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 - In an unpublished opinion, the Kentucky Court of Appeals on Feb. 6 affirmed that a managed care company that had contracted with the Commonwealth of Kentucky breached its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).
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).
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.).
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).
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).
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).
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).
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.
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).
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).
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).
NASHVILLE, Tenn. - A Tennessee federal judge on Jan. 23 dismissed a Medicare False Claims Act case, saying the plaintiff failed to plead the claims with the specificity required (Kathleen McFeeters v. Northwest Hospital, et al., No. 13-467, M.D. Tenn.; 2015 U.S. Dist. LEXIS 8523).
WASHINGTON, D.C. - The House of Representatives lacks standing to challenge implementation of the Patient Protection and Affordable Care Act (ACA)'s employer mandate in court, the U.S. Department of Health and Human Services (HHS) told a federal judge in the District of Columbia on Jan. 26 (United States House of Representatives v. Sylvia Mathews Burwell, et al., No. 14-1967, D. D.C.).
NEW YORK - A federal judge erred by finding that a health care provider settled its claims under the Employee Retirement Income Security Act for services rendered with a self-funded employee benefit plan based on the plan's "one-sided representation," the Second Circuit U.S. Court of Appeals ruled Jan. 21 in an unpublished order (Montefiore Medical Center v. Teamsters Local 272, et al., No. 13-4221-cv, 2nd Cir.; 2015 U.S. App. LEXIS 844).
NEW YORK - The Second Circuit U.S. Court of Appeals on Jan. 22 reversed the dismissal of a due process claim in a class action Medicare payment dispute, saying the lower court erred in concluding that the plaintiffs lacked a property interest in being treated as "inpatients." The court affirmed the dismissal of a claim brought under the Medicare Act (Lee Barrows, et al. v. Sylvia Matthews Burwell, secretary of Health and Human Services, No. 13-4179, 2nd Cir.; 2015 U.S. App. LEXIS 986).
WEST DES MOINES, Iowa - The Iowa insurance commissioner will liquidate CoOportunity Health Inc., a consumer-owned health insurance company started with $146 million in Patient Protection and Affordable Care Act (ACA) funds, it announced Jan. 23 (State of Iowa, et al. v. CoOpportunity Health Inc., No. N/A, Iowa Dist., Polk Co.).
WASHINGTON, D.C. - The U.S. Supreme Court on Jan. 26 denied a petition from the State of Oklahoma seeking a writ of certiorari before judgment in its challenge to the availability of subsidies in Patient Protection and Affordable Care Act (ACA) insurance exchanges (State of Oklahoma, ex rel. Scott Pruitt v. Sylvia Mathews Burwell, et al., No. 14-586, U.S. Sup.).
BOSTON - The presence of a few uninjured members in a class does not prevent certification, the First Circuit U.S. Court of Appeals ruled Jan. 21, affirming the certification of the class of indirect purchasers of Nexium in a pay-for-delay lawsuit over the heartburn drug (In re Nexium Antitrust Litigation, Astrazeneca AB, et al. v. United Food and Commercial Workers Unions and Employers Midwest Health Benefits Fund, et al., Nos. 14-1521 & 14-1522, 1st Cir.; 2015 U.S. App. LEXIS 968).
PRESCOTT, Ariz. - An Arizona federal judge on Jan. 16 dismissed a self-funded employee welfare benefit plan's subrogation lawsuit against the estate of a plan participant regarding settlement proceeds in an underlying wrongful death action because the participant's children did not incur health care expenses for which another party is responsible (MedCath Incorporated Employee Health Care Plan v. Dustin Stratton, et al., No. 14-08099, D. Ariz.; 2015 U.S. Dist. LEXIS 5514).
DETROIT - A doctor was sentenced to 15 months in prison and ordered to pay $1.3 million in restitution by a federal judge in Michigan on Jan. 14 for her role in a $2.1 million home health care fraud scheme, the U.S. Department of Justice announced (United States of America v. Paula Williamson, No. 13-cr-20347, E.D. Mich.).
HARTFORD, Conn. - An osteopathic physician on Jan. 16 pleaded guilty in Connecticut federal court to one count of committing health care fraud and agreed to pay the government $270,528 to resolve federal civil claims arising from his conduct (United States of America v. David Lester Johnston, No. 14-cr-00047, D. Conn.).
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.).
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.).
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).
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).