LexisNexis® Legal Newsroom
    Mealey's Health Law - ACA Creates Singular Standard For Discrimination Cases, Federal Judge Says

    MINNEAPOLIS - A transgendered individual may proceed with a Patient Protection and Affordable Care Act (ACA) Section 1557 discrimination case because the law creates a singular standard regardless of protected class status, a federal judge in Minnesota held March 16 (Jakob Tiarnan Rumble v. Fairview Health Services d/b/a/ Fairview Southdale Hospital and Emergency Physicians P.A., No. 14-2037, D. Minn.; 2015 U.S. Dist. LEXIS 31591).

    Mealey's Health Law - Judge Stays Challenge To ACA Mandate Accommodation For 11th Circuit Ruling

    TAMPA, Fla. - A federal judge on March 18 granted the government's motion to stay a challenge to the Patient Protection and Affordable Care Act (ACA) contraceptive mandate accommodation until the 11th Circuit U.S. Court of Appeals weighs in on a closely related case (Christian and Missionary Alliance Foundation Inc., et al. v. Sylvia Mathews Burwell, et al., No. 14-580, M.D. Fla.; 2015 U.S. Dist. LEXIS 12506).

    Mealey's Health Law - Home Health Care Companies Owner Pleads Guilty To $12.6M Medicare Fraud Scheme

    DETROIT - The owner of two home health care companies on March 13 pleaded guilty in Michigan federal court for tax fraud as well as his involvement in a $12.6 million Medicare fraud scheme in which services were not provided to patients or obtained through illegal kickbacks (United States of America v. Mohammed Sadiq, et al., No. 12-cr-2027, E.D. Mich.).

    Mealey's Health Law - Judge Refuses To Dismiss Superseding Indictment Of Health Care Fraud Defendant

    NEW HAVEN, Conn. - A woman's request to dismiss a superseding indictment accusing her of 50 counts of health care fraud for allegedly billing health care plans for personal training sessions as physical therapy services was denied by a federal judge in Connecticut on March 16 after he found that there is no evidence of prosecutorial misconduct (United States of America v. Danielle Faux, No. 14-cr-28, D. Conn.; 2015 U.S. Dist. LEXIS 31527).

    Mealey's Health Law - Plan Participant Need Not Exhaust Tribal Remedies Under ERISA, Judge Rules

    KANSAS CITY, Kan. - A participant in a nongovernmental health need not exhaust tribal remedies prior to bringing a claim for recovery of health benefits under the Employee Retirement Income Security Act, a federal judge in Kansas ruled March 13 (Amy Coppe v. The Sac & Fox Casino Healthcare Plan, et al., No. 14-2598, D. Kan.; 2015 U.S. Dist. LEXIS 30992).

    Mealey's Health Law - Opening Arguments Held In Case Over Coverage For Excess Skin Removal

    ALAMEDA, Calif. - An Alameda County, Calif., Superior Court judge on March 16 heard opening arguments in a class suit brought by members accusing Kaiser Foundation Health Plan Inc. of violating California Health and Safety Code Section 1367.63 by denying all requests for surgery to remove excess skin following bariatric surgery without first having a physician review each request (Wendy Gallimore, et al. v. Kaiser Foundation Health Plan, Inc., et al., No. RG12616206, Calif. Super., Alameda Co.).

    Mealey's Health Law - Judge Won't Consider Catholic Benefits Group's Class Motion Before Appeals

    OKLAHOMA CITY - Judicial economy is not served by considering a class certification motion in a Patient Protection and Affordable Care Act (ACA) challenge while appeals are pending, a federal judge held March 13 (The Catholic Benefits Association LCA; The Catholic Insurance Co. v. Sylvia M. Burwell, et al., No. 14-240, W.D. Okla.).

    Mealey's Health Law - 5th Circuit: Medical Provider Has Standing To Sue Insurer Under ERISA

    NEW ORLEANS - An out-of-network medical provider that implemented a discount program has standing as an assignee to sue the administrator of plans regulated by the Employee Retirement Income Security Act for underpayment of benefits, the Fifth Circuit U.S. Court of Appeals ruled March 10 (North Cypress Medical Center Operating Company, et al. v. Cigna Healthcare, et al., No. 12-20695, 5th Cir.; 2015 U.S. App. LEXIS 3711).

    Mealey's Health Law - HHS Says 11.7 Million Found Insurance Through ACA Exchanges

    WASHINGTON, D.C. - Nearly 11.7 million consumers found insurance through Patient Protection and Affordable Care Act (ACA) marketplaces for 2015, the U.S. Department of Health and Human Services said March 10.

    Mealey's Health Law - Committee's Vote Leaves ACA Medicaid Expansion On Life Support In Montana

    HELENA, Mont. - Expansion of Medicaid under the Patient Protection and Affordable Care Act (ACA) appears dead in Montana after a 59-41 vote by a Montana House committee on March 10.

    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.).