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.).
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).
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).
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).
NEWARK, N.J. - In an unpublished opinion, a New Jersey federal judge on Feb. 25 granted a health insurance company's motion to dismiss a reimbursement suit against it, saying the plaintiff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).
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).
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).
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).
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).
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).
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).
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.).
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).
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).
HARRISBURG, Pa. - A federal judge in Pennsylvania affirmed an administrative ruling by the U.S. Department of Health and Human Services (HHS) excluding a physician from participating in the Medicare program for five years under the mandatory exclusion provision in the Social Security Act allowing such exclusion upon a criminal conviction related to providing Medicare services (Gregory J. Salko, M.D. v. Kathleen Sebelius, in her official capacity as Secretary of the U.S. Department of Health and Human Services, No. 3:12cv515, M.D. Pa.).
WASHINGTON, D.C. - The U.S. Supreme Court on Feb. 19 denied review of a Sixth Circuit U.S. Court of Appeals ruling that a plan administrator's denial of coverage for attention-deficit hyperactivity disorder (ADHD) testing and therapy as not being covered by the plan was not arbitrary and capricious (Jeffrey J. Christoff, et al. v. Ohio Northern University Employee Benefit Plan, No. 12-728, U.S. Sup.).
FRESNO, Calif. - A California federal judge on Feb. 13 dismissed all federal claims in a health insurance reimbursement suit that included allegations that a health insurer violated Medicare regulations and remanded the remaining state law breach of contract claims to state court (Doctors Medical Center of Modesto Inc. v. Kaiser Foundation Health Plan, No. 12-1381, E.D. Calif.; 2013 U.S. Dist. LEXIS 20351).
WASHINGTON, D.C. - The U.S. Supreme Court on Feb. 19 ruled that the state-action doctrine does not immunize the merger between two Georgia hospitals from the Federal Trade Commission's challenge that the transaction substantially lessened competition in the market for hospital services or tended to create a monopoly because Georgia did not clearly articulate and affirmatively express a policy allowing hospital authorities to make acquisitions that substantially lessen competition (Federal Trade Commission v. Phoebe Putney Health System, Inc., et al., No. 11-1160, U.S. Sup.).
WHITEHOUSE STATION, N.J. - Merck and Co. Inc. will pay $688 million to settle two securities class action lawsuits filed in New Jersey federal court alleging that the drug maker and others failed to disclose adverse results of a clinical trial for two cholesterol drugs Merck was developing, according to a Merck press release issued Feb. 14 (In Re: Merck & Co., Vytorin/Zetia Securities Litigation, No. 2:08-CV-2177, D. N.J.; In Re: Schering-Plough Corp./ENHANCE Securities Litigation, 08-397, D. N.J.).
HATTIESBURG, Miss. - A Mississippi federal judge on Feb. 12 denied a motion to dismiss a breach of contract action between a hospital and a data collection firm over the hospital's loss of Medicare payments from the U.S. Department of Health and Human Services (HHS) for failure to report patient surveys to the Centers for Medicare and Medicaid Services (CMS). The judge concluded that the action is merely a breach of contract action and is not dependent upon the hospital seeking administrative remedies through HHS (South Central Regional Medical Center v. Press Ganey Associates Inc., No. 2:12cv103, S.D. Miss., Hattiesburg Div.; 2013 U.S. Dist. LEXIS 18522).
PHOENIX - An Arizona federal judge on Feb. 8 granted a motion for summary judgment filed by Planned Parenthood Arizona Inc. and a number of Medicaid beneficiaries, saying an Arizona law barring any health care provider who performs elective abortions from receiving Medicaid funding violates the Medicaid statute's clause allowing beneficiaries the freedom to choose a "qualified" medical provider (Planned Parenthood Arizona Inc., et al., v. Tom Betlach, Director, Arizona Health Care Cost Containment System, et al., No. CV-12-01533, D. Ariz.; 2013 U.S. Dist. LEXIS 17392).
WEST PALM BEACH, Fla. - Medical providers on Feb. 8 filed a notice of appeal of a Florida federal judge's order dismissing 996 purported derivative claims asserted on behalf of 500 patients related to providers' claims that health insurers violated the Employee Retirement Income Security Act by granting preapproval for medical procedures then denying coverage (Sanctuary Surgical Centre Inc., et al. v. UnitedHealthcare Inc., et al., No. 10-81589, S.D. Fla.).
COLUMBIA, S.C. - A South Carolina federal judge on Feb. 11 dismissed the federal government from a Medicaid dispute, saying the court lacked jurisdiction over the claims (Richard Stogsdill, et al. v. Kathleen Sebelius, et al., No. 12-7, D. S.C.; 2013 U.S. Dist. LEXIS 18062).
PRESCOTT, Ariz. - In ruling on multiple summary judgment motions in a Medicaid dispute case, an Arizona federal judge on Feb. 7 held that the federal government acted arbitrarily and capriciously in approving a demonstration project for low-income childless adults but that the state government did not violate the due process rights of the plaintiffs in sending out the notice of the change to copayment requirements (Flint Wood, et al. v. Thomas Betlach, et al., No. 12-8098, D. Ariz.; 2013 U.S. Dist. LEXIS 16601).
OAKLAND, Calif. - A California federal judge on Feb. 7 granted summary judgment in favor of the federal government in a Medicare dispute, saying that an off-label use for a prescription drug that does not comport with the medically accepted indication requirement is not covered by Medicare Part D (Abraham Nievod v. Kathleen Sebelius, et al., No. 11-4134, N.D. Calif.; 2013 U.S. Dist. LEXIS 17550).