LexisNexis® Legal Newsroom
    Mealey's Health Law - Magistrate Judge: Fraud Defendants Should Pay $2.7M To GEICO Over Scheme

    NEW YORK - A federal magistrate judge in New York on Feb. 22 recommended that a judge enter default judgment against defendants accused by the Government Employees Insurance Company (GEICO) and other insurers of fraud and unjust enrichment for submitting bills from clinics that were not owned by physicians and order them to pay $2.7 million in damages (Government Employees Insurance Co., et al. v. parkway medical Care, P.C., et al., No. 15 Civ. 3670, E.D. N.Y., 2017 U.S. Dist. LEXIS 24994).

    Mealey's Health Law - Claims In Bad Faith Suit Not Subject To ERISA Preemption, Magistrate Rules

    NEWARK, N.J. - Remand of an insurance breach of contract and bad faith lawsuit to state court is proper because a third-party's claims are not preempted by the Employee Retirement Income Security Act (ERISA), a federal magistrate judge in New Jersey ruled Feb. 17 (North Jersey Brain & Spine Center v. Aetna Life Insurance Co., et al., No. 16-1544, D. N.J., 2017 U.S. Dist. LEXIS 22710).

    Mealey's Health Law - Magistrate Judge Recommends Entering Default Against Doctor, Clinics For Fraud

    NEW YORK - A federal magistrate judge in New York on Feb. 13 recommended that a federal judge enter default judgment against a doctor and the clinics he owned for common-law fraud and violation of the Racketeer Influenced and Corrupt Organizations Act for his role involving the submission of fraudulent bills and kickbacks for referring patients to doctors for medical procedures that were not necessary (Government Employee Insurance Company v. Roger Jacques, M.D., et al., No. 14 Civ. 5299, E.D. N.Y., 2017 U.S. Dist. LEXIS 20195).

    Mealey's Health Law - Judge: Claims Alleging Wrongful Antitrust, Monopolizing Conduct Are Related

    ORLANDO, Fla. - Judgment was entered in favor of insurers on Feb. 15, one day after a Florida federal judge found that there is no further coverage owed to insureds for lawsuits alleging that they have intentionally engaged in wrongful antitrust and monopolizing conduct in an effort to dominate the health care service industry (Health First Inc., et al. v. Capitol Specialty Insurance Corporation, et al., No. 15-718, M.D. Fla., 2017 U.S. Dist. LEXIS 20320).

    Mealey's Health Law - Mental Health Facility Administrator Found Guilty For Kickback Scheme

    SHREVEPORT, La. - A federal jury in Louisiana on Feb. 10 found a mental health care facility administrator guilty of organizing a kickback scheme that resulted in the submission of $6.7 million in fraudulent bills to Medicare, the U.S. Attorney's Office announced (United States of America v. Tom McCardell, No. 16-cr-212, W.D. La.).

    Mealey's Health Law - Judge Orders Liquidation Of ACA Health Care Provider

    TRENTON, N.J. - A New Jersey judge on Feb. 3 ordered a Patient Protection and Affordable Care Act (ACA) consumer-operated and oriented plan insurer's liquidation and appointed the state's insurance commissioner as liquidator (In the Matter of Freelancers Consumer Operated and Oriented Program of New Jersey d/b/a Health Republic Insurance of New Jersey, No. MCR-C-000063-16, N.J. Super., Mercer Co., Chanc. Div.).

    Mealey's Health Law - Man's Conviction, Sentence For Insurance Fraud Upheld By Ohio Appeals Court

    TOLEDO, Ohio - A trial court judge did not err when allowing a jury to hear evidence about an administrative hearing that concluded that a man should be terminated from his job for representing that he was married to obtain insurance benefits for his ex-wife because presentation of the information did not result in "a manifest miscarriage of justice," an Ohio appeals court panel ruled Jan. 20 in affirming the man's sentence and conviction (State of Ohio v. Marvin Arnold, No L-15-1126, Ohio App., 6th Dist.; 2017 Ohio App. LEIS 227).

    Mealey's Health Law - Texas Federal Judge Dismisses Gender Identity Discrimination Claims

    DALLAS - A Texas federal judge on Jan. 13 dismissed claims alleging gender identity discrimination under Section 1557 of the Patient Protection and Affordable Care Act (ACA) against an insurer and an employer because the plaintiff failed to cite any controlling precedent that recognizes a cause of action under Section 1557 for gender identity discrimination (Charlize Marie Baker v. Aetna Life Insurance Co., et al., No. 15-3679, N.D. Texas; 2017 U.S. Dist. LEXIS 5665).

    Mealey's Health Law - Judge Affirms Earlier Ruling That Fraud Scheme Netted $2.9M In Losses

    NEW YORK - A federal judge in New York, who was ordered by the Second Circuit U.S. Court of Appeals to provide more detailed findings on the intended loss of an insurance fraud scheme that involved the redistribution of drugs originally provided to HIV and AIDS patients, on Jan. 17 affirmed his earlier decision that the scheme resulted in $2.9 million in losses to Medicare, finding that a ledger found at the man's apartment detailed the prices and quantities of the drugs (United States of America v. Bladimir Rigo, No. 13 CR 897, S.D. N.Y.; 2017 U.S. Dist. LEXIS 6228).

    Mealey's Health Law - California Women Files Class Action Over Denial Of Breastfeeding Support

    OAKLAND, Calif. - A California woman on Jan. 13 filed a class action complaint in federal court alleging that she and other women have been wrongfully denied access to and coverage for a vital women's preventive service - breastfeeding support, supplies and counseling - for which coverage is mandated by the Patient Protection and Affordable Care Act (ACA) (Rachel Condry, et al. v. UnitedHealth Group Inc., et al., No. 4:17-cv-00183, N.D. Calif.).

    Mealey's Health Law - Plaintiff's Claims Are Preempted By ERISA, Illinois Federal Judge Says

    CHICAGO - An Illinois federal judge on Jan. 12 denied a plaintiff's motion to remand after determining that her state law claims arising out of the disclosure of medical records without consent are preempted by the Employment Retirement Income Security Act (Jane Doe v. Aetna Inc., et al., No. 16-8390, N.D. Ill.; 2017 U.S. Dist. LEXIS 4866).

    Mealey's Health Law - Blue Shield's Insurance Renewal Calls Found Not To Violate TCPA

    SANTA ANA, Calif. - Single calls placed to each health insurance customer about policy renewals were not telemarketing or advertising, a California federal judge ruled Jan. 13, granting summary judgment to the insurance provider in a Telephone Consumer Protection Act (TCPA) class complaint (Shannon Smith, et al. Blue Shield of California Life & Health Insurance Company, No. 16-108, C.D. Calif.; 2017 U.S. Dist. LEXIS 5620).

    Mealey's Health Law - Holistic Doctor's Expert Unqualified To Testify, Judge Finds

    ALBUQUERQUE, N.M. - A federal judge in New Mexico on Jan. 11 granted the federal government's motion to exclude the testimony of an expert designated to discuss the medical necessity of tests administered by a holistic doctor who is accused of fraudulently billing Medicare and other insurers, after finding that the proposed testimony is not relevant and does not meet the standards of Daubert v. Merrell Dow Pharmaceuticals, Inc. (509 U.S. 579, 597 [1993]) (United States of America v. Roy Heilbron, No. 15-CR-2030, D. N.M.; 2017 U.S. Dist. LEXIS).

    Mealey's Health Law - Michigan Tribe, Blue Cross Settle ERISA Plan Administration Claims

    DETROIT - Michigan's Little River Band of Ottawa Indians and Blue Cross Blue Shield have settled the tribe's claims that Blue Cross breached its fiduciary duty and violated the Employee Retirement Income Security Act (ERISA) in administering the tribe's health care plan for employees, according to a dismissal order filed Jan. 11 in federal court (Little River Band of Ottawa Indians, et al. v. Blue Cross Blue Shield of Michigan, No. 2:15-cv-13708, E.D. Mich.).

    Mealey's Health Law - Supreme Court Won't Review 6th Circuit ERISA Preemption Ruling

    WASHINGTON, D.C. - The U.S. Supreme Court on Jan. 9 let stand a Sixth Circuit U.S. Court of Appeals' ruling that affirmed the dismissal of claims that the Michigan Health Insurance Claims Assessment Act is preempted by the Employee Retirement Income Security Act (Self-Insurance Institute of America Inc. v. Rick Snyder, et al., No. 16-593, U.S. Sup.).

    Mealey's Health Law - DOJ: Neurosurgeon Sentenced To 235 Months In Prison For Fraud Scheme

    DETROIT - The U.S. Department of Justice announced that a federal judge in Michigan on Jan. 9 sentenced a neurosurgeon to 235 months in prison for his role in a $2.8 million Medicare fraud scheme that involved the doctor billing public and private insurers for spinal fusions that he never performed (United States of America v. Aria O. Sabit, No. 15cr20311, E.D. Mich.).

    Mealey's Health Law - Judge Orders Health Care Fraud Defendant To Turn Over Retirement Funds

    CHICAGO - A cardiologist who pleaded guilty to one count of health care fraud for fraudulently billing Medicare and other insurance companies was ordered by a federal judge in Illinois to turn over three retirement funds valued at $300,738.60 after finding that forfeiture of the funds would not result in an overpayment of the $12 million he owes in restitution (United States of America v. Sushil Sheth, No. 09 CR 69-1, N.D. Ill.; 2017 U.S. Dist. LEXIS 2281).

    Mealey's Health Law - 4th Circuit Upholds Requirement Of Proof Of Marriage For Health Insurance Coverage

    RICHMOND, Va. - A Baltimore employee failed to show that the city's requirement that employees submit proof of marriage for their spouses to be eligible for health insurance coverage violates state or federal law, a Fourth Circuit U.S. Court of Appeals panel ruled Jan. 4, upholding a trial court's dismissal of an employee's complaint (Adris Abdus-Shahid, et al. v. Mayor and City Council of Baltimore, No. 15-2181, 4th Cir.; 2017 U.S. App. LEXIS 118).

    Mealey's Health Law - 11th Circuit Panel Affirms COBRA Ruling In Favor Of Fired Staffing Employee

    ATLANTA - A 11th Circuit U.S. Court of Appeals panel on Dec. 30 affirmed an Alabama federal judge's ruling that a staffing business employer failed to notify a plaintiff of his rights under the Comprehensive Omnibus Budget Reconciliation Act (COBRA), saying that the evidence was sufficient that the former employee's health insurance was retroactively canceled in retaliation for filing an Equal Employment Opportunity Commission complaint and that the employer was not exempt from the COBRA requirement to provide notice to the employee of the right to continuation of health insurance coverage (Sam A. Virciglio v. Work Train Staffing LLC, et al., No. 15-10421, 11th Cir.; 2016 U.S. App. LEXIS 23422).

    Mealey's Health Law - 6th Circuit Panel: Insureds Lack Sufficient Injury To Claim Insurer Shirked ERISA Duties

    CINCINNATI - A Sixth Circuit U.S. Court of Appeals panel on Dec. 21 affirmed an Ohio federal judge's ruling that hypothetical situations lack the necessary concrete injury required to pursue claims that an insurer shirked its obligations under the Employee Retirement Income Security Act and the Patient Protection and Affordable Care Act (ACA) (Daniel Soehnlen, et al. v. Fleet Owners Insurance Fund, et al., No. 16-3124, 6th Cir.; 2016 U.S. App. LEXIS 22914).

    Mealey's Health Law - Rehabilitator Asks Court To Order ACA Insurer Into Liquidation

    TRENTON, N.J. - New Jersey's banking and insurance commissioner on Dec. 15 asked a state court to order an insolvent Patient Protection and Affordable Care Act (ACA) consumer-operated and oriented plan insurer's liquidation (Richard J. Badolato, Commissioner of the Department of Banking and Insurance of New Jersey v. Freelancers Consumer Operated and Oriented Program of New Jersey d/b/a Health Republic Insurance of New Jersey, No. MCR-C-000063-16, N.J. Super., Mercer Co., Chancery Div.).

    Mealey's Health Law - Pennsylvania Federal Judge: ERISA Controls Breach Of Contract, Fiduciary Duty Claims

    PHILADELPHIA - A Pennsylvania federal judge in an opinion filed Nov. 18 denied a plaintiff's motion to remand a case alleging improper denial of claims under an Employee Retirement Income Security Act-qualified health plan to state court, saying that claims for breach of contract and breach of fiduciary duty are properly brought under ERISA (Eric A. Shore P.C. v. Independence Blue Cross, et al., No. 16-5224, E.D. Pa.; 2016 U.S. Dist. LEXIS 160022).

    Mealey's Health Law - Former Pharmacy Owner Convicted For Role In $700,000 Medicare Fraud Scheme

    MIAMI - A former pharmacy owner was convicted by a federal jury in Florida on Nov. 16 of three counts of health care fraud for his role in a scheme in which he fraudulently billed Medicare $700,000 for prescription drugs that were never dispensed (United States of America v. Andres Alfonso, No. 16-cr-20567, S.D. Fla.).

    Mealey's Health Law - Home Health Agency Owner Convicted For Role In $13M Medicare Fraud Scheme

    HOUSTON - A federal jury in Texas on Nov. 10 convicted the co-owner of a home health agency for her role in a $13 million Medicare fraud scheme that operated from February 2006 to June 2015 (United States of America v. Ebong Tilong, et al., No. 15-cr-591, S.D. Texas).

    Mealey's Health Law - DOJ: Co-Owner Of Home Health Care Agency Sentenced To 96 Months In Prison

    ANN ARBOR, Mich. - The U.S. Department of Justice (DOJ) announced Nov. 7 that the co-owner of a Detroit-area home health care agency has been sentenced by a federal judge in Michigan to 96 months in prison and ordered to pay $38 million in restitution after being found guilty for his role in a $33 million Medicare fraud scheme (United States of America v. Zafar Mehmood, et al., No. 12-cr-20042, E.D. Mich.).