LexisNexis® Legal Newsroom
    Mealey's Health Law - Appeals Panel Finds Sufficient Truth In ACA Abortion Political Ads

    CINCINNATI - A group's advertising indicating that a politician voted for federally funded abortions cannot be considered untrue in light of the debate surrounding whether the Patient Protection and Affordable Care Act (ACA) actually permits such procedures, the Sixth Circuit U.S. Court of Appeals held March 6 (Susan B. Anthony List v. Steven Driehaus, No. 13-3238, 6th Cir.).

    Mealey's Health Law - ERISA Does Not Preempt State Prompt Pay Act, Texas Federal Judge Rules

    DALLAS - The Employee Retirement Income Security Act does not preempt the Texas Prompt Payment Act's (TPPA) mandatory payment deadlines, insofar as the deadlines apply to third-party administrators of self-funded health insurance plans, a federal judge in Texas ruled March 4 (Aetna Life Insurance Company v. Methodist Hospitals of Dallas, No. 3:14-cv-347-M, N.D. Texas; 2015 U.S. Dist. LEXIS 26455).

    Mealey's Health Law - Top Court Cites Hobby Lobby In Vacating, Remanding ACA Accommodation Ruling

    WASHINGTON, D.C. - The U.S. Supreme Court on March 9 vacated a Seventh Circuit U.S. Court of Appeals opinion that denied the University of Notre Dame an injunction in its challenge to the Patient Protection and Affordable Care Act (ACA) accommodation process and remanded the case for consideration in light of Burwell v. Hobby Lobby Stores, Inc. (University of Notre Dame v. Sylvia Burwell, et al., No. 14-392, U.S. Sup.).

    Mealey's Health Law - Top Court Hears Arguments Over ACA Federal Exchange Subsidy Availability

    WASHINGTON, D.C. - Both sides faced critical questioning from Justice Anthony Kennedy during oral arguments March 4 in the case challenging the availability of subsidies in the Patient Protection and Affordable Care Act (ACA) federal exchange (David King, et al. v. Sylvia Mathew Burwell, et al., No. 14-114, U.S. Sup.).

    Mealey's Health Law - Indiana Federal Judge Grants Plaintiff Summary Judgment In Medicaid Dispute

    FORT WAYNE, Ind. - An Indiana federal judge on March 2 granted summary judgment in favor of a nursing facility in its suit against another nursing facility for breach of contract for the defendant's failure to pay for the transfer of Medicaid certification rights that the defendant had sought so it could increase the number of comprehensive care beds it could obtain reimbursement for by Medicaid (Lutheran Homes Inc. v. Lock Realty Corporation IX, No. 14-102, N.D. Ind.; 2015 U.S. Dist. LEXIS 24588).

    Mealey's Health Law - Illinois Court Finds Dual Jury Instruction Proper, Affirms Defense Verdict

    CHICAGO - A trial judge did not err in instructing a jury on both institutional and professional negligence in a suit alleging that the death of an elderly woman was the result of negligence on the part of a nursing home and its staff, the Illinois Appellate Court for the First Judicial District ruled Feb. 27 (William M. Groeller Jr. v. The Evergreen Health Care Center LLC, No. 1-14-0932, Ill. App., 1st Jud. Dist.)

    Mealey's Health Law - New York Nursing Chain Pays $3.5 Million To Resolve Inflated Medicare Claims

    BOSTON - A New York operator of skilled nursing facilities has entered into an agreement with the United States to pay $3.5 million to resolve allegations concerning inflated Medicare claims for rehabilitation therapy, according to a March 2 news release issued by the U.S. Attorney Carmen M. Ortiz for the District of Massachusetts.

    Mealey's Health Law - Colorado Federal Judge Declines To Dismiss Health Care Breach Of Contract Suit

    DENVER - A federal judge in Colorado on Feb. 25 declined to dismiss a suit in which the plaintiff accused his health insurance company of breach of contract for allegedly wrongfully informing him that the effective date of his coverage was later than it really was, causing the plaintiff to receive treatment for pancreatic cancer later than necessary (Kent Wilson v. Humana Health Plan Inc., No. 14-3259, D. Colo.; 2015 U.S. Dist. LEXIS 22672).

    Mealey's Health Law - House Republicans Tell Judge Standing Exists In ACA Funding Challenge

    WASHINGTON, D.C. - The House of Representatives' role as controller of the purse strings gives it sufficient injury to challenge the administration's alleged misallocation of public funds related to the Patient Protection and Affordable Care Act (ACA), Republicans told a federal judge in the District of Columbia on Feb. 27 (United States House of Representatives v. Sylvia Mathews Burwell, et al., No. 14-1967, D. D.C.).

    Mealey's Health Law - New Jersey Federal Judge Dismisses Health Care Reimbursement Suit

    NEWARK, N.J. - A federal judge in New Jersey on Feb. 27 dismissed a health care reimbursement suit, saying that the plaintiff failed to follow administrative procedures for the Medicaid-related claims and that federal law preempted the common-law claims related to the Medicare-based claims (MHS LLC, D/B/A Meadowlands Hospital Medical Center v. Healthfirst Inc., et al., No. 13-6036, D. N.J.; 2015 U.S. Dist. LEXIS 23699).

    Mealey's Health Law - Divided Illinois Appeals Court Reverses Class Action Status In Subrogation Suit

    CHICAGO - A divided Illinois appeals court on Feb. 27 reversed and vacated the judgment of a trial court granting the plaintiff's motion for summary judgment and class certification in a health care subrogation dispute, saying the plaintiff had no right to rely on the common fund doctrine to support her claims (Nelli Stefanski v. The City of Chicago, No. 1-13-2844, Ill. App., 1st Dist. 6th Div.; 2015 Ill. App. LEXIS 133).

    Mealey's Health Law - Judge Denies Man's Motion To Dismiss Insurer's Fraud Suit Against Him

    CHICAGO - A federal judge in Illinois on Feb. 26 denied a man's motion to dismiss his insurance company's lawsuit accusing him of violating the Illinois Insurance Fraud Statute and stayed the case for the company to assert a portion of its allegations as a counterclaim to a separate suit brought by the defendant accusing the company of violating the Employee Retirement Income Security Act (Concert Health Plan Insurance Company v. James E. Killian, No. 14 C 4697, N.D. Ill.; 2015 U.S. Dist. LEXIS 23195).

    Mealey's Health Law - Judge Denies Health Care Fraud Defendant's Motion For Acquittal

    NEW YORK - The federal government provided sufficient evidence to a jury that a female doctor was only a paper owner of a New York medical clinic who made material misrepresentations to insurance companies as part of a conspiracy to commit health care fraud, a federal judge in New York ruled Feb. 26 in denying the defendant's motion for acquittal or new trial (United States of America v. Tatyana Gabinskaya, No. 12-cr-171 JPO, S.D. N.Y.; 2015 U.S. Dist. LEXIS 23343).

    Mealey's Health Law - High Court Will Not Review Preemption Ruling In Subrogation Case

    WASHINGTON, D.C. - The U.S. Supreme Court on Feb. 23 declined to review a Second Circuit U.S. Court of Appeals ruling that the Employee Retirement Income Security Act does not preempt a New York state anti-subrogation law that prohibits insurers from obtaining reimbursement of medical benefits from participants' tort settlements (The Rawlings Company, et al. v. Megan Wurtz, et al., No. 14-487, U.S. Sup.).

    Mealey's Health Law - High Court Denies Review Of 3rd Circuit Reimbursement Ruling

    WASHINGTON, D.C. - The U.S. Supreme Court on Feb. 23 let stand a Third Circuit U.S. Court of Appeals ruling that a multiemployer welfare benefits plan may seek reimbursement of health benefits paid on behalf of a plan participant who later received a third-party settlement because the plan language established an equitable lien by agreement (Bernard McLaughlin v. Board of Trustees of the National Elevator Industry Health Benefit Plan, No. 14-626, U.S. Sup.).

    Mealey's Health Law - High Court Denies Certiorari In Medicare Reimbursement Dispute

    WASHINGTON, D.C. - The U.S. Supreme Court on Feb. 23 denied certiorari, leaving stand a Third Circuit U.S. Court of Appeals decision holding that the Medicare as a Secondary Payer Act (MSP Act) authorizes the government to seek reimbursement from a settlement a plaintiff receives from a tortfeasor because the funds came from a "primary plan" and that the plaintiff cannot invoke a New Jersey state law to avoid her reimbursement obligations (Cecelia A. Taransky v. Secretary of the U.S. Department of Health and Human Services, et al., No. 14-758, U.S. Sup.).

    Mealey's Health Law - High Court Denies Certiorari In Suit Over Involving Antitrust, ERISA Claims

    WASHINGTON, D.C. - The U.S. Supreme Court on Feb. 23 declined to grant certiorari, which left standing an agreement reached in In re Managed Care Litigation that bars several physicians and physician groups from bringing claims against WellPoint Inc. in In re WellPoint, Inc. Out-of-Network "UCR" Rates Litigation under the Racketeer Influenced and Corrupt Organizations Act and the Sherman Act but not from bringing certain claims under the Employee Retirement Income Security Act (Medical Association of Georgia, et al. v. Wellpoint Inc., No. 14-554, U.S. Sup.).

    Mealey's Health Law - Federal Judge Declines To Dismiss Antitrust Claims In Surgery Center Dispute

    DENVER - A Colorado federal judge on Feb. 20 declined to dismiss antitrust claims in a suit alleging that health insurers conspired with hospitals to drive multiple ambulatory surgical centers out of business (Arapahoe Surgery Center, et al. v. CIGNA Healthcare Inc., et al., No. 13-3422, D. Colo.; 2015 U.S. Dist. LEXIS 20488).

    Mealey's Health Law - Magistrate Judge Recommends Accepting Guilty Plea In Health Care Fraud Suit

    MIAMI - A federal magistrate judge in Florida on Feb. 17 recommended accepting a home health care clinic owner's guilty plea in a $13 million Medicare fraud scheme, finding that the defendant was capable and competent in entering an informed plea (United States of America v. Alexander Lara, No. 15-cr-20029-KMM, S.D. Fla.).

    Mealey's Health Law - Judge Denies Defendants' Motion To Dismiss Insurers' Fraudulent Billing Lawsuit

    MINNEAPOLIS - A federal judge in Minnesota on Feb. 13 denied a motion filed by a number of chiropractic centers and their owners, seeking dismissal of a lawsuit brought by numerous insurance companies claiming that the defendants submitted fraudulent bills under Minnesota's No-Fault Automobile Insurance Act, finding that the insurers sufficiently pleaded claims under the Racketeer Influenced and Corrupt Organizations Act and Minnesota's Corporate Practice of Medicine Doctrine (CPMD) (Liberty Mutual Fire Insurance Company, et al. v. Acute Care Chiropractic Clinic P.A., et al., No. 14-cv-2651, D. Minn.; 2015 U.S. Dist. LEXIS 17933).

    Mealey's Health Law - Judge Rejects Man's Challenge To Legitimacy Of Anti-ACA Bill's Fiscal Note

    NASHVILLE, Tenn. - A man lacks standing to pursue a suit accusing a government official of fraudulently concocting a fiscal note to torpedo a Tennessee bill blocking implementation of the Patient Protection and Affordable Care Act (ACA), a federal judge held Feb. 18 (Louie E. Johnston Jr. v. Lucien C. Geise, executive director, Tennessee General Assembly's Fiscal Review Commission and JOHN DOE[s], No. 14-1425, M.D. Tenn.).

    Mealey's Health Law - Federal Judge Lifts Stay Of ACA Birth Control Mandate Challenge In Michigan

    GRAND RAPIDS, Mich. - Right to Life Michigan's action challenging implementation of the Patient Protection and Affordable Care Act (ACA) contraceptive mandate will proceed after a federal judge lifted his stay of the case on Feb. 17 (Right to Life of Michigan v. Sylvia Mathews Burwell, et al., No. 13-1202, W.D. Mich.).

    Mealey's Health Law - 11th Circuit Denies Rehearing In ACA Employer Mandate Implementation Challenge

    MIAMI - The 11th Circuit U.S. Court of Appeals on Feb. 13 declined to rehear a Patient Protection and Affordable Care Act (ACA) case, leaving stand a divided panel's conclusion that an orthodontist lacked standing to challenge delayed implementation of the law's employer mandate (Kawa Orthodontics LLP v. Secretary, U.S. Department of the Treasury, et al., No. 14-10296, 11th Cir.).

    Mealey's Health Law - Washington Federal Judge: Supplier Not Entitled To Medicare Reimbursement

    TACOMA, Wash. - Upon remand by the Ninth Circuit U.S. Court of Appeals, a Washington federal judge on Feb. 13 determined that the supplier of a piece of durable medical equipment used to treat osteoarthritis of the knee was not entitled to the benefits of any of Medicare's "limited liability" provisions (International Rehabilitative Sciences Inc. v. Sylvia M. Burwell, No. 08-5442, W.D. Wash.; 2015 U.S. Dist. LEXIS 18122).

    Mealey's Health Law - 3rd Circuit: ACA Birth Control Mandate Accommodation Doesn't Burden Religion

    PHILADELPHIA - The accommodation through which those who object to the contraceptive mandate of the Patient Protection and Affordable Care Act (ACA) can avoid providing or paying for the insurance coverage does not burden religious practice, a Third Circuit U.S. Court of Appeals panel held Feb. 11 (Geneva College, et al. v. HHS, et al., 13-3536, Geneva College, Wayne L. Hepler, et al. v. HHS, et al., No. 14-1374, Most Reverend Lawrence T. Persico, et al. v. HHS, et al., No. 14-1376, Most Reverend David A. Zubik, et al. v. HHS, et al., No. 14-1377, 3rd Cir.).