LexisNexis® Legal Newsroom
    New Jersey High Court Won't Review Ruling That ERISA Preempts Hospital's Claims

    TRENTON - The New Jersey Supreme Court on Dec. 6 denied a petition for certification of a Superior Court ruling that Employee Retirement Income Security Act Section 514(a) expressly preempts a medical provider's claims against the ERISA plan for payment of the provider's customary fees for the services it rendered to patients, rather than the discounted fees the plan would have been legally entitled to pay had it not breached its contractual obligation for timely payment (St. Peter's University Hospital v. New Jersey Building Laborers Statewide Welfare Fund, et al. v. Union Labor Life Insurance Company, No. C-224 September Term 2013, N.J. Sup.).

    Judge Remands Denial Of Chiropractic Claims To Administrator Under ERISA

    DENVER - A federal judge in Colorado ruled Dec. 3 that the third-party administrator of the NFL Player Insurance Plan abused its discretion in denying claims for chiropractic treatment as being work-related without considering the medical provider's opinion (Nelson Vetanze v. NFL Player Insurance Plan, No. 1:11-cv-02734, D. Colo.; 2013 U.S. Dist. LEXIS 170312).

    9th Circuit: Nursing Facility Did Not Follow Medicare's Supervision Requirements

    SAN FRANCISCO - In an unpublished opinion, a Ninth Circuit U.S. Court of Appeals panel affirmed a citation and fine issued to a skilled nursing facility for improperly failing to monitor a patient as required by Medicare laws (Del Rosa Villa v. Kathleen Sebelius, No. 12-71685, 9th Cir; 2013 U.S. App. LEXIS 23796).

    Oklahoma Federal Magistrate Judge Declines To Dismiss Denial Of Benefits Suit

    MUSKOGEE, Okla. - An Oklahoma federal magistrate judge on Nov. 26 denied a motion to dismiss a wrongful denial of health care benefits case (Samuel Howard Logan Jr. v. Healthcare International Global Networks, et al., No. 13-144, E.D. Okla.; 2013 U.S. Dist. LEXIS 167631).

    High Court Agrees To Hear 2 Challenges To Birth Control Mandate

    WASHINGTON, D.C. - The U.S. Supreme Court on Nov. 26 announced that it granted certiorari in two cases challenging the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA). Both of the cases involve for-profit companies opposed to the mandate on religious grounds. In one of the cases, the lower court granted a preliminary injunction to halt the implementation of the mandate, and in the other case, the lower court denied a preliminary injunction (Hobby Lobby Stores Inc., et al. v. Kathleen Sebelius, et al., No. 13-354, U.S. Sup.; Conestoga Woods Specialties Corp., et al. v. Kathleen Sebelius, et al., No. 13-356, U.S. Sup.).

    Manufacturer Asks 11th Circuit To Affirm Injunction In Birth Control Case

    ATLANTA - Plaintiffs challenging the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) asked the 11th Circuit U.S. Court of Appeals on Nov. 20 to affirm the grant of a preliminary injunction in their favor (Beckwith Electric Co. Inc., et al. v. Kathleen Sebelius, et al., No. 13-13879, 11th Cir.).

    Catholic Organizations Oppose Dismissal Of Challenge To Birth Control Mandate

    DENVER - Catholic organizations challenging the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) moved in a Colorado federal court on Nov. 22 opposing dismissal of their case (Little Sisters of the Poor Home for the Aged, et al. v. Kathleen Sebelius, et al., No. 13-02611, D. Colo.).

    Pa. Federal Judge Grants Injunctions In 2 Challenges To Birth Control Mandate

    PITTSBURGH - A Pennsylvania federal judge on Nov. 21 granted motions for expedited preliminary injunctions in two separate cases brought by Catholic organizations challenging the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) (Most Reverend David A. Zubik, et al. v. Kathleen Sebelius, et al., No. 13-1459, Most Reverend Lawrence T. Persico, et al. v. Kathleen Sebelius, et al., No. 13-303, W.D. Pa.; 2013 U.S. Dist. LEXIS 165922).

    West Virginia Supreme Court: No Right Of Action For Medicaid Dispute

    CHARLESTON, W. Va. - The West Virginia Supreme Court of Appeals on Nov. 21 affirmed that a state statute does not provide for an express or implied private cause of action by a Medicaid provider for judicial review of reimbursement rates for medical services (Appalachian Regional Healthcare Inc. v. West Virginia Department of Health and Human Resources, et al., No. 11-1187, W. Va. Sup.; 2013 W. Va. LEXIS 1338).

    1 Defendant Remains In Wrongful Denial Of Health Care Benefits Suit

    MINNEAPOLIS - A Minnesota federal judge on Nov. 21 dismissed two defendants from a wrongful denial of benefits suit related to treatment covering autism spectrum disorder and partially dismissed claims against a third defendant (Tracy L. Reid, individually and on behalf of M.A.R. v. BCBSM Inc., et al., No. 12-3005, D. Minn.; 2013 U.S. Dist. LEXIS 165364).

    Tennessee Federal Judge Dismisses Medicare False Claims Case

    NASHVILLE, Tenn. - A Tennessee federal judge on Nov. 18 dismissed a qui tam case in which the operator of multiple health care facilities was accused of submitting false claims to Medicare, saying the plaintiff failed to support his allegations (United States of America ex rel. Stephen McCullen v. Ascension Health, et al., No. 12-501, M.D. Tenn.).

    Nursing Home Operator To Pay $48 Million For Medicare False Billing

    LOS ANGELES - In two separate cases, skilled nursing provider Ensign Group Inc. agreed to pay $48 million to resolve allegations that it knowingly submitted Medicare false claims for medically unnecessary rehabilitation services, according to a Nov. 19 press release issued by the U.S. Department of Justice (United States of America ex rel. Gloria Patterson v. Ensign Group Inc., No. 06-6956, United States of America ex rel. Carol Sanchez v. Ensign Group Inc., No. 06-0643, C.D. Calif.).

    New York Federal Judge Partially Dismisses Health Care Reimbursement Suit

    WHITE PLAINS, N.Y. - A New York federal judge on Nov. 14 partially granted the defendants' motion to dismiss a health care reimbursement dispute (Bridget M. Curran v. Aetna Life Insurance Co., et al., No. 13-289, S.D. N.Y.; 2013 U.S. Dist. LEXIS 163162).

    S.C. Federal Judge Denies Injunction In Medicare Provider Termination Suit

    FLORENCE, S.C. - A South Carolina federal judge on Nov. 13 declined to grant a preliminary injunction in favor of a nursing home in a termination of Medicare provider dispute (Marion Nursing Center Inc. v. Kathleen Sebelius, No. 13-2593, D. S.C.; 2013 U.S. Dist. LEXIS 161621).

    Florida Federal Judge Grants Government Partial Judgment In Medicare Dispute

    ORLANDO, Fla. - A Florida federal judge on Nov. 13 partially granted summary judgment in favor of the federal government in a Medicare claims payment dispute (USA and Elin Baklid-Kunz v. Halifax Hospital Medical Center, et al., No. 09-1002, M.D. Fla.; 2013 U.S. Dist. LEXIS 161718).

    New Jersey Federal Magistrate Judge Recommends Dismissal Of Claim, Remand Of Suit

    NEWARK, N.J. - A New Jersey federal magistrate judge in a Nov. 13 unpublished opinion recommended that the only federal claim in a health care reimbursement suit be dismissed and the case remanded to state court (Catherine Mazzola, M.D., et al. v. AmeriChoice of New Jersey Inc., et al., No. 13-429, D. N.J.; 2013 U.S. Dist. LEXIS 161587).

    Government Seeks Judgment In Suit Over IRS Regulations In Health Care Act

    WASHINGTON, D.C. - The federal government on Nov. 12 moved for summary judgment 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.).

    Louisiana Federal Judge Dismisses Medicare False Claims Case

    LAFAYETTE, La. - A Louisiana federal judge on Nov. 8 granted a motion to dismiss a qui tam action for the false billing of Medicare claims, saying the plaintiff failed to support his allegations (Craig Thompson v. LifePoint Hospitals Inc., et al., No. 11-1771, W.D. La.; 2013 U.S. Dist. LEXIS 160678).

    Calif. Federal Judge Denies Temporary Restraining Order In Denial Of Benefits Suit

    OAKLAND, Calif. - A California federal judge on Nov. 8 denied a plaintiff's motion for a temporary restraining order to keep her health insurance company from allegedly wrongfully denying benefits for her continued residential treatment for eating disorders (Alison O. v. Anthem Blue Cross Life and Health Insurance Co., No. 13-4787, N. D. Calif.; 2013 U.S. Dist. LEXIS 160663).

    Divided 7th Circuit Reverses Denial Of Injunction In Health Care Act Cases

    CHICAGO - A divided Seventh Circuit U.S. Court of Appeals on Nov. 8 reversed the denial of preliminary injunctions in two cases brought by secular, for-profit companies and their owners in challenges to the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) (Cyril B. Korte, et al. v. Kathleen Sebelius, et al., No. 12-384; William D. Grote III, et al. v. Kathleen Sebelius, et al., No. 13-1077, 7th Cir.; 2013 U.S. App. LEXIS 22748).

    Federal Judge Dismisses Suit Alleging False Billing Of Medicare, Medicaid Claims

    CHICAGO - An Illinois federal judge on Nov. 7 dismissed a suit alleging the false billing of Medicare and Medicaid claims, saying that the relator failed to support any of his allegations (United States of America, et al. v. Ukrainian Village Pharmacy, et al., No. 09-7891, N.D. Ill.; 2013 U.S. Dist. LEXIS 159492).

    Louisiana Appeals Court Reverses Decision Denying Attorney Fees, Costs

    LAKE CHARLES, La. - A Louisiana appeals court on Nov. 6 reversed the denial of a claim for penalties and attorney fees in a wrongful denial of health care benefits suit (Amanda Pousson v. Blue Cross Blue Shield of Louisiana, No. 13-481, La. App., 3rd. Cir.; 2013 La. App. LEXIS 2290).

    Illinois Federal Judge Denies Summary Judgment Motions In Reimbursement Suit

    CHICAGO - An Illinois federal judge on Nov. 7 declined to grant summary judgment motions brought by both sides in a reimbursement dispute between chiropractors and a group of insurance companies (Pennsylvania Chiropractic Association, et al. v. Blue Cross Blue Shield Association, et al., No. 09-5619, N.D. Ill; 2101 U.S. Dist. LEXIS 159331).

    Divided En Banc 7th Circuit: Breach Of Fiduciary Duty Claim Continues

    CHICAGO - A divided en banc Seventh Circuit U.S. Court of Appeals on Nov. 7 ruled that the husband of a health plan participant may proceed with his claims that the plan sponsor and insurer breached their fiduciary duties under the Employee Retirement Income Security Act by failing to inform him during telephone conversations that the medical providers who were going to perform emergency surgery on his wife were out of network (James E. Killian v. Concert Health Plan, et al., No. 11-1112, 7th Cir.; 2013 U.S. App. LEXIS 22657).

    Wisconsin Federal Judge Dismisses Medicaid False Claims Case

    MADISON, Wis. - A Wisconsin federal judge on Nov. 5 dismissed a qui tam action brought against the owner and operator of a chain of retail pharmacies for Medicaid fraud, saying the claims were premised on an untenable legal theory (Carl Thulin v. Shopko Stores Operating Co., No. 10-196, W.D. Wis.; 2013 U.S. Dist. LEXIS 158170).