LexisNexis® Legal Newsroom
    Mealey's Health Law - Judge: Likelihood Of Success Demonstrated In Contraceptive Mandate Case

    OKLAHOMA CITY - Religious groups demonstrate a substantial likelihood of success in their Religious Freedom Restoration Act of 1993 (RFRA) challenge to the Patient Protection and Affordable Care Act (ACA)'s contraceptive mandate, an Oklahoma federal judge held March 10 (Reaching Souls International Inc., et al. v. Kathleen Sebelius, et al., No. 13-1092, W.D. Okla.; 2014 U.S. Dist. LEXIS 30497).

    Mealey's Health Law - New York Appeals Court: Prompt-Pay Law Provides Private Right Of Action

    BROOKLYN, N.Y. - In a matter of first impression, a New York appeals court on March 5 affirmed that the state's prompt-pay law affords claimants a private right of action to recover payment for health care services provided based on a violation of the law (Maimonides Medical Center v. First United American Life Insurance Co., No. 2012-03138, N.Y. Sup., App. Div., 2nd Dept.; 2014 N.Y. App. Div. LEXIS 1409).

    Mealey's Health Law - Florida Federal Judge Declines To Dismiss Fraud Claims; No Preemption Exists

    WEST PALM BEACH, Fla. - A Florida federal judge on March 6 denied a motion to dismiss claims asserted against ambulatory surgical centers and billing companies for allegedly fraudulently billing for chiropractic services, saying that the Employee Retirement Income Security Act did not preempt the claims (United Healthcare Services Inc., et al. v. Sanctuary Surgical Inc., et al., No. 10-81589, S.D. Fla.; 2014 U.S. Dist. LEXIS 28824).

    Mealey's Health Law - District Of Columbia Appeals Panel Affirms Dismissal Of ACA Suit

    WASHINGTON, D.C. - Plaintiffs cannot squeeze the individual insurance mandate in the Patient Protection and Affordable Care Act (ACA) into an "arbitrary as-applied" exemption to Congress' taxing power, a panel of the District of Columbia Circuit U.S. Court of Appeals affirmed March 7 (Association of American Physicians & Surgeons Inc., et al. v. Kathleen G. Sebelius, et al., No. 13-5003, D.C. Cir.).

    Mealey's Health Law - Calif. Senator Sues State, Claiming Improper Cancellation Of Insurance Policies

    LOS ANGELES - California's health exchange forced the cancellation of 1 million residents' health plans and threatens millions more, despite the Patient Protection and Affordable Care Act's (ACA) exclusion of existing policies from its coverage mandates, a state senator claims in a March 4 complaint (Edward Gaines, Gaines Insurance Agency Inc., et al. v. Peter Lee, in his official capacity as Executive Director of the California Health Benefit Exchange, et al., No. BS147414, Calif. Super., Los Angeles Co.).

    U.S. House Passes Bill Delaying ACA Mandate Penalties

    WASHINGTON, D.C. - The U.S. States House of Representatives on March 5 passed, by a 250-to-160 vote, legislation seeking to delay the penalty for failing to comply with the individual mandate in the president's health care legislation.

    Mealey's Health Law - CBO: Delaying ACA Mandate Penalty Saves $10B, Leaves 2M Uninsured

    WASHINGTON, D.C. - Legislation introduced Feb. 28 seeking to delay the penalty for failing to comply with the individual mandate in the president's health care legislation would cut $10 billion from the federal deficit between its enactment and 2019 and result in 2 million more uninsured individuals in 2015, the Congressional Budget Office (CBO) said in a March 4 analysis.

    Mealey's Health Law - High Court Won't Hear Case Involving Remand Of Benefits Claim To Plan

    WASHINGTON, D.C. - The U.S. Supreme Court on March 3 denied review of a Ninth Circuit U.S. Court of Appeals ruling that a district court abused its discretion when it remanded a claim for denial of health benefits under the Employee Retirement Income Security Act to the plan administrator (The Beverly Hills Hotel and Bungalows Employee Benefit Trust Employee Welfare Plan v. Ana Martinez, No. 13-818, U.S. Sup.).

    Mealey's Health Law - Appeals Court: Provider Costs Need Not Be Considered In Setting Payment Rates

    SAN FRANCISCO - In a Medicaid reimbursement case, a California appeals court on Feb. 28 affirmed a demurrer in favor of the defendant, saying that based on changes in law, states are not required to consider provider costs in setting reimbursement rates (Tim Keffeler, et al. v. Partnership Healthplan of California, No. A135536, Calif. App., 1st. Dist., Div.1; 2014 Cal. App. LEXIS 200).

    Mealey's Health Law - 6th Circuit Affirms Denial Of Benefits In Medicare Coverage Case

    CINCINNATI - In an unpublished opinion, a panel of the Sixth Circuit U.S. Court of Appeals on Feb. 27 affirmed a denial of benefits, saying Medicare did not provide coverage for the equipment sought (Mary K. Woodfill v. Secretary of Health and Human Services, No. 13-3729, 6th Cir.; 2014 U.S. App. LEXIS 3874).

    Mealey's Health Law - Missouri Federal Judge Grants Transfer Of Drug Rebate Case

    ST. LOUIS - A Missouri federal judge on Feb. 27 denied defendants' motion to dismiss a dispute over prescription drug rebates but granted a motion to transfer the case to another federal court (Express Scripts Inc. v. Jefferson Health System Inc., et al., No. 13-379, E.D. Mo.; 2014 U.S. Dist. LEXIS 25057).

    Mealey's Health Law - Texas Federal Judge Remands Reimbursement Suit To State Court

    DALLAS - A Texas federal judge on Feb. 27 remanded a health care reimbursement suit between a health care provider and insurer to state court, saying the claims were not preempted (Texas Center for Obesity Surgery v. UnitedHealthCare of Texas Inc., et al., No. 13-922, N.D. Texas; 2014 U.S. Dist. LEXIS 24996).

    Mealey's Health Law - New Jersey Federal Judge Grants Defendant Partial Judgment In Reimbursement Suit

    NEWARK, N.J. - A New Jersey federal judge on Feb. 27 granted partial summary judgment in favor of an insurer in a health care benefits reimbursement dispute, dismissing the claims asserted by the plaintiff but denying the defendant's motion for recovery for its counterclaim and request for attorney fees (New Jersey Back Institute ASO Juan Rodriguez v. Horizon Blue Cross Blue Shield Insurance Co., No. 12-4985, D. N.J.; 2014 U.S. Dist. LEXIS 25639).

    Mealey's Health Law - 8th Circuit Urged To Affirm Denial Of Injunction In Birth Control Case

    ST. LOUIS - The federal government on Feb. 27 filed a brief with the Eighth Circuit U.S. Court of Appeals, urging the court to affirm the denial of a preliminary injunction in a case brought by a Missouri family challenging the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) (Paul Wieland, et al. v. U.S. Department of Health and Human Services, No. 13-3528, 8th Cir.).

    Mealey's Health Law - 4th Circuit Affirms Dismissal Of False Claims Act Case

    RICHMOND, Va. - A Fourth Circuit U.S. Court of Appeals panel on Feb. 21 held that a relator who sued his former employer for allegedly filing false Medicare and Medicaid claims failed to allege that the defendants made a false statement or that they acted with the necessary scienter. The appeals court also affirmed that the lower court did not abuse its discretion in denying the relator's request to file a third amended complaint (United States ex rel. Barry Rostholder v. Omnicare Inc., et al., No. 12-2431, 4th Cir.; 2015 U.S. App. LEXIS 3269).

    Mealey's Health Law - Split 7th Circuit Affirms Denial Of Injunction In Birth Control Case

    CHICAGO - A divided Seventh Circuit U.S. Court of Appeals panel on Feb. 21 affirmed a decision denying the University of Notre Dame's motion for a preliminary injunction in its case challenging the birth control mandate contained in the Patient Protection and Affordable Care Act (University of Notre Dame v. Kathleen Sebelius, et al., No. 13-3853, 7th Cir.; 2014 U.S. App. LEXIS 3326).

    Mealey's Health Law - Pa. Commonwealth Court Reverses Decision Ordering Release Of Medicaid Records

    HARRISBURG, Pa. - A divided Commonwealth Court of Pennsylvania on Feb. 19 reversed a decision ordering the disclosure of the rates managed care organizations (MCOs) paid to subcontractors and the rates the subcontractors paid to the providers of Medicaid dental services (Dental Benefit Providers Inc., et al. v. James Eiseman Jr., et al., Nos. 945 C.D. 2013, 957 C.D. 2013, 958 C.D. 2013, Pa. Comm.; 2014 Pa. Commw. LEXIS 113).

    Mealey's Health Law - 11th Circuit Affirms Dismissal Of Class Action Reimbursement Case

    ATLANTA - In an unpublished per curiam opinion, a panel of the 11th Circuit U.S. Court of Appeals on Feb. 20 affirmed the dismissal of a class action complaint brought by a group of medical associations and medical providers against multiple health insurers for allegedly wrongfully reducing payments for out-of-network services provided to the insureds' members, agreeing that the claims were "released claims" barred by settlement agreements in a similar case (The American Medical Association, et al. v. Connecticut General Life Insurance Co., et al., No. 13-10916, 11th Cir.; 1014 U.S. App. LEXIS 3088).

    Mealey's Health Law - California Appeals Court Reverses Decision Over Payment Of Emergency Services

    LOS ANGELES - In reversing a lower court decision, a California appeals panel on Feb. 19 held that emergency room physicians alleged sufficient facts to reflect the existence of a claim for negligent delegation asserted against health maintenance organizations for allegedly knowing that their independent practice associations (IPAs) were unable to pay the physicians for providing statutorily required services (Centinela Freeman Emergency Medical Associates, et al. v. Health Net of California Inc., et al., No. B238867, Calif. App., 2nd. Dist., Div. 3; 2014 Cal. App. LEXIS 158).

    Mealey's Health Law - Pa. Federal Judge Leaves Equitable Remedies Claim In Health Benefits Dispute

    HARRISBURG, Pa. - A Pennsylvania federal judge on Feb. 19 partially dismissed a dispute related to the payment of health care benefits for the treatment of autism, dismissing claims for legal damages and breach of contract but leaving a claim for equitable remedies (Patrick C. Jarman v. Capital Blue Cross, et al., No. 13-932, M.D. Pa.; 2014 U.S. Dist. LEXIS 20464).

    Mealey's Health Law - Certiorari Denied; Arizona Can't Bar Medicaid Patients From Choosing Own Doctors

    WASHINGTON, D.C. - The U.S. Supreme Court on Feb. 24 denied a petition for writ of certiorari, leaving in place a Ninth Circuit U.S. Court of Appeals decision affirming that Arizona cannot bar state Medicaid patients from obtaining covered family planning services from health care providers who also perform elective abortions (Tom Betlach, et al. v. Planned Parenthood of Arizona Inc., No. 13-621, U.S. Sup.).

    Mealey's Health Law - Wisconsin Federal Judge Dismisses Medicare False Claims Suit

    MADISON, Wis. - A Wisconsin federal judge on Feb. 18 dismissed a Medicare false claims suit but gave the plaintiff permission to amend her suit (United States of America ex rel. Jodi Miller v. SSM Health Care Corp., et al., No. 12-885, W.D. Wis.; 2014 U.S. Dist. LEXIS 19722).

    Mealey's Health Law - Texas Federal Judge Dismisses Class Action Suit Over Denial Of Benefits

    HOUSTON - A Texas federal judge on Feb. 13 dismissed a class action lawsuit related to the denial of health care benefits based on a plan's subrogation provisions, saying that some claims were preempted by federal law and that the plan administrator acted in accordance with plan terms in denying benefits (Joe Hollingshead v. Aetna Health Inc., No. 13-231, S.D. Texas; 2014 U.S. Dist. LEXIS 18770).

    Mealey's Health Law - Puerto Rico Federal Judge Dismisses Medicare Billing Suit

    SAN JUAN, Puerto Rico - A Puerto Rico federal judge on Feb. 13 dismissed a Medicare dispute, saying the court lacked jurisdiction because the plaintiff had yet to receive a "final decision" from Medicare's Departmental Appeals Board (DAB) (Centro Radiologico Rolon Inc., et al. v. United States of America, et al., No. 12-2051, D. P.R.; 2014 U.S. Dist. LEXIS 19112).

    Mealey's Health Law - Texas Federal Judge Remands Prompt-Pay Suit To State Court

    FORT WORTH, Texas - A federal Texas judge on Feb. 12 remanded a prompt-pay case to state court, saying that the Employee Retirement Income Security Act did not preempt the claims (Texas Health Resources v. Aetna Health Inc., No. 13-1013, N.D. Texas; 2014 U.S. Dist. LEXIS 17939).