LexisNexis® Legal Newsroom
    Federal Judge: Qui Tam Plaintiffs Fraud Claims Meet Public Disclosure Rule

    JACKSON, Miss. - A federal judge in Mississippi on Sept. 30 denied a motion to dismiss a qui tam action filed by three former employees of SouthernCare Inc., a hospice provider in Mississippi, saying the claims of fraud met the False Claims Act (FCA) requirement that whistle-blowers are the original source of the fraud allegations (United States of America, ex rel. Deborah Woods, et al., v. SouthernCare Inc., No. 3:09cv00313, S.D. Miss., Jackson Div.; 2013 U.S. Dist. LEXIS 141524).

    Federal Judge Grants Injunctive Relief To Children Denied Increase In Nursing Care

    ATLANTA - A federal judge in Georgia on Sept. 27 granted a request for injunctive relief by two severely disabled children against David A. Cook, as commissioner of the Georgia Department of Community Health (GDCH), ordering the state department to provide the plaintiffs' requested increase of skilled home nursing care under the Medicaid program (Marketric Hunter, et al. v. David A. Cook, Comissioner of the Georgia Department of Community Health, No. 1:08cv2930, N.D. Ga., Atlanta Div.; 2013 U.S. Dist. LEXIS 139963).

    Maryland High Court Partially Reverses Decision On Balance Billing

    ANNAPOLIS, Md. - Maryland's highest court on Sept. 30 held that a health maintenance organization (HMO) member who has been billed by a health care provider for a covered service does not have an implied private cause of action under Maryland Code, Health-General Article, Section 19-710(p), but is not precluded from bringing an action under the state's Consumer Protection Act (David Scull, et al. v. Groover, Christie & Merritt, No. 71, Md. App.; 2013 Md. LEXIS 609).

    Class Certification Denied In ERISA Coordination-Of-Benefits Action

    CAMDEN, N.J. - A federal judge in New Jersey on Sept. 26 denied class certification of claims that United Healthcare, as the claims administrator for thousands of health insurance plans, violated the Employee Retirement Income Security Act by using a method for estimating what Medicare would have paid for services that resulted in underpayment for insureds under the plans' coordination-of-benefits provisions (Mark Lipstein, et al. v. UnitedHealth Group, et al., No. 11-1185, D. N.J.; 2013 U.S. Dist. LEXIS 138045).

    Maine Federal Judge Dismisses Challenge To Medicaid Amendment

    PORTLAND, Maine - A Maine federal judge on Sept. 30 dismissed without prejudice a potential class action suit against the secretary of Health and Human Services, which alleges that a recent amendment to Maine's Medicaid plan that reduced or terminated Medicaid benefits does not comply with the "maintenance of effort" requirement of the Patient Protection and Affordable Care Act (PPACA), saying it would be improper to proceed in the state's absence (Louis Bourgoin, et al. v. Kathleen Sebelius, No. 13-55, D. Maine; 2013 U.S. Dist. LEXIS 140599).

    House Blocks Health Care Act In Budget Negotiations; Senate To Take Up Measure

    WASHINGTON, D.C. - The U.S. Senate will meet at 2 p.m. Sept. 30 - 10 hours before a government shutdown deadline - to decide what to do after the Republican-controlled House approved legislation yesterday imposing a one-year delay of the Patient Protection and Affordable Care Act (PPACA) and repealing a tax on medical devices in budget negotiations.

    Colorado Federal Judge Affirms HHS Council's Denial Of Medicaid Dental Benefits

    DENVER - A federal judge in the U.S. District Court for the District of Colorado on Sept. 24 affirmed a U.S. Department of Health and Human Services (DHHS) Medicare Appeals Council ruling finding that coverage for dental surgery is unavailable under Medicare. The judge explained that surgery to repair a beneficiary's mandible to improve her overall health did not fall under the exceptions to Medicare's prohibition for coverage for dental services under Medicare Part B (Dixie Born v. Kathleen Sebelius, Secretary of Health and Human Services, No. 11cv002507, D. Colo.; 2013 U.S. Dist. LEXIS 136396).

    La. Federal Judge Dismisses Denial Of Benefits Case, Allows Amendment

    LAFAYETTE, La. - A Louisiana federal judge on Sept. 23 adopted the findings of a magistrate judge in dismissing a wrongful denial of health benefits case, but allowed the plaintiff time to amend her complaint to assert violations of the Employee Retirement Income Security Act (Amelia Simon v. Express Scripts Inc., et al., No. 13-187, W.D. La.; 2013 U.S. Dist. LEXIS 136090).

    Federal Judge Declines To Dismiss Fraudulent Health Care Billing Claims

    NEWARK, N.J. - A New Jersey federal judge on Sept. 24 declined to dismiss a fraudulent health care billing suit, finding that the plaintiff health insurer properly supported its claims against the health care provider (Connecticut General Life Insurance Co. v. Roseland Ambulatory, No. 12-5941, D. N.J.; 2013 U.S. Dist. LEXIS 136374).

    Kan. Federal Judge Denies Motion To Acquit Defendant Convicted Of Medicaid Fraud

    TOPEKA, Kan. - A Kansas federal judge on Sept. 20 denied a defendant's motion for acquittal or, in the alternative, a new trial following her conviction for 12 counts of health care benefit fraud and conspiracy to commit health care fraud in violation of Medicaid laws (United States of America v. Caela M. White-Kinchion, No. 11-40023, D. Kan.; 2013 U.S. Dist. LEXIS 134516).

    Federal Judge Declines To Dismiss Fraudulent Advertising Of Health Policy Claim

    MADISON, Wis. - A Wisconsin federal judge on Sept. 20 declined to dismiss a complaint alleging that a health insurer and companies hired to advertise its policies on television committed fraud and bad faith in their advertising practices, allowed the plaintiffs to amend their complaint and declined to grant class action status to the case (Harry R. Wiedenbeck, et al. v. Cinergy Health Inc., et al., No. 12-508, W.D. Wis.; 2013 U.S. Dist. LEXIS 134672).

    Kentucky Federal Judge Declines To Vacate Contempt Order In Medicaid Waiver Suit

    LEXINGTON, Ky. - A Kentucky federal judge on Sept. 18 denied the Kentucky Cabinet for Health and Family Service's request to vacate and dissolve a partial finding of contempt issued against the cabinet for failing to properly process requests by Medicaid patients to transfer from one in-network Coventry Health and Life Insurance Co. facility to another facility in light of Coventry's impending termination of its provider contract with Appalachian Regional Healthcare Inc. and ARH Breckenridge Health Services Inc. (collectively, ARH) Appalachian Regional Healthcare, et al. v. Coventry Health and Life Insurance Co., et al., No. 12-114, E.D. Ky.; 2013 U.S. Dist. LEXIS 133126).

    Massachusetts Federal Judge Dismisses Provider's Suit, Says Fax Is Not Advertisement

    BOSTON - A Massachusetts federal judge on Sept. 18 dismissed a health care provider's suit against a network facilitator for violations of the Telephone Consumer Protection Act (TCPA) and the Junk Fax Prevention Act (JFPA), saying that the fax in question was not an advertisement (Physicians Healthsource Inc. v. Multiplan Services Corp., No. 12-11693, D. Mass.; 2013 U.S. Dist. LEXIS 133397).

    California Federal Judge Remands Health Care Payment Dispute; No ERISA Preemption

    LOS ANGELES - A California federal judge on Sept. 18 remanded a breach of health care contract suit to state court, saying that the Employee Retirement Income Security Act did not preempt the claims (Port Medical Wellness Inc. v. Connecticut General Life Insurance Co., et al., No. 13-3604, C. D. Calif.; 2013 U.S. Dist. LEXIS 134612).

    9th Circuit Denies Rehearing In California Medicaid Coverage Lawsuit

    SAN FRANCISCO - The Ninth Circuit U.S. Court of Appeals on Sept. 17 denied a motion for rehearing and rehearing en banc filed by the California Department of Health Services, thus reaffirming its ruling that California legislation eliminating coverage for certain health care 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.).

    D.C. Court: HHS Within Its Discretion To Not Join Medicare Qui Tam Suit

    WASHINGTON, D.C. - A federal judge in the District of Columbia on Sept. 16 held that the federal government's decision to not intervene in two qui tam actions filed under the U.S. False Claims Act was within its discretion and cannot be reviewed by the court, concluding that the federal agencies may choose not to intervene in a qui tam action even when evidence suggested fraud under the Medicare statute has been committed (Michael L. Davis v. U.S. Department of Health and Human Services, et al., No. 12-1246, D. D.C.; 2013 U.S. Dist. LEXIS 131796).

    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).