COLUMBUS, Ohio - An Ohio federal judge on Jan. 29 denied a mail order pharmacy's motion for a temporary restraining order and preliminary injunction in its case seeking to keep a pharmacy services administrative organization (PSAO) from terminating its pharmacy provider participation agreement, saying the plaintiff failed to demonstrate a likelihood of success on the merits (Med-Care Diabetic & Medical Supplies Inc. v. Strategic Health Alliance II Inc. d/b/a AccessHealth, No. 14-82, S.D. Ohio; 2014 U.S. Dist. LEXIS 10881).
TRENTON, N.J. - A New Jersey federal judge in a Jan. 30 unpublished opinion granted a motion to dismiss brought by defendants in a health care reimbursement dispute, saying the patient's health care plan contained a valid anti-assignment of benefits provision that precluded the plaintiff provider from bringing the suit (Dr. Brian M. Torpey v. Blue Cross Blue Shield of Texas, at al., No. 12-7618, D. N.J.; 2014 U.S. Dist. LEXIS 11412).
NEW ORLEANS - In a 4-3 vote, the Louisiana Supreme Court on Jan. 28 reversed a verdict of more than $330.6 million against Janssen Pharmaceutical Inc. and parent company Johnson & Johnson, finding that the state attorney general failed to prove that misrepresenting the safety of the atypical antipsychotic drug Risperdal violated the state's Medicaid fraud law (James D. "Buddy" Caldwell, ex rel. State of Louisiana v. Janssen Pharmaceutical, Inc., et al., Nos. 2012-C-2447 and 2012-C-2466, La. Sup.).
BROOKLYN, N.Y. - A New York federal judge on Jan. 27 declined to remand a health care reimbursement suit to state court, saying that the Employee Retirement Income Security Act preempted claims against one of the defendants (Enigma Management Corp. v. Multiplan Inc., et al., No. 13-5524, E.D. N.Y.; 2014 U.S. Dist. LEXIS 9738).
BOISE, Idaho - A federal judge in Idaho on Jan. 24 ordered the divestiture of a consummated merger between Idaho's largest health system and the state's largest independent, multispecialty physician group, finding that the acquisition was anticompetitive (Saint Alphonsus Medical Center - Nampa, Inc., et al. v. St. Luke's Health System, Ltd., No. 12-560, D. Idaho; Federal Trade Commission, et al. v. St. Luke's Health System, Ltd., et al., No. 13-116, D. Idaho; 2014 U.S. Dist. LEXIS 9264).
FRANKFORT, Ky. - A Kentucky appeals court in a Jan. 24 unpublished opinion affirmed an order denying a motion to compel arbitration between a Medicaid managed care organization (MCO) and a health care provider (Kentucky Spirit Health Plan Inc., et al. v. PremierTox Inc., et al., No. 2012-CA-001457-MR, Ky. App.; 2014 Ky. App. Unpub. LEXIS 57).
SEATTLE - A Washington federal judge on Jan. 24 granted a preliminary injunction and class certification in a case challenging the denial of benefits for the treatment of autism (K.M., et al. v. Regence BlueShield, et al., No. 13-1214, W.D. Wash.; 2014 U.S. Dist. LEXIS 9156).
MONTGOMERY, Ala. - A divided Alabama Supreme Court on Jan. 24 held that a trial court erred in submitting a claim for intentional interference with business relationship to a jury in a health care network dispute, saying the defendants had no obligation to do business with the plaintiff health care provider (Alabama Psychiatric Services, et al. v. A Center for Eating Disorders, No. 1110703, Ala. Sup.; 2014 Ala. LEXIS 9).
PHOENIX - An Arizona state appeals court in a Jan. 23 unpublished opinion affirmed that a health insurance company properly denied benefits for a prescription drug because the plan and state law expressly prohibited coverage for drugs not included in the plan's formulary (Deanna M. Cancino v. Arizona Health Cost Containment Administration, et al., No. 13-130, Ariz. App., Div. 1; 2014 Ariz. App. Unpub. LEXIS 84).
HATTIESBURG, Miss. - A Mississippi federal judge on Jan. 22 denied a health insurance company's motion for summary judgment on a plaintiff's breach of contract claim in a dispute over denial of benefits but granted the motion as to the plaintiff's remaining claims (Larry R. Mixon v. The Golden Rule Insurance Co., No. 12-234, S.D. Miss.; 2014 U.S. Dist. LEXIS 7760).
JEFFERSON CITY, Mo. - A Missouri federal judge on Jan. 23 granted a motion for preliminary injunction, enjoining the enforcement of Missouri's Health Insurance Market Innovation Act (HIMIA) as it applies to entities and individuals certified under federal law to provide services or perform functions pursuant to the Patient Protection and Affordable Care Act (PPACA) (St. Louis Effort for Aids, et al. v. John Huff, director of the Missouri Department of Insurance, Financial Institutions and Professional Registration, No. 13-4246, W.D. Mo.; 2014 U.S. Dist. LEXIS 8187).
WASHINGTON, D.C. - The U.S. Supreme Court on Jan 24 enjoined 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 pending final disposition of an appeal by the 10th Circuit U.S. Court of Appeals (Little Sisters of the Poor Home for the Aged, et al. v. Kathleen Sebelius, et al., No. 13A691, U.S. Sup.).
ROCHESTER, N.Y. - A New York federal judge on Jan. 16 denied a motion by a nursing home operator to reinstate a preliminary injunction pending its appeal of a decision dismissing its suit challenging the termination of its Medicare and Medicaid provider agreement (Blossom South v. Kathleen Sebelius, et al., No. 13-6474, W.D. N.Y.; 2014 U.S. Dist. LEXIS 6474).
NEWARK, N.J. - In an unpublished opinion, a New Jersey federal judge on Jan. 21 granted a plaintiffs' motion to remand its health care reimbursement suit, saying neither complete preemption nor an embedded federal question of jurisdiction existed (MHA d/b/a Meadowlands Hospital Medical Center v. UnitedHealth Group Inc., et al., No. 13-6130, D. N.J.; 2014 U.S. Dist. LEXIS 7035).
MILWAUKEE - A Wisconsin federal magistrate judge on Jan. 15 denied a defendant's motion to transfer a wrongful denial of benefits case to another federal court (Ryan M. Redmond v. Sirius International Insurance Corp., No. 12-587, E.D. Wis.; 2014 U.S. Dist. LEXIS 5089).
BOSTON - A Virginia podiatrist on Jan. 15 pleaded guilty to lying to a federal grand jury during an investigation into health care fraud and kickbacks related to bone growth stimulators sold by Orthofix Holdings Inc. (United States of America v. Ilene Terrell, No. 1:13-10180, D. Mass.).
WASHINGTON, D.C. - A District of Columbia federal judge on Jan. 15 granted summary judgment in favor of the federal government in a suit challenging an Internal Revenue Service regulation imposed under the Patient Protection and Affordable Care Act (PPACA) that extends eligibility for premium assistance subsidies to people who purchase health insurance through exchanges established by the PPACA (Jacqueline Halbig, et al. v. Kathleen Sebelius, et al., No. 13-623, D. D.C.).
LITTLE ROCK, Ark. - An Arkansas federal judge on Jan. 10 granted summary judgment in favor of the federal government in a challenge to a final decision of the secretary of the U.S. Department of Health and Human Service (DHHS) to disallow Medicare payments to a diagnostic audiological testing facility when the tests were not ordered by physicians (Doctors Testing Centers v. U.S. Department of Health and Human Services, et al., No. 11-857, E.D. Ark.; 2014 U.S. Dist. LEXIS 3781).
DETROIT - A Michigan federal judge on Jan. 13 granted a preliminary injunction in favor of five religious organizations challenging the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) (The Ave Marie Foundation, et al. v. Kathleen Sebelius, et al., No. 13-15198, E.D. Mich.; 2014 U.S. Dist. LEXIS 3516).
SAN FRANCISCO - A Ninth Circuit U.S. Court of Appeals panel on Jan. 9 reversed a decision affirming a preliminary injunction prohibiting the California Department of Health Care Service (DHCS) from implementing Medicaid reimbursement rate reductions, saying the lower court erroneously interpreted the statute governing the reimbursements (Santa Rosa Memorial Hospital, et al. v. Toby Douglas, No. 09-17633, 9th Cir.; 2014 U.S. App. LEXIS 449).
ST. LOUIS - An Eighth Circuit U.S. Court of Appeals panel on Jan. 9 affirmed the dismissal of a Medicare false claims billing case, saying the plaintiff failed to plead fraud with the sufficient particularity required (United States of America, ex rel. Michael Dunn v. North Memorial Health Care, et al., No. 13-1099, 8th Cir.; 2014 U.S. App. LEXIS 413).
HARRISBURG, Pa. - A Pennsylvania court on Jan. 8 affirmed that the Pennsylvania Department of Public Welfare's (DPW) new methodology for determining Medicaid reimbursement rates was rational (Armstrong County Memorial Hospital v. Department of Public Welfare, No. 711 C.D. 2013, Pa. Comm., 2014 Pa. Commw. LEXIS 40).
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.).
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.).
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.).