LexisNexis® Legal Newsroom
    Mealey's Health Law - Pharmacy Employee Sentenced To 13 Months For Scheme To Defraud Benefits Programs

    BALTIMORE - A pharmacy employee was sentenced by a federal judge in Maryland on Jan. 15 to 13 months in prison and ordered to pay $102,066.25 in restitution for his role in a scheme to defraud Medicare, Medicaid and the Federal Employees Health Benefits Program by submitting false prescriptions for refills, the U.S. Attorney's Office for the District of Maryland announced (United States of America v. Jigar Patel, No. 13-cr-00374, D. Md.).

    Mealey's Health Law - State Of Oregon Wins Dismissal Of Copyright Infringement Claims

    PORTLAND, Ore. - Allegations by Oracle America Inc. that the State of Oregon infringed its copyrighted software were rejected Jan. 13 by an Oregon federal judge, on the basis of sovereign immunity (Oracle America Inc. v. The Oregon Health Insurance Exchange Corporation, et al., No. 14-1279, D. Ore.; 2015 U.S. Dist. LEXIS 3484.).

    Mealey's Health Law - Owners Of Mental Health Clinic Sentenced For Medicare Fraud Scheme

    HOUSTON - Two physician owners of a mental health clinic were sentenced to 148 months and 120 months, respectively, in prison for their roles in a $97 million Medicare fraud scheme, according to docket entries entered Jan. 12 in Texas federal court (United States of America v. Mansour Sanjar, et al., No. 11-cr-00861, S.D. Texas).

    Mealey's Health Law - Federal Judge Dismisses 1 Claim From Health Care Reimbursement Suit

    TAMPA, Fla. - A Florida federal judge on Jan. 12 partially dismissed a complaint alleging that a health insurance company wrongfully declined to reimburse two health care providers for services, dismissing a fraud claim and granting the plaintiff leave to amend the complaint to assert claims under the Employee Retirement Income Security Act, but otherwise denied the motion (Tran Chiropractic Wellness Center Inc., et al. v. Aetna Inc., et al., No. 14-47, M.D. Fla.; 2015 U.S. Dist. LEXIS 3124).

    Mealey's Health Law - Federal Judge Allows Home-Care Group's Challenge To ACA

    WASHINGTON, D.C. - A home-care association with at least one member denied reimbursement from Medicare has standing to challenge Patient Protection and Affordable Care Act (ACA) rules and need not exhaust administrative remedies first given the unlikelihood of success, a District of Columbia federal judge held Jan. 6 (National Association for Home Care & Hospice Inc. v. Sylvia Mathews Burwell, secretary, U.S. Department of Health and Human Services, et al., No. 14-950, D. D.C.; 2015 U.S. Dist. LEXIS 477).

    Mealey's Health Law - Physical Injury Not Needed For Medical-Monitoring Claim, Nevada High Court Rules

    CARSON CITY, Nev. - Members of a health maintenance organization who seek medical monitoring for potential exposure to blood-borne diseases may maintain negligence claims against the HMO, the Nevada Supreme Court ruled Dec. 31, finding in a case of first impression under Nevada law that "a plaintiff may state a cause of action for negligence with medical monitoring as the remedy without asserting that he or she has suffered a present physical injury" (Susan Sadler, et al. v. PacifiCare of Nevada Inc., No. 62111, Nev. Sup.; 2014 Nev. LEXIS 133).

    Mealey's Health Law - 3rd Circuit Affirms Sentence Given To Doctor Who Violated Medicare, Medicaid

    PHILADELPHIA - A panel of the Third Circuit U.S. Court of Appeals on Dec. 31 affirmed the sentence given to a radiologist who pleaded guilty to illegally paying physicians to refer their patients to his facility so he could obtain more reimbursement from Medicare and Medicaid (United States of America v. Ashokkumar Babaria, No. 14-2694, 3rd Cir.; 2014 U.S. App. LEXIS 24656).

    Mealey's Health Law - Decision Reverses Injunction Enjoining Termination Of Provider Agreement

    BATON ROUGE, La. - In a Dec. 29 unpublished opinion, a Louisiana appeals court reversed a summary judgment opinion granting a permanent injunction to halt the termination of a health care clinic's Medicaid provider agreement, saying the plaintiff failed to meet its required prima facie showing of irreparable harm (Midtown Medical v. The Department of Health & Hospitals, et al., Nos. 2014 CA 0530 c/w 2014 CA 0531 c/w 2014 CA 0532, La. App., 1st Cir.; 2014 La. App. Unpub. LEXIS 792).

    Mealey's Health Law - Preliminary Injunction Halts Recoupment Of Medicaid Funds To Pediatric Hospitals

    WASHINGTON, D.C. - A federal judge in the District of Columbia on Dec. 29 granted a preliminary injunction to enjoin the U.S. Department of Health and Human Services (HHS) from recouping any federal disproportionate-share hospital (DSH) funds provided to two pediatric teaching and research hospitals based on a state's noncompliance with a new Medicaid funding rule (Texas Children's Hospital, et al. v. Sylvia Burwell, secretary, United States Department of Health and Human Services, et al., No. 14-2060, D. D.C.; 2014 U.S. Dist. LEXIS 177644).

    Mealey's Health Law - 4th Circuit Affirms Verdict, Sentencing In Health Care Fraud Case

    RICHMOND, Va. - A Fourth Circuit U.S. Court of Appeals panel on Dec. 19 upheld a jury's verdict finding a dermatologist guilty of 13 counts of health care fraud and affirmed a judge's sentencing of the defendant, holding that the evidence presented during the trial supported the jury's decision (United States of America v. Allen G. Saoud, No. 14-4288, 4th Cir.; 2014 U.S. App. LEXIS 24002).

    Mealey's Health Law - Judge: Government's Loss Of Evidence Warrants Dismissal Of Fraud Indictment

    SALT LAKE CITY - The government's loss of computer data from a women's health care clinic operated by a woman accused of defrauding Medicare by coaching illegal aliens to apply for benefits under the Baby Your Baby (BYB) program warrants the dismissal of her indictment, a federal judge in Utah ruled Dec. 12, ruling that the loss of the information prevents the defendant from defending herself (United States of America v. Larohnda Dennison, No. 13CR805DAK, D. Utah; 2014 U.S. Dist. LEXIS 173303).

    Mealey's Health Law - Petition Denied; Law Prohibiting Use Of Abortion- Inducing Drugs Enjoined

    WASHINGTON, D.C. - In denying a petition for writ of certiorari, the U.S. Supreme Court on Dec. 15 left standing a Ninth Circuit U.S. Court of Appeals decision reversing a lower court's decision denying Planned Parenthood of Arizona's motion for a preliminary injunction and remanding the case with instructions for the district court to issue the injunction in a case seeking to enjoin enforcement of an Arizona law prohibiting the use of certain drugs to induce abortions (Planned Parenthood of Arizona Inc., et al. v. William Humble, director of the Arizona Department of Health Services, No. 14-284, U.S. Sup.).

    Mealey's Health Law - Solicitor General View Sought Regarding ERISA Preemption Of State Database Law

    WASHINGTON, D.C. - The U.S. Supreme Court on Dec. 15 invited the solicitor general to weigh in on whether the court should grant review of a divided Second Circuit U.S. Court of Appeals ruling that the Employee Retirement Income Security Act preempts Vermont's health care data collection law as applied to a self-funded ERISA benefit plan (Alfred J. Gobeille v. Liberty Mutual Insurance Company, No. 14-181, U.S. Sup.).

    Mealey's Health Law - Parties In Pro-Life Group's Birth-Control Mandate Challenge Brief Court On Priests

    WASHINGTON, D.C. - A pro-life employer and the government filed supplemental briefs on Dec. 10 in the District of Columbia federal court on the impact of a recent District of Columbia Circuit U.S. Court of Appeals ruling on the Patient Protection and Affordable Care Act (ACA) contraceptive mandate (March for Life, Jeanne F. Monahan and Bethany A. Goodman v. Sylvia M. Burwell, et al., No. 14-1149, D. D.C.).

    Mealey's Health Law - Nursing Assistant Sentenced To 150 Months For Role In Medicare Fraud Scheme

    MIAMI - A nursing assistant was sentenced by a federal judge in Florida on Dec. 8 to 150 months in prison and ordered to pay $18.2 million in restitution for participating in a $200 million scheme to fraudulently bill Medicare for mental health services (United States v. Rodolfo Santaya, No. 14-cr-20052, S.D. Fla.).

    Mealey's Health Law - Connecticut Federal Judge Dismisses Medicare Case; Plaintiffs Have No Standing

    NEW HAVEN, Conn. - A federal judge in Connecticut on Dec. 8 dismissed a class action lawsuit over the denial of Medicare benefits, holding that Medicare patients do not have standing to sue if Medicare denies a health care claim, but then Medicaid ends up paying the claim (Carolyn Hull v. Sylvia Burwell, No. 14-801, D. Conn.; 2014 U.S. Dist. LEXIS 169538).

    Mealey's Health Law - Claims Over Fraudulent Billing Of Medicare Claims For Hospice Benefits Continue

    BIRMINGHAM, Ala. - A federal judge in Alabama on Dec. 4 declined to dismiss False Claims Act (FCA) claims brought against the operator of 60 hospice facilities for allegedly submitting fraudulent claims to Medicare for people who were not eligible to receive hospice benefits, saying genuine issues of material fact exist (United States of America v. AseraCare Inc., et al., No. 12-245, N.D. Ala.; 2014 U.S. Dist. LEXIS 167970).

    Mealey's Health Law - 10th Circuit: Denial Under Plan Proper Despite Award Of Social Security Benefits

    DENVER - A disability insurer did not act arbitrarily or capriciously by terminating benefits under the any-reasonable-occupation disability standard of a plan governed by the Employee Retirement Income Security Act, despite a contrary determination by the Social Security Administration (SSA) under the SSA all-occupation disability standard, the 10th Circuit U.S. Court of Appeals affirmed Dec. 3 (Christy M. Liebel v. Aetna Life Insurance Co., No. 14-6046, 10th Cir.).

    Mealey's Health Law - 9th Circuit Rules On Permissible Offsets To Disability Benefits

    SAN FRANCISCO - A long-term disability plan governed by the Employee Retirement Income Security Act properly offset a firefighters' workers' compensation settlement, but remand is necessary to determine the amount of salary continuation benefits that the plan can properly offset under the plan terms, the Ninth Circuit U.S. Court of Appeals ruled Dec. 2 in an unpublished opinion (David Barboza v. California Association of Professional Firefighters, et al., Nos. 12-17439 and 13-16652, 9th Cir.).

    Mealey's Health Law - Federal Judge Expands Injunction To Cover ACA Insurers, Administrators

    OKLAHOMA CITY - A federal judge in Oklahoma on Dec. 3 modified an order enjoining the implementation of the Patient Protection and Affordable Care Act (ACA) contraceptive mandate, expanding it to prevent the government from interfering with insurers or third-party administrators (The Catholic Benefits Association LCA, et al. v. Sylvia M. Burwell, et al., No. 14-240, W.D. Okla.).

    Mealey's Health Law - 11th Circuit: Standing Lacking In ACA Employer Mandate Implementation Challenge

    MIAMI - An orthodontics company lacks standing to challenge the delay in implementing the Patient Protection and Affordable Care Act (ACA)'s employer mandate, a divided 11th Circuit U.S. Court of Appeals panel held Dec. 2 (Kawa Orthodontics LLP v. Secretary, U.S. Department of the Treasury, et al., No. 14-10296, 11th Cir.).

    Mealey's Health Law - 1st Circuit: 'First-To-File' Rule Bars 2nd Medicare False Claims Act Suit

    BOSTON - A panel of the First Circuit U.S. Court of Appeals on Dec. 1 affirmed that the "first-to-file" rule barred a False Claims Act (FCA) suit alleging that a pharmaceutical company defrauded federal Medicaid and Medicare programs (United States, ex rel. Ven-A-Care of The Florida Keys Inc. v. Baxter Healthcare Corp. v. Linnette Sun, et al., Nos. 13-1732, 13-2083, 1st Cir.; 2014 U.S. App. LEXIS 22564).

    Mealey's Health Law - 11th Circuit Applies Clear- Repudiation Rule To Termination Of ERISA Benefits

    ATLANTA - A disability plan participant's cause of action under the Employee Retirement Income Security Act based on the termination of his benefits accrued when the participant had reason to know that the claims administrator clearly repudiated his claim for benefits, the 11th Circuit U.S. Court of Appeals ruled Nov. 25 in concluding that the participant's complaint was time-barred (Don L. Witt v. Metropolitan Life Insurance Co., et al., No. 14-11349, 11th Cir.; 2014 U.S. App. LEXIS 22321).

    Mealey's Health Law - Louisiana Appeals Court: Plaintiffs Have Private Right Of Action Under Billing Act

    GRETNA, La. - A Louisiana appeals court on Nov. 25 vacated a trial court's decision granting a hospital summary judgment and denying class certification in a wrongful billing suit, saying a recent state Supreme Court decision established that the plaintiffs had a private right of action under the state's Billing Act (Nell Ladieu, et al. v. Jefferson Parish Hospital Service District No. 2 d/b/a East Jefferson General Hospital, No. 14-CA-449, La. App., 5th Dist.; 2014 La. App. LEXIS 2824).

    Mealey's Health Law - FDA Issues ACA-Mandated Nutritional Labeling Rules

    WASHINGTON, D.C. - Restaurants, retail food establishments and vending machines with more than 20 locations will need additional nutritional labeling under rules finalized by the U.S. Food and Drug Administration on Nov. 25 in compliance with the Patient Protection and Affordable Care Act (ACA).