LexisNexis® Legal Newsroom
    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).

    Federal Judge Affirms Doctor's Exclusion From Medicare Program

    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.).

    High Court Denies ERISA Plan's Petition For Review Of Benefit Denial Decision

    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.).

    California Federal Judge Dismisses Medicare Claims, Remands State Law Claims

    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).

    U.S. Supreme Court: Hospital Merger Is Not Immune From Antitrust Scrutiny

    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.).

    Merck To Pay $688M To Settle 2 Securities Class Action Lawsuits

    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.).

    Judge: Third-Party Suit Over Medicare Payments Doesn't Fall Under Medicare Act

    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).

    Judge: Arizona Law Defunding Planned Parenthood Violates Medicaid Statute

    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).

    Medical Providers Appeal Federal Judge's Dismissal Of Denial Of Benefits Claims

    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.).

    Federal Government Dismissed From Suit Over Change To State Medicaid Law

    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).

    Arizona Federal Judge Grants, Denies Summary Judgment Motions In Medicaid Case

    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).

    Off-Label Use Of Drug Not Covered By Medicare, California Federal Judge Affirms

    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).

    5th Circuit Affirms Finding Of Medicare Violations At Mississippi Nursing Home

    NEW ORLEANS - A Fifth Circuit U.S. Court of Appeals panel on Feb. 7 in an unpublished opinion affirmed findings that a nursing home violated Medicare regulations after residents were found to be in immediate jeopardy (Mississippi Care Center of Greenville v. United States Department of Health and Human Service, No. 12-60420, 5th Cir.; 2013 U.S. App. LEXIS 2668).

    Federal Judge Dismisses Challenge To Birth Control Mandate For Lack Of Standing

    CHICAGO - A federal judge in Illinois on Feb. 8 dismissed a suit alleging that the Patient Protection and Affordable Care Act (PPACA) mandate requiring all health plans to provide preventive services for free, including those for birth control, violates the religious rights of religious organizations, finding that the plaintiffs lacked standing and that the claims were unripe for review (R. Daniel Conlon, Bishop of the Roman Catholic Diocese of Joliet, Illinois, et al. v. Kathleen Sebelius, No. 12-3932, N.D. Ill.; 2013 U.S. Dist. LEXIS 17407).

    Divided 3rd Circuit Denies Stay Pending Appeal Of Birth Control Mandate Suit

    PHILADELPHIA - A divided Third Circuit U.S. Court of Appeals panel on Feb. 7 denied a motion for stay pending appeal of the denial of preliminary injunction in a case challenging the "birth control mandate" in the Patient Protection and Affordable Care Act (PPACA) (Conestoga Wood Specialties Corp., et al. v. Secretary of the US. Department of Health and Human Services, et al., No. 13-1144, 3rd Cir.; 2013 U.S. App. LEXIS 2706).

    ERISA Plan Participants Seek Judge's Recusal In Reimbursement Suit

    NEWARK, N.J. - Health plan participants who are suing a health care insurer for using flawed data to calculate the reimbursement rate for out-of-network providers on Feb. 7 moved for the federal judge in New Jersey who is overseeing the action to recuse himself and vacate his decision denying class certification (Darlery Franco v. Connecticut General Life Insurance Co., et al., No. 07-6039, D. N.J.).

    Wisconsin Appeals Court Affirms $22M Drug-Pricing Judgment Against Pharmacia

    MADISON, Wis. - A Wisconsin appeals court panel on Feb. 6 upheld a $22 million judgment against Pharmacia Corp. for reporting inflated average wholesale prices (AWPs) that resulted in the state Medicaid program overpaying for prescription drugs (State of Wisconsin v. Abbott Laboratories, et al., No. 2010AP232-AC, Wis. App., Dist. IV).

    Federal Judge Allows Claims Against California In Reimbursement Suit

    SAN FRANCISCO - A federal judge in California on Feb. 1 granted a motion to dismiss declaratory claims against the U.S. Department of Health and Human Services (HHS) regarding an interpretation of agency rules regarding reporting requirements under the Medicaid statute. However, the judge determined that the health care provider could maintain a claim against the California Department of Healthcare Services (DHCS) and its director for failure to reimburse it for services provided to Medicaid-eligible beneficiaries under federal laws and regulations (Northeast Medical Services Inc. v. California Department of Healthcare Services, et al., No. C-12-2895, N.D. Calif.; 2013 U.S. Dist. LEXIS 14147).

    New Jersey Federal Judge Dismisses Health Care Reimbursement Suit

    NEWARK, N.J. - In an unpublished opinion, a New Jersey federal judge on Feb. 5 granted summary judgment in favor of the defendants in a health care insurance reimbursement dispute, saying the plaintiffs failed to exhaust administrative remedies before filing suit (Montvale Surgical Center LLC a/s/o Justin Gutschmidt v. Horizon Blue Cross Blue Shield of New Jersey, et al., No. 12-3685, D. N.J.; 2013 U.S. Dist. LEXIS 15327).

    8th Circuit Grants Injunction Pending Resolution Of Appeal Of Birth Control Case

    ST. LOUIS - A panel of the Eighth Circuit U.S. Court of Appeals on Feb. 1 granted a motion made by the manufacturer of medical devices for a preliminary injunction pending resolution of its appeal contesting the denial of 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.).

    Motion To Intervene Denied In Case Challenging Missouri Health Insurance Law

    ST. LOUIS - A Missouri federal judge on Jan. 31 denied a motion by a not-for-profit corporation to intervene in a suit seeking a declaration that portions of a state law are unconstitutional because they are in direct conflict with portions of the federal Patient Protection and Affordable Care Act (PPACA) (Missouri Insurance Coalition, et al. v. John M. Huff, in his capacity as Director of the Missouri Department of Insurance, Financial Institutions, and Professional Registration, No. 12-2354, E.D. Mo.; 2013 U.S. Dist. LEXIS 13105).

    Split 7th Circuit Grants Injunction Pending Appeal In Birth Control Mandate Suit

    CHICAGO - In a split opinion, a panel of the Seventh Circuit U.S. Court of Appeals on Jan. 30 granted an injunction pending appeal of the denial of a motion for preliminary injunction brought by a vehicle safety manufacturer and its owners challenging the "birth control" mandate contained in the Patient Protection and Affordable Care Act (PPACA) (William D. Grote III, et al. v. Kathleen Sebelius, et al., No. 13-1077, 7th Cir.; 2013 U.S. App. LEXIS 2112).