dist. LEXIS 122331).

    Louisiana Federal Judge Remands Breach Of Health Care Contract

    NEW ORLEANS - A Louisiana federal judge on Aug. 26 remanded a breach of health care contract suit to state court, finding that the defendant did not show that the amount in controversy for removal to federal court had been met (Omega Hospital LLC v. Blue Cross Blue Shield of Illinois, No. 13-4891, E.D. La.; 2013 U.S. Dist. LEXIS 12195).

    Ill. Federal Judge Dismisses Antitrust Claims Against Health Insurer, Hospital

    EAST ST. LOUIS, Ill. - An Illinois federal judge on Aug. 26 dismissed antitrust claims brought by an outpatient surgery center against a health insurance company and a corporation owning multiple hospitals in Illinois, holding that the plaintiff failed to properly show a relevant market (Marion Healthcare v. Southern Illinois Healthcare, et al., No. 12-871, S.D. Ill.; 2013 U.S. Dist. LEXIS 120722).

    Mississippi Federal Judge Declines To Remand Denial Of Benefits Suit

    JACKSON, Miss. - A Mississippi federal judge on Aug. 26 denied a motion to remand a wrongful denial of health care benefits suit, saying a later-added defendant timely and properly removed the case to federal court (Silas Anderson v. Blue Cross and Blue Shield, et al., No. 13-402, S.D. Miss.; 2013 U.S. Dist. LEXIS 121014).

    11th Circuit Affirms Reversal Of Denial Of Health Care Benefits

    ATLANTA - In an unpublished, per curiam opinion, a panel of the 11th Circuit U.S. Court of Appeals on Aug. 22 affirmed judgment in favor of a plaintiff in a wrongful denial of benefits suit, agreeing that the plan excluded coverage for injuries received committing felonies and not misdemeanors (Cornelius B. Faison v. Donalsonville Hospital Inc., No. 12-15400, 11th Cir.; 2013 U.S. App. LEXIS 17578).

    N.Y. Justice Consolidates Balance Billing Disputes, Dismisses 1 Defendant

    NEW YORK - A New York justice on Aug. 21 consolidated two disputes related to balance billing and health care reimbursements into one action, moved the location of the consolidated suit and dismissed one of the defendants (Aetna Health Inc., et al. v. Shuriz Hishmeh, M.D., et al., No. 653477/12, N.Y. Sup.; New York Co.; 2013 N.Y. Misc. LEXIS 3702).

    Arizona Federal Judge Declines To Dismiss Health Care Denial Of Benefits Case

    PHOENIX - An Arizona federal judge on Aug. 22 denied a health insurance company's motion to dismiss a wrongful denial of benefits suit, saying the court had personal jurisdiction over the case (Jason Brown v. Anthem Blue Cross and Blue Shield, et al., No. 13-990, D. Ariz.; 2013 U.S. Dist. LEXIS 119457).