LexisNexis® Legal Newsroom
    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).

    Hospice Provider To Pay $3 Million To Resolve Medicare False Claims

    ORLANDO, Fla. - Hospice of the Comforter Inc. agreed to pay $3 million to resolve allegations that it violated the False Claims Act by submitting false claims to the Medicare program for hospice services provided to patients who were not eligible for the Medicare hospice benefit program, the U.S. Department of Justice announced in a Nov. 5 news release (United States ex rel. Stone v. Hospice of the Comforter Inc., No. 11-1498, M.D. Fla.).

    Appeals Court Affirms Case Dismissal, Orders Transfer To Insurance Department

    TRENTON, N.J. - A New Jersey appeals court in a Nov. 4 unpublished opinion affirmed the dismissal of chiropractors' challenge to a health insurer's policy provision limiting reimbursement of diagnostic imaging services but ordered the case transferred to the state insurance department for review of a claim alleging violation of a state law requiring group health policies to cover services performed by chiropractors if the services are also reimbursed when provided by other health providers (The Association of New Jersey Chiropractors Inc., et al. v. Horizon Healthcare Services Inc., et al., No. A-6022-11T4, N.J. Super., App. Div.; 2013 N.J. Super. Unpub. LEXIS 2677).

    D.C. Federal Judge Transfers Case Challenging Birth Control Mandate

    WASHINGTON, D.C. - A District of Columbia federal judge on Nov. 5 granted the federal government's request to transfer a suit challenging the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) to another federal court, saying the plaintiffs engaged in forum shopping in their choice of where to file the suit (M & N Plastics Inc., et al. v. Kathleen Sebelius, et al., No. 13-919, D. D.C.; 2013 U.S. Dist. LEXIS 157945).

    New Jersey Federal Judge Partially Dismisses Medicare False Claims Act Claims

    NEWARK, N.J. - A New Jersey federal judge on Oct. 31 granted in part and denied in part motions to dismiss a qui tam case brought under the False Claims Act against multiple hospitals and health care providers for allegedly improperly billing Medicare for inpatient admissions (United States of America ex rel. Paul Tahlor, M.D., et al. v. AHS Hospital Corp., et al., No. 088-03042, D. N.J.; 2013 U.S. Dist. LEXIS 156226).

    Georgia Federal Judge Allows Plaintiff To Amend Denial Of Benefits Suit

    SAVANNAH, Ga. - A Georgia federal judge on Oct. 30 denied a health insurer's motion to dismiss a wrongful denial of health care benefits suit but granted the plaintiff's motion to amend his complaint to plead claims under the Employee Retirement Income Security Act (Marwin Moss v. Blue Cross and Blue Shield of Florida Inc., et al., No. 13-159, S.D. Ga.; 2013 U.S. Dist. LEXIS 155751).

    R.I. Federal Judge Grants Health Insurer Judgment In Denial Of Benefits Suit

    PROVIDENCE, R.I. - A Rhode Island federal judge on Oct. 31 granted summary judgment in favor of a health maintenance organization in a wrongful denial of benefits dispute, saying that the plan clearly did not cover the services sought (Jean Ho Rath, et al. v. Tufts Associated Health Maintenance Organization, No. 12-546, D. Rhode Island; 2013 U.S. Dist. LEXIS 156469).

    Va. Federal Judge Denies Preliminary Injunction In IRS Rule In Health Care Act

    RICHMOND, Va. - A federal judge in Virginia on Oct. 31 denied the plaintiffs' request for a preliminary injunction in their 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 federal government (David King, et al. v. Kathleen Sebelius, et al., No. 13-630, E.D. Va.).

    Split Federal Appeals Court Reverses Denial Of Injunction In Birth Control Case

    WASHINGTON, D.C. - A divided District of Columbia Circuit U.S. Court of Appeals Court on Nov. 1 reversed a decision denying the plaintiffs' request for a preliminary injunction to halt the implementation of the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) (Francis A. Gilardi, et al. v. United States Department of Health and Human Services, et al., No. 13-5069, D.C. Cir.; 2013 U.S. App. LEXIS 22256).

    Providers Fail To Allege Assignments; Federal Judge Dismisses Claims For Benefits

    NEWARK, N.J. - Health care providers seeking payment for services provided to plan participants failed to allege with specificity the assignments on which they asserted derivative standing under the Employee Retirement Income Security Act, a federal judge in New Jersey ruled Oct. 24 (NJSR Surgical Center, L.L.C., et al. v. Horizon Blue Cross Blue Shield of New Jersey, Inc., et al., No. 12-753, D. N.J.; 2013 U.S. Dist. LEXIS 153630).

    Federal Judge Rules On Expert Testimony, Access In Merger Trial

    BOISE, Idaho - The federal judge in Idaho overseeing the trial involving an antitrust challenge to a consummated merger between a hospital system and a physician group on Oct. 18 refused to exclude certain expert testimony regarding the impact of unwinding the merger and ruled that the Associated Press' counsel may review all trial material under the same obligation as counsel for the parties (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; 2013 U.S. LEXIS 150450, 2013 U.S. LEXIS 150451).

    Suit Over IRS Regulations In Health Care Act Continues; Injunction Denied

    WASHINGTON, D.C. - A District of Columbia federal judge on Oct. 22 said from the bench that he would not dismiss 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 but that he also would not issue an order enjoining the rule (Jacqueline Halbig, et al. v. Kathleen Sebelius, et al., No. 13-623, D. D.C.).

    Hobby Lobby Asks High Court To Grant Petition, Affirm Birth Control Ruling

    WASHINGTON, D.C. - Owners of a craft store chain and Christian bookstore on Oct. 21 asked the U.S. Supreme Court to grant the federal government's petition for writ of certiorari in their suit challenging the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) but said the high court should affirm the lower court's decision granting a preliminary injunction (Hobby Lobby Stores Inc., et al. v. Kathleen Sebelius, et al., No. 13-354, U.S. Sup.).

    Government Asks 11th Circuit To Reverse Injunction In Birth Control Suit

    ATLANTA - The federal government on Oct. 21 filed a brief asking the 11th Circuit U.S. Court of Appeals to overturn the grant of a preliminary injunction in favor of the plaintiffs in a challenge to the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) Beckwith Electric Co. Inc., et al. v. Kathleen Sebelius, et al., No. 13-13879, 11th Cir.).

    Federal Judge Reverses Decision, Dismisses Health Care Reimbursement Suit

    WASHINGTON, D.C. - In reconsidering a previous opinion, a District of Columbia federal judge on Oct. 21 held that the prior decision was incorrect and granted a managed care organization (MCO)'s motion to dismiss a reimbursement suit, saying that the plaintiff was not an intended third-party beneficiary of the contract at issue (Prince George's Hospital Center v. Advantage Healthplan Inc., No. 03-2392, D. D.C.; 2013 U.S. Dist. LEXIS 150842).

    N.Y. Appellate Court Reverses Order In Health Care Premium Suit

    ALBANY, N.Y. - A New York state appeals court on Oct. 17 modified an order of a lower court in a suit contesting changes to a state law regulating premium rates, reversing the grant of summary judgment in favor of the plaintiffs while affirming the denial of summary judgment in favor of the defendants (Healthnow New York Inc. v. New York State Insurance Department, et al., N.Y. Sup., App. Div., 3rd Dept., No. 516179; 2013 N.Y. App. Div. LEXIS 6733).

    Missouri Federal Judge Dismisses Couple's Suit Challenging Birth Control Mandate

    ST. LOUIS - A Missouri federal judge on Oct. 16 granted the federal government's motion to dismiss a couple's challenge to the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA), saying that they lacked standing (Paul Joseph Wieland, et al. v. United States Department of Health and Human Services, et al., E.D. Mo., No. 13-1577; 2013 U.S. Dist. LEXIS 148526).

    Judge: Provider Neither Competitor Not Consumer Of Insurer; Unfair Claim Fails

    SACRAMENTO, Calif. - Claims that a health insurer misrepresented its power to authorize and provide coverage for treatment form the basis for a California unfair competition law (UCL) unlawful-prong claim, but because the provider is neither a consumer nor a competitor, its unfair-prong claim fails, a federal judge held Oct. 15 (Centre for Neuro Skills v. Blue Cross of California dba Anthem Blue Cross, et al., No. 13-743, E.D. Calif.; 2013 U.S. Dist. LEXIS 148432).

    Ohio Federal Judge Grants In Part Motions To Compel Against Non-Party

    DAYTON, Ohio - Non-party Community Insurance Co., doing business as Anthem Blue Cross and Blue Shield (Anthem), must produce certain documents regarding its deliberations not to contract with a medical center in the medical center's lawsuit claiming that it was denied contracts with managed care providers as a result of a purported conspiracy involving other hospitals to exclude the medical center from the marketplace in violation of federal antitrust law, a federal judge in Ohio ruled Oct. 16 (The Medical Center at Elizabeth Place, LLC v. Premier Health Partners, et al., No. 3:12-cv-26, S.D. Ohio; 2013 U.S. Dist. LEXIS 148839).

    Vote Funds Government Without Demands To Change Health Care Act Being Met

    WASHINGTON, D.C. - President Obama signed a bill Oct. 17 to fund the government after the House and Senate reached an agreement Oct. 16 to end the partial government shutdown and to raise the debt ceiling without House Republicans' demands for a one-year delay of the Patient Protection and Affordable Care Act (PPACA) and to repeal a tax on medical devices being met.

    High Court Hears Arguments On Limitations Period In ERISA Benefits Denial Case

    WASHINGTON, D.C. - A beneficiary's claim for wrongful denial of disability benefits under the Employee Retirement Income Security Act does not accrue for limitations purposes until the plan's internal benefits resolution process has been exhausted, notwithstanding a plan provision providing that the limitations period commences before the plan has resolved the claim for benefits, a plan participant told the U.S. Supreme Court in oral arguments on Oct. 15 (Julie Heimeshoff v. Hartford Life & Accident Insurance Co., et al., No. 12-729, U.S. Sup.).

    Calif. Appeals Court Affirms Hospital Does Not Have To Arbitrate Payment Suit

    LOS ANGELES - A California appeals court in an Oct. 11 unpublished opinion affirmed that the City of Long Beach did not have to arbitrate a health care reimbursement dispute because it was not a party to the contract that contained the disputed arbitration provision (Promise Hospital of East Los Angeles v. CIGNA Corp., et al., No. B243126, Calif. App., 2nd Dist., Div. 8).

    Georgia Federal Judge Declines To Dismiss Qui Tam Action

    COLUMBUS, Ga. - A Georgia federal judge on Oct. 9 declined to dismiss a qui tam action against a doctor accused of submitting false claims to Medicare and Medicaid, saying the plaintiff's allegations were stated with sufficient particularity to put the defendant on notice of the claims asserted against him (Richard Barker, on behalf of the United States of America and the State of Georgia v. Columbus Regional Healthcare System Inc., et al., No. 12-108, M.D. Ga.; 2013 U.S. Dist. LEXIS 145695).

    Government Seeks To Stay Health Act Cases Due To Government Shutdown

    Several federal courts on Oct. 4 granted motions by the government to stay proceedings in challenges to the Patient Protection and Affordable Care Act (PPACA) during the current lapse in appropriations due to the partial government shutdown that began Oct. 1. The government began filing motions to stay the proceedings on Oct. 1 in courts across the country, with courts beginning to issue rulings on Oct. 2.

    N.J. Federal Judge Remands Health Care Reimbursement Suit To State Court

    NEWARK, N.J. - A New Jersey federal judge on Oct.7 remanded a health care reimbursement suit to state court, finding that the defendant failed to show that federal preemption existed under the Employee Retirement Income Security Act (Medwell v. CIGNA Healthcare of New Jersey Inc., No. 13-3998, D. N.J.; 2013 U.S. Dist. LEXIS 144577).