NEW ORLEANS - A Fifth Circuit U.S. Court of Appeals panel on Aug. 17 affirmed a jury's verdict convicting a man of committing health care fraud and paying and receiving kickbacks for approving patients for home health care when they did not need such treatment (United States v. Warren Dailey, No. 16-20517, 5th Cir., 2017 U.S. App. LEXIS 15595).
ST. LOUIS - A federal judge on Aug. 15 sentenced a podiatrist to 90 months in prison and ordered him to pay $6.9 million in restitution for fraudulently billing Medicare for services that were not rendered (United States v. Yev Gray, No. 15cr464, E.D. Mo.).
HOUSTON - A registered nurse who owned two home health care companies was found guilty on Aug. 10 by a federal jury in Texas of one count of conspiracy to commit health care fraud and four counts of health care fraud for her role in a $20 million Medicare fraud scheme (United States v. Evelyn Mokwuah, No. 16cr254, S.D. Texas).
GREENVILLE, Miss. - The U.S. Department of Justice announced Aug. 10 that a federal judge in Mississippi has sentenced a doctor to 39 months in prison and ordered him to pay $1.9 million in restitution to the Medicare program for referring patients to hospice care when such treatment was not necessary (United States v. Nathaniel Brown, No. 16cr74, N.D. Miss.).
SAN FRANCISCO - A Ninth Circuit U.S. Court of Appeals panel on Aug. 10 held that two medical assistants who filed a qui tam lawsuit under the False Claims Act (FCA) against a podiatrist they worked for could not intervene in a criminal forfeiture action brought by the federal government seeking $1.2 million for false billing to Medicare because the employees lacked standing (United States v. Neil A. Van Dyck, et al., No. 16-10160, 9th Cir., 2017 U.S. Dist. LEXIS 14780).
CHICAGO - A federal judge in Illinois on Aug. 7 granted a motion for summary judgment filed by a podiatry firm and its owner that are accused by a former employee of violating the Illinois Insurance Claims Fraud Protection Act (IICFPA) and illegally destroying medical records, finding that there was not enough evidence to show that the procedures the firm billed to Medicare were not medically necessary and that the defendants were not aware of the lawsuit at the time the records were shredded (James Youn, M.D. v. Keith D. Sklar, et al., No. 10 CV 5583, N.D. Ill., 2017 U.S. Dist. LEXIS 124394).
SEATTLE - A federal judge in Washington on July 27 denied a chiropractor and his practice's motion to amend counterclaims against State Farm Mutual Automobile Insurance Co., finding that the insurer had sufficient reason to report his billing practices to the National Insurance Crime Bureau (NICB) (State Farm Mutual Automobile Insurance Company v. Peter J. Hanson, P.C. d/b/a Hanson Chiropractic, et al., No. C16-1085RSL, W.D. Wash., 2017 U.S. Dist. LEXIS 118045).
ANN ARBOR, Mich. - A Native American tribe cannot pursue claims that its health care plan administrator violated the Employee Retirement Income Security Act (ERISA) by failing to charge the tribe Medicare-like rates for contracted services at a hospital because the tribe waited too long to sue, a Michigan federal judge held July 21 (Grand Traverse Band of Ottawa and Chippewa Indians, et al. v. Blue Cross Blue Shield of Michigan v. Munson Medical Center, No. 5:14-cv-11349, E.D. Mich., 2017 U.S. Dist. LEXIS 113759).
PHILADELPHIA - A Third Circuit U.S. Court of Appeals panel ruled July 19 that administrators of an outpatient surgical facility cannot be found liable for violating Pennsylvania's insurance fraud statute because the anti-kickback provision of the statute applies only to health care providers (Aetna Life Insurance Company v. Huntingdon Valley Surgery Center, et al., No. 16-1468, 3rd Cir., 2017 U.S. App. LEXIS 12971).
COLUMBIA, S.C. - A failed Patient Protection and Affordable Care Act (ACA) co-operative insurer's liquidator should file his lawsuit challenging a federal loan repayment demand in the U.S. Court of Federal Claims, the government says in a July 19 motion filed in South Carolina federal court (Raymond G. Farmer v. United States of America, et al., No. 17-cv-00956, D. S.C.).
CINCINNATI - Three companies and their executives have agreed to pay $19.5 million for allegedly violating the False Claims Act (FCA) by billing Medicare for medically unnecessary rehabilitation therapy and hospice services, the U.S. Department of Justice announced July 18 (United States, ex rel. Trakhter v. Provider Services Inc., et al., No. 11-CV-217, United States, ex rel. Goodwin, et al. v. Brian Colleran, et al.., No. 11-CV-935, S.D. Ohio.).
BAY CITY, Mich. - A health care plan administrator owes a Michigan Indian tribe more than $8.4 million for violating the Employee Retirement Income Security Act by charging hidden administrative fees for the tribe's employee benefit program but is not liable for any alleged damages related to the tribe's separate health care plan for all of its members, even though some are also employees, a federal judge held July 14 (Saginaw Chippewa Indian Tribe of Michigan, et al. v. Blue Cross Blue Shield of Michigan, No. 1:16-cv-10317, E.D. Mich., 2017 U.S. Dist. LEXIS 109366).
WASHINGTON, D.C. - A trio of women successfully allege standing in their class action claiming that an insurer improperly charged them for out-of-network lactation services in violation of the Patient Protection and Affordable Care Act (ACA), a federal judge in the District of Columbia held July 17 (Lindsay Ferrer, et al. v. CareFirst Inc., et al., No. 16-2162, D. D.C., 2017 U.S. Dist. LEXIS 110304.)
NEW ORLEANS - The owners of two psychological services companies were sentenced by a federal judge in Louisiana for their roles in a $25.2 million Medicare fraud scheme, the U.S. Department of Justice announced July 14 (United States of America v. Rodney Hesson, et al., No. 15-cr-152, E.D. La.).
WEST PALM BEACH, Fla. - Finding that a health insurer's fraud claims related to kidney dialysis were pleaded only for its Patient Protection and Affordable Care Act (ACA) plans, a Florida federal magistrate judge on July 10 denied in part a motion to compel non-ACA plan information from the dialysis provider defendants (UnitedHealthcare of Florida Inc., et al. v. American Renal Associates Holdings Inc., et al., No. 9:16-cv-81180, S.D. Fla.).
PHILADELPHIA - A federal judge in Pennsylvania on July 7 denied a motion for pretrial release filed by a man accused of health care fraud, conspiracy to commit and 15 counts of possession of oxycodone with intent to distribute, finding that the nature of the drug trafficking claims showed that no condition would reasonably assure the safety of other people in the community (United States of America v. Michael Milchin, No. 17-cr-284, E.D. Pa., 2017 U.S. Dist. LEXIS 105570).
HARTFORD, Conn. - A Connecticut federal judge on June 27 granted union employees' motion for a preliminary injunction and ordered Honeywell International Inc. to reinstate previously existing medical coverage benefits, saying that the threat of termination and the actual termination of medical coverage benefits constitute irreparable harm (David Kelly, et al. v. Honeywell International Inc., No. 3:16-cv-00543, D. Conn., 2017 U.S. Dist. LEXIS 99419).
CHARLESTON, S.C. - An expert for health care defendants accused of running kickback schemes cannot testify because his opinion draws on legal conclusions that should be left to the court to decide, is based on unsound methodology and would mislead a jury, a South Carolina federal judge held June 26 in excluding the expert from the case (United States of America, et al. v. Berkeley Heartlab, Inc., et al., Nos. 9:14-cv-00230, 9:11-cv-1593 and 9:15-cv-2485, D. S.C., 2017 U.S. Dist. LEXIS 98147).
RICHMOND, Va. - A Fourth Circuit U.S. Court of Appeals panel on June 13 affirmed the grant of summary judgment to defendants in a case where a plaintiff sued under the Employee Retirement Income Security Act seeking additional reimbursement for a series of steroid knee injections that an orthopedic surgeon administered to his spouse, finding no abuse of discretion in the defendants' decision to not provide additional insurance coverage and no error in the trial court's refusal to consider information that the plaintiff failed to provide during the administrative appeals process (Monte Hooper, et al. v. UnitedHealthcare Insurance Co., et al., No. 15-2157, 4th Cir., 2017 U.S. App. LEXIS 10482).
MINNEAPOLIS - A putative class action brought pursuant to the Employee Retirement Income Security Act alleging that pharmacy benefits managers' violation of their fiduciary duty caused the price of a drug used to treat severe, life-threatening allergic reaction to skyrocket was filed June 2 in Minnesota federal court (Elan and Adam Klein, et al. v. Prime Therapeutics LLC, et al., No. 0:17-cv-01884, D. Minn.).
BUFFALO, N.Y. - A federal judge in New York on May 12 upheld a magistrate judge's decision finding that an attorney representing a man accused of health care fraud should be removed as his counsel due to a conflict of interest because the government intends to call him as a witness (United States of America v. Eugene Gosy, No. 16-cr-46-FPG, W.D. N.Y., 2017 U.S. Dist. LEXIS 72989).
COLUMBIA, S.C. - The government is improperly withholding payments from, and setting off debts owed by, a failed South Carolina Patient Protection and Affordable Care Act (ACA) co-operative insurer, illegally placing its own interests before those of policyholders and others entitled to priority, the insurer's liquidator allege in an April 12 federal complaint filed in South Carolina (Raymond G. Farmer, et al. v. The United States of America, et al., No. 17-956, D. S.C.).
SEATTLE - A Washington federal judge on April 10 issued an order granting final approval of a settlement under which the Washington State Health Care Authority (WHCA) has agreed to provide coverage for direct-acting antiviral medications for the treatment of hepatitis C (HCV) for Medicaid enrollees who claimed that they were previously denied the drugs due to the cost (B.E., et al. v. Dorothy F. Teeter, No. 16-227, W.D. Wash.).
GREENSBORO, N.C. - An insurer received mixed results in its challenge to claims that it failed to properly compensate the developer of a colorectal cancer screening test, with a federal judge in North Carolina dismissing some of the claims on March 27 but largely allowing Employee Retirement Income Security Act claims to proceed (Exact Sciences Corp. and Exact Sciences Laboratories LLC v. Blue Cross and Blue Shield of North Carolina, No. 16-125, M.D. N.C., 2017 U.S. Dist. LEXIS 44679).
CHICAGO - A federal judge in Illinois dismissed without prejudice claims from a man that his former employer falsely billed Medicare, Medicaid and other private insurers for endovascular laser therapy (EVLT) procedures that were not medically necessary or done with reused laser fibers, finding that the allegations were not made with the required level of specificity to support his False Claims Act (FCA) allegations (United States of America, ex rel. Constantine Zverev, et al. v. USA Vein Clinics of Chicago, LLC, et al., No. 12 CV 8004, N.D. Ill., 2017 U.S. Dist. LEXIS 43807).