LexisNexis® Legal Newsroom
    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.).

    Mealey's Health Law - Ambulance Company Manager Sentenced To 78 Months Over Fraudulent Billing Scheme

    LOS ANGELES - The general manager of a California ambulance company was sentenced to 78 months in prison and ordered to pay $1.3 million in restitution by a federal judge in California on Feb. 9 for his role in a $5.5 million scheme to defraud Medicare (United States of America v. Wesley H. Kingsbury, 12-cr-903, C.D. Calif.).

    Mealey's Health Law - DOJ: Home Health Care Facility To Pay $5.6M Over Fraudulent Billing

    WASHINGTON, D.C. - An Iowa home health care facility agreed to pay $5.6 million to resolve allegations that it submitted false billing claims to Medicare and Medicaid in violation of the False Claims Act (FCA), the U.S. Department of Justice announced Feb. 10.

    Mealey's Health Law - Class Action Lawsuit Accuses Anthem Of Failing To Secure Private Data

    LOS ANGELES - A California resident on Feb. 9 filed a class action lawsuit in federal court accusing Anthem Inc. of violating, among other things, the state's unfair competition law (UCL) in failing to safeguard personal information contained on the defendant's information technology (IT) systems after a massive breach of the company's systems (John Doe v. Anthem Inc., et al., No. 15-934, C.D. Calif.).

    Mealey's Health Law - California Federal Judge: Fraud Claim Continues In Reimbursement Case

    LOS ANGELES - A California federal judge on Feb. 9 allowed a fraud claim to continue in a health care reimbursement suit, but dismissed three other claims (Mountain View Surgical Center v. CIGNA Health Corp., No. 13-8083, C.D. Calif.; 2015 U.S. Dist. LEXIS 15320).

    Mealey's Health Law - Kentucky Appeals Court: Insurer Breached Contract In Terminating Agreement

    STANTON, Ky. - In an unpublished opinion, the Kentucky Court of Appeals on Feb. 6 affirmed that a managed care company that had contracted with the Commonwealth of Kentucky breached its contract to provide Medicaid services to state residents by terminating the contract early (Kentucky Spirit Health Plan Inc. v. Commonwealth of Kentucky, et al., Nos. 2014-CA-1050-MR, 2013-CA-1201-MR, Ky. App.; 2015 Ky. App. Unpub. LEXIS 85).

    Mealey's Health Law - New York Federal Judge Leaves Breach Claim In Health Care Billing Dispute

    BROOKLYN, N.Y. - A New York federal judge on Feb. 4 declined to dismiss a breach of contract claim but did dismiss claims for negligence and breach of fiduciary duty in a dispute between a home health care company and its billing management company over the preparation and submission of claims (Excellent Home Care Services v. FGA Inc., No. 13-5390, E.D. N.Y.; 2015 U.S. Dist. LEXIS 13351).

    Mealey's Health Law - Official: Individual Mandate Provides Standing For ACA Constitutional Challenge

    WASHINGTON, D.C. - The universal application of the Patient Protection and Affordable Care Act (ACA) individual mandate cannot preclude a constitutional challenge to the law, a local-level politician argues in a Feb. 4 brief to the District of Columbia Circuit U.S. Court of Appeals (Jeffrey Cutler v. United States Department of Health and Human Services, et al., No. 14-5183, D.C. Cir.).

    Mealey's Health Law - Judge Enjoins Disclosure Of Insurance Details Under ACA Mandate Accommodation

    TAMPA, Fla. - The Patient Protection and Affordable Care Act (ACA) contraceptive mandate substantially burdens religious practice, as does requiring objectors to provide details of their insurance carrier to the government, which forces objectors to "become excessively entangled" in the process, a federal judge in Florida held Feb. 3 (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 - Health Care Provider Sues In Texas Federal Court For Wrongful Reimbursement

    HOUSTON - A health care provider on Feb. 2 sued an insurance company in a Texas federal court for allegedly failing to properly reimburse the provider for services provided to the defendant's insureds (Grand Parkway Surgery Center v. Health Care Service Corp., et al., No. 15-297, S.D. Texas).

    Mealey's Health Law - Florida Federal Judge Vacates Jury Verdict In Medicare False Claims Case

    OCALA, Fla. - A Florida federal judge on Jan. 28 vacated a jury verdict in favor of the plaintiff in a Medicare false claims case, saying that the plaintiff failed to present sufficient evidence to the jury that defendant's alleged violation of Florida's licensing laws with respect to the diagnostic procedures performed was a condition of payment (United States of America and State of Florida, ex rel. Charles Ortolano v. Amin Radiology, No. 10-583, M.D. Fla.; 2015 U.S. Dist. LEXIS 9724).

    Mealey's Health Law - Judge: Insurance Benefits Administrator Shielded By State Sovereign Immunity

    AUSTIN, Texas - A federal judge in Texas on Jan. 27 granted an insurance benefits administrator's motion for summary judgment in an insurance bad faith lawsuit, ruling that the benefits administrator is a state instrumentality that is shielded by sovereign immunity (Kerri Kirby v. Health Care Service Corp, No. 14-892, W.D. Texas; 2015 U.S. Dist. LEXIS 8953).

    Mealey's Health Law - Report: Even After ACA, Cost Remains Barrier To Insurance

    WASHINGTON, D.C. - Cost remains a barrier to obtaining medical insurance, with nearly one-third of uninsured but Patient Protection and Affordable Care Act (ACA)-eligible adults citing it as the reason they remain uninsured, according to a Henry J. Kaiser Family Foundation report issued Jan. 29.

    Mealey's Health Law - Judge: Government's Evidence Supported Guilty Verdict In Health Care Fraud Suit

    DETROIT - A federal judge in Michigan on Jan. 27 denied a defendant's motion for acquittal and new trial, ruling that the government presented sufficient evidence to support the jury's finding that the man conspired to commit health care fraud (United States of America v. Vinod Patel, No. 11-20468-36, E.D. Mich.; 2015 U.S. Dist. LEXIS 8952).

    Mealey's Health Law - Hospital's Reimbursement Action Not Preempted By ERISA, Calif. Federal Judge Rules

    SAN JOSE, Calif. - A federal judge in California on Jan. 26 remanded to state court a hospital's lawsuit seeking reimbursement for charges for treatment of a participant in a health plan governed by the Employee Retirement Income Security Act, holding that the hospital's state unfair competition law claims were not completely preempted by ERISA (Community Hospital of the Monterey Peninsula v. Blue Cross of California, et al., No. 14-CV-04552, N.D. Calif.; 2015 U.S. Dist. LEXIS 9248).

    Mealey's Health Law - Medicare Suit Dismissed For Failure To Exhaust Administrative Remedies

    AKRON, Ohio - An Ohio federal judge on Jan. 26 dismissed a Medicare reimbursement dispute, finding that the plaintiffs failed to exhaust administrative remedies as required under the Medicare Act (Ohio State Chiropractic Association, et al. v. Humana Health Plan Inc., No. 14-2313, N.D. Ohio; 2015 U.S. Dist. LEXIS 8764).