LexisNexis® Legal Newsroom
    Supreme Court Denies Petition In Suits Over Medicaid Reimbursements

    WASHINGTON, D.C. - The U.S. Supreme Court on Jan. 13 denied a petition for writ of certiorari in two cases in which the Ninth Circuit U.S. Court of Appeals vacated preliminary injunctions prohibiting the California Department of Health Care Services and its director from implementing Medi-Cal reimbursement reductions authorized by the California Legislature and approved by the secretary of Health and Human Services (Managed Pharmacy Care, et al. v. Kathleen Sebelius, et al., No. 13-253, California Medical Association v. Kathleen Sebelius, et al., No. 13-380, U.S. Sup.).

    High Court Will Not Review ERISA Benefit And Disclosure Claims

    WASHINGTON, D.C. - The U.S. Supreme Court on Jan. 13 denied a plan participant's petition for a writ of certiorari seeking review of an 11th Circuit U.S. Court of Appeals ruling that a health plan insurer did not abuse its discretion in calculating benefits and that the insurer was not liable for penalties for failing to disclose documents it relied on in calculating the amount of the benefit (Brian Fox v. Blue Cross and Blue Shield of Florida Inc., No. 13-342, U.S. Sup.).

    U.S. Supreme Court Denies Certiorari In Medicare Part D Challenge

    WASHINGTON, D.C. - The U.S. Supreme Court on Jan. 13 denied a petition for certiorari in a case seeking review of an appeals court decision affirming a federal trial court order denying judicial review of a challenge to the U.S. Department of Health and Human Services (HHS) Medicare Part D rule allowing prescription drug plans (PDPs) to establish preferred pharmacy networks (Southwest Pharmacy Solutions v. Centers for Medicare and Medicaid Services, No. 13-144, U.S. Sup.).

    Judge Dismisses Suit Over Individual, Employer Mandates In Health Care Act

    HOUSTON - A Texas federal judge on Jan. 10 dismissed a case challenging the individual and employer mandates contained in the Patient Protection and Affordable Care Act (PPACA), holding that the mandates did not violate the origination clause of the U.S. Constitution or the taking clause of the Fifth Amendment. Also on Jan. 10, the plaintiffs filed a notice indicating their intent to appeal the decision to the Fifth Circuit U.S. Court of Appeals (Steven F. Hotze, M.D., et al. v. Kathleen Sebelius, et al., No. 13-1318, S.D. Texas; 2014 U.S. Dist. LEXIS 3149).

    5th Circuit Affirms Convictions Of 3 People For Health Care Fraud

    NEW ORLEANS - A Fifth Circuit U.S. Court of Appeals panel on Jan. 7 affirmed the convictions of three people accused of health care fraud related to Medicare and Medicaid billing (United States of America v. Umawa Oke Imo, et al., No. 11-20791, 5th Cir.; 2014 U.S. App. LEXIS 280).

    D.C. Federal Judge Grants Defense Summary Judgment In Medicare Suit

    WASHINGTON, D.C. - A District of Columbia federal judge on Jan. 6 granted summary judgment in favor of the U.S. Department of Health and Human Services in a Medicare reimbursement dispute, saying that the secretary's methodology in setting the rates was not arbitrary and capricious (District Hospital Partners, et al. v. Kathleen Sebelius, No. 11-0116, D. D.C.; 2014 U.S. Dist. LEXIS 738).

    Injunction Pending Appeal Granted After Judge Dismisses Birth Control Case

    WASHINGTON, D.C. - A divided District of Columbia Circuit U.S. Court of Appeals panel on Dec. 31 granted an emergency motion for injunction pending appeal in a nonprofit religious organization's case challenging the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA). By its own motion, the court consolidated the case with a similar case (Priests for Life, et al. v. U.S. Department of Health and Human Services, et al., No. 13-1261, D.C. Cir.).

    6th Circuit Grants Injunction Pending Appeal In Birth Control Suit

    GRAND RAPIDS, Mich. - The Sixth Circuit U.S. Court of Appeals on Dec. 31 granted an injunction pending appeal in favor of two Catholic institutions after a Michigan federal judge on Dec. 27 declined to grant a preliminary injunction in favor of the plaintiffs in their suit seeking to keep the government from implementing the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) against them and their health plans (Michigan Conference, et al. v. Kathleen Sebelius, et al., No. 13-2723, 6th Cir.).

    Texas Federal Judge Grants Injunction To Halt Implementation Of Mandate

    BEAUMONT, Texas - A Texas federal judge on Jan. 2 granted a permanent injunction to halt the implementation of the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) against the Catholic Diocese of Beaumont and Catholic Charities of Southeast Texas Inc. but dismissed a claim for violation of the Administrative Procedure Act (APA) (Catholic Diocese of Beaumont, et al. v. Kathleen Sebelius, et al., No. 13-709, E.D. Texas; 2014 U.S. Dist. LEXIS 467).

    9th Circuit Vacates Injunctions In Medicare Secondary Payer Class Action Suit

    SAN FRANCISCO - A Ninth Circuit U.S. Court of Appeals panel on Jan. 2 filed an amended opinion vacating injunctions entered by a lower court prohibiting the secretary of the U.S. Department of Health and Human Services (DHHS) from demanding "up front" reimbursement for secondary payments from beneficiaries who have appealed a Medicare reimbursement determination and remanded the class action case with instructions for the lower court to consider the merits of the plaintiffs' due process claim (Patricia Haro, et al. v. Kathleen Sebelius, No. 11-16606, 9th Cir.; 2014 U.S. App. LEXIS 61).

    Government Opposes Supreme Court's Halt Of Birth Control Mandate

    WASHINGTON, D.C. - The federal government on Jan. 3 filed a brief with the U.S. Supreme Court opposing an emergency injunction pending appellate review or, in the alternative, a petition for a writ of certiorari before judgment and injunction pending resolution following a Dec. 31 order by Justice Sonia Sotomayor that temporarily blocked the federal government from enforcing the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) against an order of Catholic nuns at the request of the group after a lower court denied a motion for a preliminary injunction in a case challenging the mandate (Little Sisters of the Poor Home for the Aged, et al. v. Kathleen Sebelius, et al., No. 13A691, U.S. Sup.).

    Indiana Federal Judge Grants Injunction In Birth Control Suit

    SOUTH BEND, Ind. - An Indiana federal judge on Dec. 27 granted a preliminary injunction in favor of two not-for-profit Christ-center institutions of higher learning in their challenge to the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) (Grace Schools, et al. v. Kathleen Sebelius, et al., No. 12-459, N.D. Ind.; 2013 U.S. Dist. LEXIS 180576).

    Preliminary Injunction Granted In Religious Groups' Challenge To Mandate

    FORT WAYNE, Ind. - An Indiana federal judge on Dec. 27 granted a preliminary injunction in favor of a group of Catholic organizations in their challenge to the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) (Diocese of Fort Wayne-South Bend Inc., et al. v. Kathleen Sebelius, et al., No. 12-159, N.D. Ind.; 2013 U.S. Dist. LEXIS 180641).

    Supreme Court Justice Halts Birth Control Mandate For Catholic Group

    WASHINGTON, D.C. - U.S. Supreme Court Justice Sonia Sotomayor on Dec. 31 temporarily blocked the federal government from enforcing the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) against an order of Catholic nuns at the request of the group after a lower court denied a motion for a preliminary injunction in a case challenging the mandate (Little Sisters of the Poor Home for the Aged, et al. v. Kathleen Sebelius, et al., No. 13A691, U.S. Sup.).

    N.Y. Federal Judge Dismisses Medicare Provider Termination Suit

    ROCHESTER, N.Y. - A New York federal judge on Dec. 17 dismissed a suit challenging the termination of a Medicare and Medicaid provider agreement without a pretermination hearing and other administrative review procedures, saying the termination was proper (Blossom South v. Kathleen Sebelius, et al., No. 13-6452, W.D. N.Y.; 2013 U.S. Dist. LEXIS 176996).

    California Federal Judge Remands Reimbursement Suit, Finds No Preemption Exists

    SAN JOSE, Calif. - A California federal judge on Dec. 16 remanded a reimbursement dispute to state court, holding that the Employee Retirement Income Security Act did not preempt the state law claims (Bay Area Surgical Management v. United Healthcare Insurance Co., et al., No. 13-2512, N.D. Calif.; 2013 U.S. Dist. LEXIS 176682).

    Judge Grants Injunction, Dismisses Plaintiffs In Birth Control Suit

    BROOKLYN, N.Y. - A New York federal judge on Dec. 16 granted non-Diocesan plaintiffs' motion for summary judgment as to their Religious Freedom and Restoration Act (RFRA) claim and issued a preliminary injunction in their favor in a challenge to the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) but granted the government's motion for summary judgment as to claims made by Diocesan plaintiffs (The Roman Catholic Archdiocese of New York, et al. v. Kathleen Sebelius, No. 12-2542, E.D. N.Y.).

    Split Montana High Court Reverses Certification Of Class Question In Benefits Suit

    HELENA, Mont. - A split Montana Supreme Court on Dec. 13 upheld a state court's order defining the class in a suit challenging the denial of a preauthorization request for a medical procedure but reversed and remanded with respect to the court's certification of the plaintiffs' claim as to "$(w$)hether the State of Montana breached its contract" and remanded to allow the court to consider whether a question could be presented where individual questions would not predominate (Steve Sangwin, et al. v. State of Montana, et al., No. 12-0712, Mont. Sup.; 2013 Mont. LEXIS 496).

    New Jersey Appeals Court Affirms Dismissal Of Denial-Of-Benefits Suit

    TRENTON, N.J. - A New Jersey appeals court on Dec. 11 affirmed the dismissal of a wrongful-denial-of-health-benefits suit, saying that the plaintiff brought his challenge of the final decision denying the benefits in the wrong court (Irvin B. Beaver v. Magellan Health Services Inc., No. A-1311-12T3, N.S. Super., App. Div.; 2013 N.J. Super. LEXIS 175).

    Supreme Court Rules On Limitations Period In ERISA Denial Case

    WASHINGTON, D.C. - The U.S. Supreme Court ruled Dec. 16 that the contractual limitations provision of a disability benefits plan that requires participants to bring suit within three years after "proof of loss" is due is enforceable under the Employee Retirement Income Security Act, even if the limitations period commences before the plan resolved the claim for benefits (Julie Heimeshoff v. Hartford Life & Accident Insurance Co., et al., No. 12-729, U.S. Sup.).

    Federal Judge Certifies Class Of Health Care Purchasers In Hospital Merger Case

    CHICAGO - End payers who purchased inpatient and outpatient health care services directly from NorthShore University HealthSystem and alleged that NorthShore illegally monopolized the market for such services following the merger of hospitals demonstrated that class adjudication of the antitrust claims was superior, a federal judge in Illinois ruled Dec. 10 in granting the purchasers' motion for class certification (In re: Evanston Northwestern Corporation Antitrust Litigation, No. 07-cv-04446, N.D. Ill.; 2013 U.S. Dist. LEXIS 173794).

    Catholic Groups Ask For Temporary Restraining Order In Birth Control Suit

    BROOKLYN, N.Y. - Multiple Catholic organizations on Dec. 10 asked a New York federal judge to grant a temporary restraining order barring implementation and enforcement of the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) until the court can rule on their motion for a preliminary injunction (The Roman Catholic Archdiocese of New York, et al. v. Kathleen Sebelius, No. 12-2542, E.D. N.Y.).

    Government Urges Appeals Court To Affirm Dismissal Of Individual Mandate Suit

    WASHINGTON, D.C. - The federal government on Dec. 9 urged the District of Columbia Circuit U.S. Court of Appeals to affirm a decision dismissing a suit challenging payments made to the Internal Revenue Service related to the individual mandate contained in the Patient Protection and Affordable Care Act (PPACA) decision (Matt Sissel v. U.S. Department of Health and Human Services, et al., No. 13-5202, D.C. Cir.).

    Conn. Federal Judge Grants Injunction To Halt Termination Of Medicare Contracts

    NEW HAVEN, Conn. - A Connecticut federal judge on Dec. 5 granted a preliminary injunction to keep a health insurance company group from terminating approximately 2,200 physicians from its Medicare Advantage program (Fairfield County Medical Association, et al. v. United Healthcare of New England, et al., No. 13-1621, D. Conn.).

    Connecticut Federal Judge Denies Injunction In Medicare Classification Suit

    NEW HAVEN, Conn. - A Connecticut federal judge on Dec. 6 held that the court has jurisdiction to hear a hospital's challenge of whether the regulatory scheme governing the Medicare Geographic Classification Review Board (MGCRB) violates the Medicare Act and the Administrative Procedure Act but denied the plaintiff's request for a preliminary injunction to halt the defendants from applying the scheme to its current and future reclassification applications (Lawrence & Memorial Hospital v. Kathleen Sebelius, et al., No. 13-1495, D. Conn.; 2013 U.S. Dist. LEXIS 172120).