LexisNexis® Legal Newsroom
    Federal Judge Dismisses Dispute Over Termination Of Medicare Provider Agreement

    SCRANTON, Pa. - A Pennsylvania federal judge on May 31 granted the government's motion to dismiss a Medicare dispute arising from the termination of a skilled nursing facility's provider agreement for failure to substantially comply with care requirements (Athens Healthcare Inc. v. Kathleen Sebelius, et al., No. 13-1443, M.D. Pa.; 2013 U.S. Dist. LEXIS 77192).

    Judge Denies Injunction To Halt Termination Of Medicare Provider Agreement

    GREENVILLE, Tenn. - A Tennessee federal judge on May 31 denied a motion for a preliminary injunction brought by a nursing home facility seeking to postpone the termination of its Medicare and Medicaid provider agreement (Bristol Health Care Investors v. Mark Emkes, et al., No. 13-137, E.D. Tenn.; 2013 U.S. Dist. LEXIS 76644).

    9th Circuit Affirms Denial Of Dental Services Under Medicare

    PASADENA, Calif. - A Ninth Circuit U.S. Court of Appeals panel on May 31 affirmed a district court's judgment affirming the secretary of the U.S. Department of Health and Human Services' (HHS) decisions denying benefits under Medicare for dental services (Ronald Fournier, et al. v. Kathleen Sebelius, No. 12-15478, 9th Cir.; 2013 U.S. App. LEXIS 10997).

    D.C. Court: Stark Act Bars Doctor Group From Self-Referring Patients

    WASHINGTON, D.C. - A federal judge in the District of Columbia on May 24 granted summary judgment to the U.S. Department of Health and Human Services' (DHHS) Centers for Medicare and Medicaid Services (CMS) in a challenge to a Stark Act-based regulation barring physician groups from self-referring patients for "designated health services" (DHS) at a hospital with which the groups have a financial arrangement (Council for Urological Interests v. Kathleen Sebelius, in her official capacity as Secretary of the Department of Health and Human Services, et al., No. 09-cv-0546, D. D.C.; 2013 U.S. Dist. LEXIS 73610).

    9th Circuit Panel Vacates Injunctions Over Medicaid Reimbursement Reductions

    SAN FRANCISCO - A Ninth Circuit U.S. Court of Appeals panel withdrew a previous decision and published a new opinion on May 24 that reverses a district court's decision in four cases and vacates 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., Nos. 12-55067, 12-55068, 12-55103, 12-55315, 12-55331, 12-55332, 12-55334, 12-55335, 12-55550, 12-55554, 9th Cir.; 2013 U.S. App. LEXIS 10718).

    Ga. Federal Judge Rules ERISA Preempts Claims; Order Certified For Appeal

    COLUMBUS, Ga. - A health plan's and plan sponsor's state law claims against a medical provider to recover benefits erroneously paid by the plan because of the provider's alleged fraudulent misrepresentations are completely preempted under the Employee Retirement Income Security Act, a federal judge in Georgia ruled May 22 (Aflac, Inc., et al. v. Richard Bloom, No. 4:12-CV-331, M.D. Ga.; 2013 U.S. Dist. LEXIS 72106).

    Rhode Island Federal Judge Finds For Providers In Health Care Contract Dispute

    PROVIDENCE, R.I. - A Rhode Island federal judge on May 22 found in favor of two health care providers in a contract dispute with a health insurer, finding that the plaintiff failed to establish that the treatment provided by the defendants was not a form of mechanical traction covered by the plan (Blue Cross and Blue Shield of Rhode Island v. Jay S. Korsen, et al., No. 09-317L, D. R.I.; 2013 U.S. Dist. LEXIS 72463).

    U.S. Supreme Court Declines To Hear Planned Parenthood Funding Case

    WASHINGTON, D.C. - The U.S. Supreme Court on May 28 declined to reconsider the Seventh Circuit U.S. Court of Appeals' affirmation of a trial court's grant of a preliminary injunction against the Indiana State Department of Health in enforcing a state law stripping Medicaid funds from Planned Parenthood of Indiana Inc. because the agency provides abortions (Secretary of the Indiana Family and Social Services Administration, et al. v. Planned Parenthood of Indiana Inc., Nos. 12-1039, 12-1159, U.S. Sup.).

    Health Insurer Granted Summary Judgment In Denial Of Benefits Suit

    NEWARK, N.J. - A New Jersey federal judge on May 22 granted summary judgment in favor of a health insurer in a wrongful denial of benefits suit, saying that the defendant's decision to deny benefits was not arbitrary and capricious (Montvale Surgical Center LLC v. Aetna Insurance Co., No. 12-2874, D. N.J.; 2013 U.S. Dist. LEXIS 72927).

    Federal Judge Denies Class Certification To Insurance Agents' Fraud Lawsuit

    LEXINGTON, Ky. - A Kentucky federal judge on May 22 denied class certification in a fraud lawsuit between insurance agents and an insurance agency regarding withheld commissions on sold Medicare Advantage plans (Harold David Cowden, et al. v. Parker & Associates Inc., et al., No. 09-323, E.D. Ky.; 2013 U.S. Dist. LEXIS 72253).

    Missouri Federal Judge: Relator's Fraud Suit Based On Nonpublic Information

    ST. LOUIS - A Missouri federal judge on May 20 dismissed a summary judgment motion filed by defendants in a qui tam Federal False Claims Act suit, saying the claims of Medicare and Medicaid fraud filed by relator Health Dimensions Rehabilitation Inc. against RehabCare Group and Rehab Systems Inc. (RSM) are not solely based upon publicly disclosed information but on an investigation by the relator over the course of a year (United States of America ex rel. Health Dimensions Rehabilitation Inc. v. RehabCare Group Inc., et al., No. 4:12CV00848, E.D. Mo., Eastern Div.).

    FTC Entitled To TRO In Merger Case, Georgia Federal Judge Rules

    ALBANY, Ga. - A federal judge in Georgia on May 15 granted the Federal Trade Commission's motion to temporarily enjoin Phoebe Putney Health System Inc. from taking any further steps to consolidate Georgia hospitals and from making any price changes to existing contracts following the U.S. Supreme Court's recent ruling that the state-action doctrine does not immunize the merger from antitrust scrutiny (Federal Trade Commission, et al. v. Phoebe Putney Health System Inc., et al., No. 1:11-cv-58, M.D. Ga.; 2013 U.S. Dist. LEXIS 68658).

    California Appeals Court Affirms Hospital Has No Duty To Prevent Balance Billing

    SAN JOSE, Calif. - A California appeals court panel held in a May 9 unpublished opinion that a hospital has no duty to inform patients admitted to the emergency room that emergency room physicians do not accept a particular health care plan and to take action to prevent emergency room physicians from "balance billing" (Maria Leon, et al. v. Watsonville Hospital Corp., No. H037288, Calif. App., 6th Dist.; 2013 Cal. App. Unpub. LEXIS 3297).

    Federal Judge Dismisses Medicare Suit For Lack Of Jurisdiction

    BOSTON - A Massachusetts federal judge on May 9 dismissed a Medicare payment dispute, saying that the plaintiff home health agency failed to exhaust administrative remedies and that, therefore, the court lacked jurisdiction to hear the case (MJG Management Associates Inc. v. NHIC Corp., et al., No. 12-11414, D. Mass.; 2013 U.S. Dist. LEXIS 66238).

    Pa. Federal Judge Reconsiders Dismissal Order In Birth Control Mandate Suit

    PITTSBURGH - A Pennsylvania federal judge on May 8 granted a motion to reconsider the dismissal of claims brought by a private, nonprofit college, two for-profit entities and the owners of those entities who are challenging the "birth control" mandate contained in the Patient Protection and Affordable Care Act (PPACA), saying that the claims are now ripe for review. The judge then went on to partially grant and partially deny the defendants' motion to dismiss (Geneva College, et al. v. Kathleen Sebelius, et al., No. 12-207, W.D. Pa.; 2013 U.S. Dist. LEXIS 65685).

    Citing Politics, Judge Will Let 2nd Circuit Stay His Plan B Access Order

    BROOKLYN, N.Y. - Saying that the U.S. secretary of Health and Human Services is playing politics and that the Food and Drug Administration inked a "sweetheart" deal with Teva Women's Health, a New York federal judge on May 10 granted only a temporary stay of his order for unrestricted sale of the Plan B emergency contraceptives and said the government will have to ask a federal appeals court to issue its own stay because he doubts its likelihood of success (Annie Tummino v. Margaret Hamburg, et al., No. 12-763, E.D. N.Y.).

    Health Insurance Purchasers May Drop $4.8M Settlement Of Antitrust Litigation

    PITTSBURGH - A federal judge in Pennsylvania on May 7 permitted purchasers of health insurance from Highmark Inc. to withdraw their motion for preliminary approval of their settlement with Highmark of their antitrust claims, where the purchasers argued that Highmark failed to disclose information that demonstrated that the value of the proposed settlement was illusory (Royal Mile Company, Inc., et al. v. UPMC, et al. No. 2:10-cv-01609, W.D. Pa.).

    Plan May Seek Reimbursement From Special Needs Trust, En Banc 5th Circuit Rules

    NEW ORLEANS - A divided en banc Fifth Circuit U.S. Court of Appeals on May 7 held that the Employee Retirement Income Security Act permits health plan fiduciaries to seek reimbursement for medical benefits the plan paid on behalf of a participant from a special needs trust funded by a third-party tortfeasor settlement (ACS Recovery Services, Inc., et al. v. Larry Griffin, et al., No. 11-40446, 5th Cir.; 2013 U.S. App. LEXIS 9324).

    Fla. Federal Judge Dismisses Suit Alleging Insurer Schemed To Avoid Paying Rebates

    FORT LAUDERDALE, Fla. - A Florida federal judge on May 7 dismissed a putative class action case against a health insurer and a third-party administrator accused of inflating medical loss ratios to avoid paying rebates for excessive premiums to subscribers as mandated by the Patient Protection and Affordable Care Act (PPACA) for lack of standing and ordered arbitration for claims against a second third-party administrator (MRI Scan Center v. National Imaging Associates Inc., et al., No. 13-60051, S.D. Fla.).

    D.C. Circuit Court Dismisses Appeal In Birth Control Suit

    WASHINGTON, D.C. - A District of Columbia Circuit U.S. Court of Appeals panel on May 3 granted the federal government's motion for voluntary dismissal of interlocutory appeal in a case challenging the grant of a preliminary injunction in favor of a for-profit Christian publishing company seeking to halt the implementation of the contraception mandate contained in the Patient Protection and Affordable Care Act (PPACA) (Tyndale House Publishers Inc., et al. v. Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, et al., No. 13-5018, D.C. Cir.).

    Illinois Federal Judge Orders Government To Provide Information In Medicare Suit

    CHICAGO - An Illinois federal judge on May 6 partially granted a defendant's motion for an order directing the federal government to file a bill of particulars in its case against him for Medicare fraud (United States of America v. Robert Kolbusz, No. 12-782, N.D. Ill.; 2013 U.S. Dist. LEXIS 64043).

    Claims Against Blue Cross In Case Alleging Hidden Administrative Fees Continue

    FLINT, Mich. - A federal judge in Michigan on May 3 declined to dismiss on statute of limitations grounds an employer's claim that Blue Cross and Blue Shield of Michigan (BCBS) violated the Employee Retirement Income Security Act by charging hidden fees that were not included in the parties' administrative service contract (ASC) (East Jordan Plastics, Inc., et al. v. Blue Cross and Blue Shield of Michigan, No. 12-cv-15621, E.D. Mich.; 2013 U.S. Dist. LEXIS 63475).

    Appeals Court: 2-Visit Rule Applies To Psychology Services For Medicaid Patients

    SACRAMENTO, Calif. - A California appeals court on May 2 held that federal law does not prohibit the application of California's two-visit rule to psychology services provided by federally qualified health centers (FQHCs) to Medi-Cal patients (Mendocino Community Health Clinic, et al. v. State Department of Health Care Services, No. C067826, Calif. App., 3rd Dist.; 2013 Cal. App. LEXIS 350).

    Texas Federal Judge Allows Amendment To Add Defendant In Reimbursement Suit

    DALLAS - A Texas federal judge on May 2 granted health care providers' motion to amend their complaint against insurance companies in a reimbursement dispute, saying that defendant the plaintiffs sought to add was a necessary party to the action (Paragon Office Services, et al. v. Aetna Inc., et al., No. 11-1898, N.D. Texas; 2013 U.S. Dist. LEXIS 62804).

    Louisiana Federal Judge Denies Motion To Remand Denial Of Benefits Case

    LAFAYETTE, La. - A Louisiana federal judge on May 1 denied a plaintiff's motion to remand her wrongful denial of prescription benefits case to state court (Amelia Simon v. Express Scripts Inc., et al., No. 13-187, W.D. La.; 2013 U.S. Dist. LEXIS 63132).