LexisNexis® Legal Newsroom
    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).

    Mealey's Health Law - 11th Circuit Affirms That ERISA Preempts Georgia's Prompt-Pay Provisions

    ATLANTA - An 11th Circuit U.S. Court of Appeals panel on Feb. 14 affirmed that the Employee Retirement Income Security Act preempted several provisions of Georgia's state code related to prompt payment of health care claims (America's Health Insurance Plans v. Ralph T. Hudgens, in his Official Capacity as Georgia Insurance and Safety Fire Commissioner, No. 13-10349, 11th Cir.; 2014 U.S. App. LEXIS 2771).

    Mealey's Health Law - ERISA Plan Terms Govern Reimbursement Obligation, Federal Judge Rules

    ROCK ISLAND, Ill. - A federal judge in Illinois on Feb. 5 ruled that where a health plan governed by the Employee Retirement Income Security Act requires a plan participant to reimburse the plan for benefits received from a third-party recovery, the participant was not relieved of his reimbursement obligation by the plan's failure to follow procedures in a document other than the plan's governing document (Plumbers and Pipefitters Local No. 25 Welfare Fund, et al. v. Wes Sedam, No. 12-4114, C.D. Ill.; 2014 U.S. Dist. LEXIS 14436).

    Mealey's Health Law - 2nd Circuit Affirms Injunction Halting Termination Of Medicare Contracts

    NEW YORK - In a Feb. 7 unpublished opinion, a panel of the Second Circuit U.S. Court of Appeals affirmed with a modification a lower court's decision to grant 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.13-4608, 2nd Cir.; 2014 U.S. App. LEXIS 2319).

    Mealey's Health Law - Ill. Federal Judge Leaves 1 Claim In Medicare, Medicaid False Billing Suit

    PEORIA, Ill. - An Illinois federal judge on Jan. 31 partially granted a defendant's motion to dismiss a suit alleging that the health care provider submitted false claims pursuant to Medicare and Medicaid, leaving only a state law claim (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 12600).

    Mealey's Health Law - Nevada Federal Judge Approves Distribution Of Settlement Funds As Cy Pres Award

    LAS VEGAS - A Nevada federal judge on Jan. 31 granted the plaintiffs' motion for a cy pres distribution of $31,680.47 in unclaimed funds remaining from the settlement of a class action case accusing an insurance company of overcharging copayments for medical treatment (Mary Forsyth, et al. v. Humana Inc., et al., No.90-249, D. Nev.; 2014 U.S. Dist. LEXIS 1324).

    Mealey's Health Law - Divided 2nd Circuit: ERISA Preempts Vermont's State Database Law

    PHILADELPHIA - A divided Second Circuit U.S. Court of Appeals on Feb. 4 reversed a finding that the Employee Retirement Income Security Act did not preempt a Vermont state law requiring health insurers to provide information for the state's health care database (Liberty Mutual Insurance Co. v. Susan L. Donegan, in her capacity as the commissioner of the Vermont Department of Financial Regulation, No. 12-4881, 2nd Cir.; 2014 U.S. App. LEXIS 2088).

    Mealey's Health Law - Official Is Granted Summary Judgment In Dispute Over Medicare Reimbursement

    BAY CITY, Mich. - A Michigan federal judge on Jan. 30 granted summary judgment in favor of the secretary of the Health and Human Services in a dispute over Medicare reimbursement related to residents' services, saying that the secretary's interpretation of the regulations at issue is reasonable (Covenant Medical Center Inc. v. Kathleen Sebelius, No. 12-12901, E.D. Mich.; 2014 U.S. Dist. LEXIS 11289).

    Mealey's Health Law - Injunction Denied In Suit Over Termination Of Provider Agreement

    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).

    Mealey's Health Law - N.J. Federal Judge Dismisses Reimbursement Suit, Says Anti-Assignment Clause Valid

    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).

    Mealey's Health Law - La. Supreme Court Reverses $330M Verdict For Risperdal Medicaid Law Violations

    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.).

    Mealey's Health Law - N.Y. Federal Judge Declines To Remand Reimbursement Suit; ERISA Preempts Claims

    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).

    Mealey's Health Law - Hospital System's Acquisition Of Physician Group Must Be Undone, Federal Judge Rules

    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).

    Mealey's Health Law - Ky. Appeals Court: Arbitration Provision Not Applicable In Reimbursement Suit

    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).

    Mealey's Health Law - Wash. Federal Judge Grants Injunction, Class Status In Denial Of Benefits Case

    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).

    Mealey's Health Law - Alabama High Court: Networks Do Not Have To Contract With Health Care Provider

    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).

    Mealey's Health Law - Arizona Appeals Court Affirms Denial Of Prescription Drug Coverage

    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).

    Mealey's Health Law - Miss. Federal Judge Leaves Breach Of Contract Claim In Denial Of Benefits Suit

    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).

    Mealey's Health Law - Mo. Federal Judge Grants Injunction, Halts Law Regulating Insurance Exchanges

    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).