LexisNexis® Legal Newsroom
    Wisconsin Federal Judge: Plaintiff Failed To Join Proper Party In Health Care Case

    GREEN BAY, Wis. - A Wisconsin federal judge on April 10 held that a plaintiff in a health care payment determination case failed to join the beneficiary as a necessary party to the action (VHC Inc. as trustee for SBV Health Plan v. University of Wisconsin Hospitals and Clinics, No. 13-92, E.D. Wis.; 2013 U.S. Dist. LEXIS 51635).

    Supreme Court Denies Certiorari; Provider Can Sue For Avandia-Related Expenses

    WASHINGTON, D.C. - The U.S. Supreme Court on April 15 denied a petition for writ of certiorari filed by GlaxoSmithKine PLC (GSK), leaving stand a decision allowing a Medicare Advantage provider to seek reimbursement from GSK under Medicare law for the costs of treating insurance customers who were injured by GSK's Avandia diabetes drug (GlaxoSmithKline, et al. v. Humana Medical Plans, et al., No. 12-690, U.S. Sup.).

    Plan Administrator Didn't Breach Fiduciary Duties In Mental Health Parity Case

    SEATTLE - A health plan administrator did not breach its fiduciary duties under the Employee Retirement Income Security Act by failing to modify its coverage certificates to reflect a court order that it provide mental health treatment because the administrator informed its members of the changes to its coverages of neurodevelopmental therapy mandated by the court's order, a federal judge in Washington ruled April 8 (Z.D., et al. v. Group Health Cooperative, et al., No. 2:11-cv-01119, W.D. Wash.; 2013 U.S. Dist. LEXIS 50402).

    Medicare Qui Tam Action Dismissed; Claims Barred By Public Disclosure

    NASHVILLE, Tenn. - A Tennessee federal judge on April 5 dismissed a qui tam action brought by a state resident who accused local medical clinics of offering illegal inducements to Medicare beneficiaries to secure patronage, saying that the relator obtained his information from public records (United States of America, ex rel. Marc Osheroff v. HealthSpring Inc., et al., No. 10-1015, M.D. Tenn.; 2013 U.S. Dist. LEXIS 49526).

    Oklahoma Federal Judge Remands Medicare Reimbursement Dispute

    OKLAHOMA CITY - An Oklahoma federal judge remanded to the U.S. Department of Health and Human Services a Medicare reimbursement case, finding that an appeals board erred in determining that a contractor administering the program established the reimbursement codes at issue (Oklahoma Procure Management v. Kathleen Sebelius, secretary of the United States department of Health and Human Services, No. 12-680, W.D. Okla.; 2013 U.S. Dist. LEXIS 48829).

    N.D. Supreme Court Affirms Medical Providers Not Liable For Lawsuit Expenses

    BISMARCK, N.D. - The North Dakota Supreme Court on April 4 affirmed summary judgment in favor of health care providers in a suit in which plaintiffs were seeking reimbursement for expenses and liabilities incurred in pursuing a federal court action to get health insurance companies to pay for medical services provided by the hospitals (Arthur M. Hayden, et al. v. Medcenter One Inc., et al., No. 20120337, N.D. Sup.; 2013 N.D. LEXIS 47).

    9th Circuit Affirms, Reverses Decision In Medicaid Payment Calculation Case

    SAN FRANCISCO - A Ninth Circuit U.S. Court of Appeals panel on April 4 affirmed in part and reversed in part the dismissal of two federally funded health care clinics' actions alleging that the California Department of Health Care Services incorrectly calculated payments for Medicaid-covered pharmacy services provided to "dual-eligible" Medicare beneficiaries who also receive Medicaid (North East Medical Services Inc., et al. v. State of California, et al., Nos. 11-16795, 11-16796, 9th Cir.; 2013 U.S. App. LEXIS 6808).

    Louisiana Federal Judge Grants Remand In Health Care Reimbursement Dispute

    LAFAYETTE, La. - A Louisiana federal judge on April 4 granted a motion to remand in a class action health care reimbursement case, saying that one of the defendants was not fraudulently joined and that the plaintiffs met an exception to the Class Action Fairness Act (CAFA) (Opelousas General Trust Authority v. Multiplan Inc., et al., No. 12-1830, W.D. La.; 2013 U.S. Dist. LEXIS 49824).

    New York Federal Judge Allows False Claims Suit To Proceed Against Americare

    BROOKLYN, N.Y. - A federal judge in the U.S. District Court for the Eastern District of New York on April 3 partially granted a motion to dismiss a federal and New York state False Claims Act (FCA) suit against Americare Inc. and partially denied the motion, saying that the plaintiff was able to sufficiently assert that the corporate defendants may have altered medical records to justify unnecessary home health services under Medicare (United States of America, ex rel. Patricia Mooney, v. Americare Inc., et al., No. 06cv1806, E.D. N.Y.; 2013 U.S. Dist. LEXIS 48398).

    Kentucky Federal Judge Allows Amendment To Add Defendant In Medicaid Waiver Case

    LEXINGTON, Ky. - A Kentucky federal judge on March 28 allowed plaintiffs to amend a complaint to add a defendant in a Medicaid waiver dispute (Appalachian Regional Healthcare, et al. v. Coventry Health and Life Insurance Co., et al., No. 12-114, E.D. Ky.; 2013 U.S. Dist. LEXIS 44394).

    Federal Appeals Court Grants Injunction Pending Appeal In Birth Control Suit

    WASHINGTON, D.C. - In reconsidering a previous decision, a District of Columbia Circuit U.S. Court of Appeals panel on March 29 granted a motion for injunction pending appeal in a case in which a secular, for-profit food company and the company owners are challenging 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, et al. v. United States Department of Health and Human Services, et al., No. 13-5069, D.C. Cir.).

    Florida Federal Judge Dismisses Challenge To Birth Control Mandate

    FORT MYERS, Fla. - A Florida federal judge on March 29 denied a motion to dismiss a challenge to the birth control mandate contained in the Patient Protection and Affordable Care Act, saying that the plaintiff's claims were not ripe (Ave Maria University v. Kathleen Sebelius, et al., No. 12-88, M.D. Fla.; 2013 U.S. Dist. LEXIS 45685).

    Michigan Federal Judge Denies Temporary Injunction In Birth Control Suit

    DETROIT - A Michigan federal judge on March 22 denied an emergency motion for a temporary injunction brought by a natural foods company and its owner, who are seeking to halt the implementation of the "birth control mandate" contained in the Patient Protection and Affordable Care Act (PPACA) (Eden Foods Inc., et al. v. Kathleen Sebelius, et al., No. 13-11229, E. D. Mich.; 2013 U.S. Dist. LEXIS 40768).

    California Appeals Court Finds No Showing Of Unlawful Conduct In Premium Case

    LOS ANGELES - In an unpublished opinion, a California appeals panel on March 21 affirmed summary judgment in favor of a health insurer in a premium dispute case, saying there was no showing that the defendant engaged in any unlawful conduct (Richard Feder v. Blue Cross of California, No. B239534, Calif. App., 2nd Dist., Div. 8; 2013 Cal. App. Unpub. LEXIS 2076).

    Judge: Recoupment Of Medicare Payments Does Not Violate Bankruptcy Discharge

    AIKEN, S.C. - A South Carolina federal judge on March 22 affirmed a ruling by a bankruptcy judge that the withholding of post-petition Medicare reimbursement claims to recoup pre-petition Medicare reimbursement overpayments does not violate the Chapter 7 discharge injunction (In re: Gary T. Fischbach, Debtor, v. Centers for Medicare and Medicaid Services, et al., No. 12-513, D. S.C.; 2013 U.S. Dist. LEXIS 39855).

    DOJ, Michigan Move To Dismiss Antitrust Suit Against Blue Cross Over MFN Clauses

    DETROIT - Following the Michigan Legislature's passage of bills prohibiting the use of "most favored nation" (MFN) clauses, the United States, Michigan and Blue Cross Blue Shield of Michigan on March 25 filed a joint motion to dismiss allegations that Blue Cross violated federal and state antitrust laws by including such clauses in its contracts with hospitals in Michigan (United States of America and the State of Michigan v. Blue Cross Blue Shield of Michigan, No. 10-14155, E.D. Mich.).

    High Court Will Not Review ERISA Subrogation Case

    WASHINGTON, D.C. - The U.S. Supreme Court on March 25 declined to review an Eighth Circuit U.S. Court of Appeals ruling that a welfare benefit plan may not enforce its subrogation provision as an implied contract or in equity under the Employee Retirement Income Security Act against a law firm that acknowledged the validity of the provision during its representation of a plan beneficiary in a civil lawsuit but that did not agree to be bound by the provision(Treasurer, Trustees of Drury Industries, Inc. Health Care Plan and Trust v. Sean Goding, et al., No. 12-982, U.S. Sup.).

    N.Y. Federal Judge Denies Remand In Health Care Denial Of Benefits Case

    NEW YORK - A New York federal judge on March 21 denied a plaintiff's motion to remand her denial of health care benefits case to state court, holding that the Employee Retirement Income Security Act preempted her claims (S.M. v. Oxford Health Plans (NY) Inc., et al., No. 12-4679, S.D. N.Y.; 2013 U.S. Dist. LEXIS 40408).

    Supreme Court Hears Arguments In Health Care Class Arbitration Dispute

    WASHINGTON, D.C. - The U.S. Supreme Court on March 25 heard oral arguments to address whether, in a dispute over a health insurer's reimbursement of physicians' claim, an arbitrator acted within his authority in determining that the dispute could proceed as a class arbitration Oxford Health Plans LLC v. John Ivan Sutter, M.D., No. 12-135, U.S. Sup.).

    Ohio Federal Judge Dismisses Birth Control Mandate Suit For Lack Of Standing

    COLUMBUS, Ohio - An Ohio federal judge on March 22 dismissed an action brought by religious organizations to stop the implementation of a provision in the Patient Protection and Affordable Care Act (PPACA) mandating that all health plans provide preventive services for free, including those for birth control, holding that the plaintiffs lacked standing to bring the suit (Franciscan University of Steubenville, et al. v. Kathleen Sebelius, No. 12-440, S.D. Ohio; 2013 U.S. Dist. LEXIS 40192).

    Minn. Federal Judge Issues Sanctions For Defendants' Violations In Medicare Case

    ST. PAUL, Minn. - A federal Minnesota judge on March 20 granted in part a motion for violation of a protective order brought by plaintiffs in a Medicare and Medicaid false claims suit (United States of America, ex rel Ricia Johnson, et al. v. Golden Gate National Senior Care, et al., No.08-1194, D. Minn.; 2013 U.S. Dist. LEXIS 39011).

    Florida Federal Judge Dismisses False Claims Suit For Lack Of Specifics

    FORT MYERS, Fla. - A federal judge in Florida on March 19 dismissed a federal False Claims Act (FCA) suit against Health Management Associates and one of its hospitals, saying the relator failed to state a claim with specificity regarding the submission of medical claims under the Medicare and Medicaid statutes (United States of America ex rel. Michael Mastej, v. Health Management Associates Inc., et al., No. 2:11cv89, M.D. Fla., Fort Myers Div.; 2013 U.S. Dist. LEXIS 37863).

    Minnesota Federal Judge Dismisses Medicare Case For Lack Of Jurisdiction

    MINNEAPOLIS - Saying that although he found the allegations in the complaint to be "highly disconcerting," a Minnesota federal judge on March 19 granted the government's motion to dismiss a Medicare dispute, saying the Medicare Prescription Drug Improvement Act (MMA) deprives the court of jurisdiction to hear the dispute (Key Medical Supply Inc. v. Kathleen Sebelius, et al., No. 12-752, D. Minn.; 2013 U.S. Dist. LEXIS 37680).

    Supreme Court Holds Medicaid' Anti-Lien Provision Preempts State Law

    WASHINGTON, D.C. - In a divided opinion, the U.S. Supreme Court on March 20 held that an anti-lien provision contained in the federal Medicaid Act preempts North Carolina's irrebuttable statutory presumption that one-third of a tort recovery is attributable to medical expenses (Aldona Wos, secretary of North Carolina Department of Health and Human Services v. E.M.A., a minor, by and through her guardian ad litem, Johnson, et al., No. 12-98, U.S. Sup.).

    Supreme Court Declines Review Of Medicare Reimbursement Suit

    WASHINGTON, D.C. - The U.S. Supreme Court on March 18 denied a petition for writ of certiorari brought by psychiatric providers alleging that they were not fully reimbursed for services provided to Medicare patients (Michigan Department of Community Health, et al. v. Kathleen Sebelius, et al., No. 12-589, U.S. Sup.).