LexisNexis® Legal Newsroom
    Mealey's Health Law - Additional Factual Allegations Allowed In Medicare Dispute; Additional Claims Denied

    WASHINGTON, D.C. - A District of Columbia federal judge on July 7 partially granted plaintiffs' motion to amend their complaint challenging regulations governing Medicare reimbursements and allow the plaintiffs to include factual allegations concerning a Final Interim Rule, but not allowing the plaintiffs to include claims that the secretary's failure to disclose the rule and its contents violated the federal code (Banner Health fbo Banner Good Samaritan Medical Center, et al. v. Sylvia M. Burwell, secretary, Department of Health and Human Services, No. 10-1638, D. D.C.; 2014 U.S. Dist. LEXIS 91668).

    Mealey's Health Law - HHS Announces $100M For Expanded Primary Care, $83.4M In Training Awards

    WASHINGTON, D.C. - The U.S. Department of Health and Human Services is making $100 million available to expand access to primary care under the Patient Protection and Affordable Care Act (ACA), the government announced July 8.

    Mealey's Health Law - Trade Group Claims D.C. Funding Exchange On Back Of Non-Exchange Insurers

    WASHINGTON, D.C. - To fund the "extraordinary" costs of its Patient Protection and Affordable Care Act (ACA) health insurance exchange, the District of Columbia assesses fees on insurers with no products in the exchange, a trade association alleges in a July 3 complaint (American Council of Life Insurers v. District of Columbia Health Benefits Exchange Authority, et al., No. 14-1138, D. D.C.).

    Mealey's Health Law - La. High Court Says Insured Has Private Right Of Action Under Balance Billing Law

    NEW ORLEANS - A divided Louisiana Supreme Court on July 1 held that a health insurance beneficiary has a private right of action for damages against a health care provider under the state's balance billing act (Yana Anderson v. Ochsner Health System, et al., No. 3-13-2970, La. Sup.; 2014 La. LEXIS 1556).

    Mealey's Health Law - Illinois Federal Judge Dismisses All Claims In False Billing Suit

    PEORIA, Ill. - An Illinois federal judge on July 1 dismissed with prejudice a first amended complaint alleging that a health care provider submitted false claims pursuant to Medicare and Medicaid, holding that the plaintiff failed to adequately plead his claims and would not be able to correct the deficiencies with further amendment (United States of America, ex rel. Gail McGinnis v. OSF Healthcare System, et al., No. 11-1392, C.D. Ill.; 2014 U.S. Dist. LEXIS 89167).

    Mealey's Health Law - La. Supreme Court: Insured Can Sue Insurer For Balance Billing Violations

    NEW ORLEANS - A divided Louisiana Supreme Court on July 1 held that a participant in a health insurance plan can sue her insurer for alleged violations of the state's balance billing law committed by a health care provider contracting with the insurer (Aaron Emigh, et al. v. West Calcasieu Cameron Hospital, et al., No. 2013-2985, La. Sup.; 2014 La. LEXIS 1555).

    Mealey's Health Law - 6th Circuit Rules On Coordination Of Benefits Provisions In Coverage Dispute

    CINCINNATI - A panel of the Sixth Circuit U.S. Court of Appeals on July 1 affirmed that a coordination of benefits provision in an employee welfare benefit plan governed by the Employee Retirement Income Security Act trumped a coordination of benefits policy in a regular health insurance policy, thus making the regular insurer the primary party responsible for paying medical claims when beneficiaries had coverage under both plans (Central States, Southeast and Southwest Areas and Welfare Fund v. First Agency Inc., et al., No. 13-2077, 6th Cir.; 2014 U.S. App. LEXIS 12370).

    Mealey's Health Care Law Supreme Court Enjoins ACA Birth Control Mandate During College's Appeal

    WASHINGTON, D.C. - The Supreme Court on July 3 enjoined enforcement of the Patient Protection and Affordable Care Act (ACA)'s contraceptive mandate while a nonprofit Christian liberal arts college appeals an adverse ruling (Wheaton College v. Sylvia Mathews Burwell, et al., No. 13A1284, U.S. Sup.).

    Mealey's Health Law - Missouri Federal Judge Grants Injunction In ACA Birth-Control Case

    ST LOUIS - Finding that the Patient Protection and Affordable Care Act (ACA) contraceptive mandate imposed a substantial burden on the religious beliefs of two groups and that the government had not instituted the least restrictive method of achieving its goals, a Missouri federal judge granted a motion for preliminary injunction June 30 (Archdiocese of St. Louis and Catholic Charities of St. Louis v. Sylvia M. Burwell, et al., No. 13-2300, E.D. Mo.; 2014 U.S. Dist. LEXIS 88918).

    Mealey's Health Law - HHS Urges Top Court Not To Grant Emergency Injunction During ACA Appeal

    WASHINGTON, D.C. - The Supreme Court should deny a nonprofit Christian liberal arts college's request for an emergency injunction of the Patient Protection and Affordable Care Act (ACA) contraceptive mandate while it appeals an adverse ruling, the government said July 2 in its first post-Burwell v. Hobby Lobby Stores Inc. (573 U.S. ___ [2014]) filing (Wheaton College v. Sylvia Mathews Burwell, et al., No. 13A1284, U.S. Sup.).

    Mealey's Health Law - 7th Circuit Finds Jurisdiction Lacking, Remands ACA Payment Dispute

    CHICAGO - A battle over Patient Protection and Affordable Care Act (ACA) fund disbursement is heading back to state court after the Seventh Circuit U.S. Court of Appeals ruled June 27 that practical considerations cannot overcome the lack of federal jurisdiction (Hartland Lakeside Joint No. 3 School District, Oconomowoc Area School District, and Arrowhead Union High School District v. WEA Insurance Corp., et al., No. 13-3787, 7th Cir.).

    Mealey's Health Law - Parties Shut Out Of Earlier ACA Mandate Injunction Granted Restraining Order

    OKLAHOMA CITY - A federal judge in Oklahoma on July 1 granted a temporary restraining order enjoining the government from enforcing the Patient Protection and Affordable Care Act (ACA)'s contraceptive mandate against a Catholic benefits organization members who joined the group after his June 4 injunction ruling (The Catholic Benefits Association LCA; The Catholic Insurance Co. v. Sylvia M. Burwell, et al., No. 14-685, W.D. Okla.).

    Mealey's Health Law - Top Court Vacates Judgment, Remands 3 ACA Cases, Denies Review In 3 Others

    WASHINGTON, D.C. - The U.S. Supreme Court on July 1 summarily granted three writs of certiorari brought by Catholics challenging the Patient Protection and Affordable Care Act (ACA) contraceptive mandate, vacated the judgments and remanded the cases in light of Burwell v. Hobby Lobby Stores Inc. (573 U.S. ___ [2014]). The court also denied review without explanation in three appeals brought by the government (Eden Foods Inc., et al. v. Kathleen Sebelius, et al. No. 13-591, Francis A. Gilardi Jr., et al. v. Kathleen Sebelius, et al. No. 13-567, Autocam Corp., et al. v. Kathleen Sebelius, et al. No. 13-482, Burwell v. William Newland No. 13-919, Burwell, HHS v. Cyril B. Korte, et al. No. 13-937, Department of HHS v. Francis Gilardi, et al., No. 13-915, U.S. Sup.).

    Mealey's Health Law - 11th Circuit Cites Hobby Lobby, Enjoins Mandate During Appeal

    MONTGOMERY, Ala. - A Catholic media outlet is entitled to an injunction while it appeals rejection of its Patient Protection and Affordable Care Act (ACA)'s contraceptive mandate challenge in light of Burwell v. Hobby Lobby (Nos. 13-354, 13-356, U.S. Sup.), an 11th Circuit U.S. Court of Appeals panel held June 30 (Eternal Word Television Network Inc. and State of Alabama v. Secretary, U.S. Department of Health and Human Services, et al., No. 14-12696, 11th Cir.).

    Mealey's Health Law - ACA Birth-Control Mandate Burdens Closely Held Corporations, High Court Says

    WASHINGTON, D.C. - The Patient Protection and Affordable Care Act (ACA)'s contraceptive mandate substantially burdens closely held religious corporations' religious rights, a divided U.S. Supreme Court held June 30 (Burwell, Secretary of Health and Human Services, et al. v. Hobby Lobby Stores Inc., et al., No. 13-354, U.S. Sup.; Conestoga Woods Specialties Corp., et al. v. Burwell, Secretary of Health and Human Services, et al., No. 13-356, U.S. Sup.).

    Mealey's Health Law - DOJ: Nursing Home Pharmacy To Pay $124M To Resolve Claims Over Fraudulent Billing

    WASHINGTON, D.C. - The U.S. Department of Justice on June 25 announced that Omnicare Inc., the nation's largest supplier of pharmaceutical drugs to nursing homes, has agreed to pay $124.2 million to settle allegations that it offered improper financial incentives to nursing homes in return for their use of its services to supply pharmaceutical drugs to Medicare and Medicaid beneficiaries.

    Mealey's Health Law - Judge: Local Official Lacks Standing To Challenge ACA Individual Mandate

    WASHINGTON, D.C. - A local elected official challenging the Patient Protection and Affordable Care Act (ACA)'s individual mandate lacks injury sufficient for standing as either an individual or in his representative capacity, a District of Columbia federal judge held June 25 (Jeffrey Cutler v. United States Department of Health and Human Services, et al., No. 13-2066, D. D.C.).

    Mealey's Health Law - Judge Refuses Philadelphia Archdiocese ACA Injunctive Relief Request

    PHILADELPHIA - Catholic plaintiffs misconstrue the effects of the Patient Protection and Affordable Care Act (ACA) opt out, which does not trigger contraceptive coverage by third parties, a Pennsylvania federal judge held June 26 in denying injunctive relief (Catholic Charities of the Archdiocese of Philadelphia, et al. v. Sylvia Burwell, in her official capacity as Secretary of the Department of Health and Human Services, et al., No. 14-3096, E.D. Pa.).

    Mealey's Health Law - ACA Injunction Excludes New Benefits Group Members, Oklahoma Judge Says

    OKLAHOMA CITY - Expanding a Patient Protection and Affordable Care Act (ACA) contraceptive mandate injunction to new parties threatens creation of "open-ended" relief and would do little to assist judicial economy, an Oklahoma federal judge held June 26 (The Catholic Benefits Association LCA, et al. v. Sylvia M. Burwell, et al., No. 14-240, W.D. Okla.).

    Mealey's Health Law - Colorado Federal Judge Finds ACA Birth Control Mandate Burdens Christian College

    DENVER - Saying the ease with which a Christian college can opt out of the Patient Protection and Affordable Care Act (ACA) contraceptive mandate ignores that that the school finds facilitating such coverage "religiously repugnant," a Colorado federal judge on June 20 enjoined application of the statute (Colorado Christian University v. Kathleen Sebelius, et al., No. 13-2105, D. Colo.; 2014 U.S. Dist. LEXIS 84234).

    Mealey's Health Law - College Seeks Reconsideration Of Ruling Denying Injunction In Birth Control Case

    CHICAGO - Saying it faces "a terrible choice" just days from now, a Christian liberal arts college on June 24 asked an Illinois federal judge to reconsider his decision to not enjoin the Patient Protection and Affordable Care Act (ACA) contraceptive mandate (Wheaton College v. Sylvia Mathews Burwell, et al., No. 13-8910, N.D. Ill.; 2014 U.S. Dist. LEXIS 85194).

    Mealey's Health Law - 4th Circuit Upholds Conviction, Forfeiture Ruling In Ambulance Fraud Case

    RICHMOND, Va. - A Fourth Circuit U.S. Court of Appeals panel on June 23 affirmed the conviction and forfeiture order requiring the president of a medical transportation company to forfeit almost $1 million after finding that there was sufficient evidence presented to a jury showing that he knowingly submitted false claims to Medicare and a private insurance company for the transportation of three dialysis patients who did not medically require the company's services (United States of America v. Eddie Wayne Louthian Sr., No. 13-4231, 4th Cir.; 2014 U.S. App. LEXIS 11752).

    Mealey's Health Law - Pa. Federal Judge Grants Preliminary Injunction In Birth-Control Mandate Case

    PITTSBURGH - Providing or facilitating the provision of contraceptive coverage imposes a substantial burden on religious freedom and absent an injunction would leave plaintiffs choosing between their beliefs and costly fines, a Pennsylvania federal judge held June 20 (Most Reverend Lawrence E. Brandt, et al. v. Sylvia Burwell, et al., No. 14-681, W.D. Pa.).

    Mealey's Health Law - Judge Rejects Challenge To ACA Birth-Control Mandate, Injunction During Appeal

    MONTGOMERY, Ala. - Plaintiffs challenging the Patient Protection and Affordable Care Act (ACA) contraceptive mandate lack evidence that they will prevail on their claims, an Alabama federal judge held June 19 in denying a preliminary injunction pending appeal of an order partially dismissing their case (Eternal Word Television Network Inc. and State of Alabama v. Sylvia M. Burwell, et al., No. 13-521, S.D. Ala.).

    Mealey's Health Law - HHS Report: Most Silver Plan Enrollees Received Credits; Average Credit: $276

    WASHINGTON, D.C. - Individuals who obtained insurance through the federal Patient Protection and Affordable Care Act (ACA) marketplace had, on average, access to 47 plans offered by five health insurers and paid just $69 per month for the most popular "silver plan" after tax credits, according to a June 18 Department of Health and Human Services report.