NEWARK, N.J. - In an unpublished opinion, a New Jersey federal judge on May 30 allowed a doctor to pursue the submission of false claims made by his medical practice to a diagnostic testing laboratory but dismissed claims involving allegations of false claims involving other providers to the laboratory (United States of America, ex rel. James J. Judd, M.D. v. Quest Diagnostics Inc., No. 10-4914, D. N.J.; 2014 U.S. Dist. LEXIS 73760).
BROOKLYN, N.Y. - Religious groups opting out of the Patient Protection and Affordable Care Act (ACA) contraceptive mandate are not giving third-party administrators of their church plans a "permission slip" to provide such coverage, the government told the Second Circuit U.S. Court of Appeals on May 27 (The Roman Catholic Archdiocese of New York, et al. v. Kathleen Sebelius, No. 14-427, 2nd Cir.).
ATLANTA - A Georgia federal judge on May 23 granted the defendants' summary judgment in a qui tam action, finding that the relator presented no evidence that the defendants were knowingly submitting claims for off-label prescription drugs for reimbursement under Medicare Part D (United States of America ex rel. Fox Rx Inc. v. Omnicare Inc., No. 11-962, N.D. Ga.; 2014 U.S. Dist. LEXIS 70902).
MADISON, Wis. - A Wisconsin federal judge on May 23 denied the plaintiffs' summary judgment motion in their challenge to a Wisconsin statute requiring that every physician who provides abortions in the state to have admitting privileges at a hospital within 30 miles of the health center where the abortion is performed, saying a genuine issue of material fact exists as to whether admitting privileges are being denied arbitrarily or for improper reasons by hospitals without an adequate opportunity for review by a governmental entity (Planned Parenthood of Wisconsin Inc., et al. v. J.B. Van Hollen, et al., No. 13-465, W.D. Wis.; 2014 U.S. Dist. LEXIS 71377).
AUSTIN, Texas - A professional organization of oncologists on May 23 sued a health insurance company in Texas federal court for allegedly wrongfully reduce the rates it paid to the plaintiff for services covered under the defendants' health plans as a result of the federal government's decreasing payments it made to Medicare Advantage Organizations (MAOs) and other managed care organizations (Texas Oncology v. Humana Insurance Co., et al., No. 14-476, W.D. Texas).
HANNIBAL, Mo. - Separate regulations govern a third party's decision to provide contraceptive coverage after religious groups opt out of providing such coverage under the Patient Protection and Affordable Care Act (ACA), and the opt out is neither a facilitation of such coverage nor a substantial burden on their religious practices, the government argues in a May 22 brief in the Eighth Circuit U.S. Court of Appeals (Sharpe Holdings Inc., et al. v. Kathleen Sebelius, et al., No. 13-1507, 8th Cir.).
WASHINGTON, D.C. - A District of Columbia federal judge on May 23 granted a pharmaceutical manufacturer's motions for an injunction and summary judgment in a case challenging a final rule of the U.S. Department of Health and Human Service (HHS) related to when an orphan drug may be offered at a discounted price, saying that HHS lacked the authority to engage in the rulemaking process in this instance (Pharmaceutical Research and Manufacturers of America v. U.S. Department of Health and Human Service, No. 13-1501, D. D.C.; 2014 U.S. Dist. LEXIS 70894).
WASHINGTON, D.C. - A man pursuing an origination-clause challenge to the Patient Protection and Affordable Care Act (ACA) must file a brief showing that the individual mandate applies to him and, therefore, that he has standing, a District of Columbia Circuit U.S. Court of Appeals panel ordered May 22 (Matt Sissel v. U.S. Department of Health and Human Services, et al., No. 13-5202, D.C. Cir.).
CEDAR RAPIDS, Iowa - Eighth Circuit precedent and the likelihood of resulting harm warrants enjoining implementation of the Patient Protection and Affordable Care Act (ACA) contraceptive mandate, a federal judge in Iowa held May 21 (Dordt College and Cornerstone University v. Kathleen Sebelius, et al., No. 13-4100, N.D. Iowa; 2014 U.S. Dist. LEXIS 69406).
ODMULGEE, Okla. - When read as a whole, the plain language of the Patient Protection and Affordable Care Act (ACA) clearly permits subsidies for individuals enrolled through federal exchanges, the federal government told a federal judge May 19 (State of Oklahoma, ex rel. Scott Pruitt v. Kathleen Sebelius, et al., No. 11-30, E.D. Okla.; 2013 U.S. Dist. LEXIS 113232).
CARSON CITY, Nev. - Citing "extensive and reoccurring errors" with Nevada's "underperforming" Patient Protection and Affordable Care Act (ACA) health insurance exchange, the board governing the exchange abandoned it on May 20 in favor of the federal one, sources told Mealey Publications.
CHICAGO - An Illinois federal judge on May 19 set the terms a permanent injunction should take against a Blue Cross Blue Shield entity found to have failed to provide adequate notice and appeal notices before recouping money from previously paid claims, saying the injunction would provide relief only to members of the chiropractic association involved and not all providers associated with the defendant and that the injunction would provide only prospective relief instead of the retroactive relief requested by the plaintiff (Pennsylvania Chiropractic Association, et al. v. Blue Cross Blue Shield Association, et al., No. 09-5619, N.D. Ill.).
WASHINGTON, D.C. - Individuals who knowingly provide false information to a Patient Protection and Affordable Care Act (ACA) health care exchange may be subject to $250,000 in civil penalties, according to a U.S. Department of Health and Human Services (HHS) final rule released May 16.
BANGOR, Maine - A Maine federal judge on May 15 partially dismissed a lawsuit challenging state law regulating the importation of prescription drugs from foreign countries, dismissing one plaintiff but holding that the remaining plaintiffs have standing (Charles Ouellette, et al. v. Janet Mills, et al., No. 13-347, D. Maine; 2014 U.S. Dist. LEXIS 66880).
HOUSTON - A Texas federal judge on May 14 partially denied a defendant's request to dismiss a False Claims Act (FCA) case against it, saying that the plaintiff adequately provided factual content allowing the court to reasonably infer that the defendant knowingly submitted false claims for Medicaid reimbursement (United States of America and the State of Texas ex rel Patricia M. Carroll v. Planned Parenthood of Gulf Coast Inc., No. 12-3505, S.D. Texas; 2014 U.S. Dist. LEXIS 66385).
CHEYENNE, Wyo. - The Patient Protection and Affordable Care Act (ACA) contraceptive mandate does not substantially burden religious beliefs because the statute, and not the self-certification process, requires coverage by third-party administrators (TPAs), a Wyoming federal judge held May 13 (Diocese of Cheyenne, et al. v. Kathleen Sebelius, in her official capacity as Secretary of the U.S. Department of Health and Human Services, No. 14-21, D. Wyo.; 2014 U.S. Dist. LEXIS 65837).
DETROIT - Imposing jurisdiction on a nonparty insurer allegedly affected by a ruling enjoining implementation of the Patient Protection and Affordable Care Act (ACA)'s contraceptive mandate requires impermissible speculation, a Michigan federal judge held May 11 in refusing to clarify his injunction (The Ave Marie Foundation, et al. v. Kathleen Sebelius, et al., No. 13-15198, E.D. Mich.).
OKLAHOMA CITY - The government improperly asks a district judge to second-guess religious universities' beliefs, which the Patient Protection and Affordable Care Act (ACA)'s contraceptive mandate substantially burdens, plaintiffs told the 10th Circuit U.S. Court of Appeals on May 12 (Southern Nazarene University, et al. v. Kathleen Sebelius, et al., No. 14-6026, 10th Cir.).
NEWARK, N.J. - A New Jersey orthopedic surgeon on May 9 sued a health insurer and plan administrator in federal court for allegedly underpaying for out-of-network services provided to a patient (Dr. Marc S. Menkowitz v. Blue Cross Blue Shield of Illinois, et al., No. 14-2946, D. N.J.).
BOSTON - In what it called a matter of first impression, a First Circuit U.S. Court of Appeals panel on May 9 held that complete preemption does not exist under the Federal Employees Health Benefits Act (FEHBA) and ordered a district court to remand a denial of health benefits case to state court (Raquel Lopez-Munoz, et al. v. Triple-S Salud Inc., No. 13-1417, 1st Cir.; 2014 U.S. App. LEXIS 8796).
SAN FRANCISCO - A health insurer's categorical exclusion of myoelectric prosthetics from coverage under a health insurance plan governed by the Employee Retirement Income Security Act does not violate the California Health and Safety Code, the Ninth Circuit U.S. Court of Appeals affirmed May 8 (Martha Garcia v. PacifiCare of California, Inc., et al., No. 8:12-cv-02022, 9th Cir.; 2014 U.S. App. LEXIS 8659).
HOUSTON - Supreme Court precedent and the "long history" of the origination clause of the U.S. Constitution render the Patient Protection and Affordable Care Act (ACA) and its individual mandate unconstitutional, plaintiffs told the Fifth Circuit U.S. Court of Appeals in a May 8 brief (Steven F. Hotze, M.D., et al. v. Kathleen Sebelius, et al., No. 14-20039, 5th Cir.).
WASHINGTON, D.C. - A District of Columbia judge on May 9 denied a motion by multiple licensed home health care providers for a preliminary injunction to halt the suspension of Medicaid payments for their services, saying that the plaintiffs were unlikely to succeed on the merits of their claim that they were terminated from the Medicaid program in violation of their due process rights and that they failed to exhaust administrative services (ABA Inc., et al. v. District of Columbia, No. 14-550, D. D.C.; 2014 U.S. Dist. LEXIS 64126).
LOS ANGELES - A California federal judge on May 9 vacated an order to show cause issued May 8 after a plaintiff moved to voluntarily dismiss its case seeking a temporary restraining order to stop the U.S. Department of Health and Human Service (HHS) from terminating its privileges to provide ambulance services to Medicare patients (Royalty Ambulance Services Inc. v. Department of Health and Human Services, et al., No. 14-2936, C.D. Calif.; 2014 U.S. Dist. LEXIS 64000).
WASHINGTON, D.C. - A District of Columbia U.S. Circuit Court of Appeals panel on May 8 heard oral arguments over whether the Patient Protection and Affordable Care Act (ACA)'s contraceptive mandate substantially burdens Catholic groups' religious freedoms (Priests for Life, et al. v. U.S. Department of Health and Human Services, et al., No. 113-5368; Roman Catholic Archbishop of Washington, et al. v. Kathleen Sebelius, et al., No. 13-5371, D.C. Cir.).