LexisNexis® Legal Newsroom
    Plaintiffs Seek Injunction To Halt Implementation Of Birth Control Mandate

    PITTSBURGH - Plaintiffs challenging the "birth control" mandate contained in the Patient Protection and Affordable Care Act (PPACA) asked a Pennsylvania federal judge on March 11 for a preliminary injunction to protect them from having to provide the coverage in their health plan beginning in July (Geneva College, et al. v. Kathleen Sebelius, et al., No. 12-207, W.D. Pa.).

    Federal Judge: Plaintiff Can Bring Denial Of Benefits Suit In Court

    PORTLAND, Ore. - An Oregon federal judge on March 8 denied a health insurer's motion for summary judgment in a denial of benefits suit, saying a plaintiff could bring her claims in court because a review by an independent review organization did not constitute arbitration (Kelly J. Yox v. Providence Health Plan, No. 12-1348, D. Ore.; 2013 U.S. Dist. LEXIS 32761).

    Plaintiffs Ask 8th Circuit To Reverse Decision In Birth Control Mandate Suit

    ST. LOUIS - A manufacturer of medical devices asked the Eighth Circuit U.S. Court of Appeals on March 7 reverse a lower court's decision denying a preliminary injunction in its suit challenging the "birth control" mandate contained in the Patient Protection and Affordable Care Act (PPACA) (Annex Medical Inc., et al. v. Kathleen Sebelius, et al., No. 13-1118, 8th Cir.).

    Ruling In Medicare Case Leaves Claims Against 1 Facility, Individual Doctors

    CHICAGO - An Illinois judge on March 6 dismissed two medical facilities from a Medicare and Medicaid fraud case but left claims against a third facility and individual doctors (Robert S. Goldberg, M.D., et al. v. Rush University Medical Center, et al., No. 04-4584, N.D. Ill.; 2013 U.S. Dist. LEXIS 31715).

    Oklahoma Federal Judge Awards $65,000 In Denial Of Benefits Case

    OKLAHOMA CITY - An Oklahoma federal judge on March 8 awarded a plaintiff $65,000 in medical benefits in a wrongful denial of benefits case, saying a health insurer could not change the reasons it denied the benefits (Patrick Garrett v. Principal Life Insurance Co., No. 09-1378, W.D. Okla.; 2013 U.S. Dist. LEXIS 32198).

    Pennsylvania Federal Judge Partially Dismisses Claims In Birth Control Mandate Suit

    PITTSBURGH - A Pennsylvania federal judge on March 6 partially granted the federal government's motion to dismiss claims brought by a private, nonprofit college, two for-profit entities and the owners of those entities who are challenging the "birth control" mandate contained in the Patient Protection and Affordable Care Act (PPACA) (Geneva College, et al. v. Kathleen Sebelius, et al., No. 12-207, W.D. Pa.; 2013 U.S. Dist. LEXIS 30265).

    Federal Judge Declines To Dismiss Medicaid Dispute; Claims Sufficiently Pleaded

    CHICAGO - An Illinois federal judge on March 4 denied a motion to dismiss made by a managed care organization in a Medicaid fraud case, saying the plaintiffs met pleading standards for false claims allegations (United States of America, ex rel. Gloria Upton, et al. v. Family Health Network Inc., et al., No. 09-6022, N.D. Ill.; 2013 U.S. Dist. LEXIS 29620).

    District Of Columbia Federal Judge Denies Injunction In Birth Control Mandate Suit

    WASHINGTON, D.C. - A District of Columbia federal judge on March 3 denied a preliminary injunction in a suit brought by a secular, for-profit food company seeking to halt the implementation of a mandate contained in the Patient Protection and Affordable Care Act (PPACA) aimed at providing free preventive services to women, including those for birth control (Francis A. Gilardi Jr., et al. v. Kathleen Sebelius, et al., No. 13-104, D.D.C.; 2013 U.S. Dist. LEXIS 28719).

    6th Circuit: Health Insurer Properly Denied Benefits In Eating Disorder Suit

    CINCINNATI - A panel of the Sixth Circuit U.S. Court of Appeals on March 4 affirmed that a health insurance company did not err in denying coverage for the treatment of eating disorders (Mark Brigolin, et al. v. Blue Cross Blue Shield of Michigan, No. 11-1525, 6th Cir.).

    Calif. Appeals Court Affirms Judgment In Favor Of Insurer In Reimbursement Suit

    LOS ANGELES - In an unpublished opinion, a California appeals court on Feb. 27 affirmed a motion for summary judgment in favor of a health insurance company in a reimbursement dispute (City of Hope National Medical Center v. PacifiCare of California, No. B232591, Calif. App., 2nd Dist., Div. 7; 2013 Cal. App. Unpub. LEXIS 1480).

    New Jersey Federal Judge Dismisses Reimbursement Suit, Finds ERISA Preemption

    NEWARK, N.J. - In an unpublished opinion, a New Jersey federal judge on Feb. 28 granted a motion to dismiss brought by a welfare benefit fund in a health insurance reimbursement dispute, holding that the Employee Retirement Income Security Act preempted the claims (Middlesex Surgery Center v. Horizon, et al., No. 13-112, D. N.J.; 2013 U.S. Dist. LEXIS 27542).

    High Court Won't Review Waiver Doctrine In ERISA Case

    WASHINGTON, D.C. - The U.S. Supreme Court on March 4 denied a health plan's petition seeking review of a Ninth Circuit U.S. Court of Appeals ruling that the plan, which is governed by the Employee Retirement Income Security Act, waived its right to assert medical necessity as a reason for denial of benefits (California Physicians' Service v. Jeanene Harlick, No. 12-457, U.S.).

    Federal Judge Denies Restraining Order In Birth Control Mandate Suit

    DENVER - A Colorado federal judge on Feb. 27 denied a motion for a temporary restraining order made by the owner of for-profit senior care assisted living centers and skilled nursing centers in a suit challenging the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) (Stephen W. Briscoe, et al. v. Kathleen Sebelius, et al., No. 13-285, D. Colo.; 2013 U.S. Dist. LEXIS 26911).

    Federal Judge Denies TRO In Medicaid Termination Of Benefits Suit

    PORTLAND, Maine - A federal judge in Maine on Feb. 28 denied a motion for a temporary restraining order (TRO) to vacate an order by the U.S. Department of Health and Human Services (HHS) approving a new Maine Medicaid plan amendment tightening eligibility requirements for health care assistance (Louis Bourgoin, et al., v. Kathleen Sebelius, Secretary U.S. Department of Health and Human Services, No. 2:13cv00055, D. Maine; 2013 U.S. Dist. LEXIS 27680).

    10th Circuit Affirms Dismissal Of Medicare Reimbursement Suit

    DENVER - The 10th Circuit U.S. Court of Appeals on Feb. 26 affirmed the dismissal of a Medicare provider lawsuit against the U.S. Department of Health and Human Services, saying the trial court lacked subject matter jurisdiction because the provider failed to file a timely administrative appeal (Full Life Hospice v. Kathleen Sebelius, Secretary, U.S. Department of Health and Human Services, No. 11-6242, 10th Cir.; 2013 U.S. App. LEXIS 3974).

    N.J. Federal Judge Dismisses Reimbursement Suit; Plaintiff Lacks ERISA Standing

    NEWARK, N.J. - In an unpublished opinion, a New Jersey federal judge on Feb. 25 granted a health insurance company's motion to dismiss a reimbursement suit against it, saying the plaintiff hospital lacks standing to sue under the Employee Retirement Income Security Act (MHA LLC v. Aetna Health Inc., No. 12-2984, D.N.J.; 2013 U.S. Dist. LEXIS 25743).

    Federal Judge Dismisses Discrimination Suit By Disabled Medicaid Beneficiary

    DENVER - A federal judge in Colorado on Feb. 25 dismissed a discrimination lawsuit filed by a disabled Medicaid beneficiary, saying relief under the Americans with Disabilities Act (ADA) and the Rehabilitation Act is not warranted (Leslie Taylor, et al., v. Colorado Department of Health Care Policy and Financing, et al., No. 12-cv00300, D. Colo.; 2013 U.S. Dist. 25954).

    Texas Federal Judge Dismisses Birth Control Suit, Says Claims Unripe For Review

    DALLAS - A Texas federal judge on Feb. 26 dismissed a challenge to the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) brought by a Catholic institution, saying the claims were not ripe for review (The Roman Catholic Diocese of Dallas v. Kathleen Sebelius, No. 12-1589, N.D. Texas).

    Idaho Top Court Holds Contract Not Health Insurance, Says Group Assumes No Risk

    BOISE, Idaho - In reversing a lower court, the Idaho Supreme Court on Feb. 25 held that a nonprofit "nationwide faith based membership of individuals" was not transacting health insurance without a certificate of authority because the organization did not assume some risk of paying its members' claims (Altrua Healthshare Inc. v. Bill Deal, in his capacity as Director of the Idaho Department of Insurance, et al., No. 39388, Idaho Sup.; 2013 Ida. LEXIS 56).

    Indiana Federal Judge Dismisses, Leaves Claims In Medicare, Medicaid Fraud Suit

    INDIANAPOLIS - An Indiana federal judge on Feb. 21 partially granted motions to dismiss brought by multiple doctors in a Medicare and Medicaid billing fraud suit (United States of America, et al. v. Indianapolis Neurosurgical Group Inc., et al., No. 06-1778, S.D. Ind.; 2013 U.S. Dist. LEXIS 23610).

    Company Asks 10th Circuit To Affirm Injunction Ruling In Birth Control Suit

    DENVER - A heating, ventilation and air conditioning company on Feb. 22 filed a brief asking the 10th Circuit U.S. Court of Appeals to affirm a preliminary injunction issued in its suit seeking to keep the federal government from enforcing a mandate contained in the Patient Protection and Affordable Care Act (PPACA) that requires most employers to provide birth control coverage as part of their employee health plans (William Newland, et al. v. Kathleen Sebelius, in her official capacity as Secretary of the United States Department of Health and Human Services, et al., No. 12-1123).

    Arkansas Supreme Court: Insurer Can Seek Subrogation Benefits From Third Party

    LITTLE ROCK, Ark. - In reversing a lower court, the Arkansas Supreme Court held Feb. 21 that an insurer can properly seek subrogation benefits from a third party when its insured failed to satisfy prerequisites for the insurer to have a right to reimbursement from its insured (Progressive Halcyon Insurance v. Margarita Saldivar, No. 12-458, Ark. Sup.; 2013 Ark. LEXIS 89).

    High Court Will Not Review ERISA Preemption Case

    WASHINGTON, D.C. - The U.S. Supreme Court on Feb. 25 denied a health insurance company's petition seeking review of a Fifth Circuit U.S. Court of Appeals ruling that the Employee Retirement Income Security Act does not preempt a third-party medical device provider's state law claims for negligent misrepresentation, promissory estoppel and violations of the Texas Insurance Code (United Healthcare Insurance Co. v. Access Mediquip, No. 12-806, U.S. Sup.).

    Washington Appeals Court Affirms Supervisory Care Not Covered By Medicaid

    TACOMA, Wash. - A Washington appeals court on Feb. 20 affirmed that general supervisory care for a disabled individual does not qualify as a covered medical assistance service under the federal Medicaid Act (Faith K. Freeman v. The Department of Social and Health Services, No. 40811-2-11, Wash. App, Div. 2; 2013 Wash. App. LEXIS 344).

    Indiana Federal Judge Denies Dismissal Of False Claims Qui Tam Suit

    INDIANAPOLIS - A federal judge in Indiana on Feb. 21 mostly denied three motions to dismiss a qui tam action filed under the federal False Claims Act (FCA) and the Indiana False Claims Act (IFCA) against a neurosurgical practice and several of its current and former physicians. The judge concluded that the relators' second amended complaint was sufficiently pleaded to survive a motion to dismiss (United States of America, et al., ex rel. Tom Herron, et al. v. Indianapolis Neurosurgical Group Inc., et al., No. 1:06cv1778, S.D. Ind., Indianapolis Div.; 2013 U.S. Dist. LEXIS 23610).