CHICAGO - A divided Illinois appeals court on Feb. 27 reversed and vacated the judgment of a trial court granting the plaintiff's motion for summary judgment and class certification in a health care subrogation dispute, saying the plaintiff had no right to rely on the common fund doctrine to support her claims (Nelli Stefanski v. The City of Chicago, No. 1-13-2844, Ill. App., 1st Dist. 6th Div.; 2015 Ill. App. LEXIS 133).
CHICAGO - A federal judge in Illinois on Feb. 26 denied a man's motion to dismiss his insurance company's lawsuit accusing him of violating the Illinois Insurance Fraud Statute and stayed the case for the company to assert a portion of its allegations as a counterclaim to a separate suit brought by the defendant accusing the company of violating the Employee Retirement Income Security Act (Concert Health Plan Insurance Company v. James E. Killian, No. 14 C 4697, N.D. Ill.; 2015 U.S. Dist. LEXIS 23195).
NEW YORK - The federal government provided sufficient evidence to a jury that a female doctor was only a paper owner of a New York medical clinic who made material misrepresentations to insurance companies as part of a conspiracy to commit health care fraud, a federal judge in New York ruled Feb. 26 in denying the defendant's motion for acquittal or new trial (United States of America v. Tatyana Gabinskaya, No. 12-cr-171 JPO, S.D. N.Y.; 2015 U.S. Dist. LEXIS 23343).
WASHINGTON, D.C. - The U.S. Supreme Court on Feb. 23 declined to review a Second Circuit U.S. Court of Appeals ruling that the Employee Retirement Income Security Act does not preempt a New York state anti-subrogation law that prohibits insurers from obtaining reimbursement of medical benefits from participants' tort settlements (The Rawlings Company, et al. v. Megan Wurtz, et al., No. 14-487, U.S. Sup.).
WASHINGTON, D.C. - The U.S. Supreme Court on Feb. 23 let stand a Third Circuit U.S. Court of Appeals ruling that a multiemployer welfare benefits plan may seek reimbursement of health benefits paid on behalf of a plan participant who later received a third-party settlement because the plan language established an equitable lien by agreement (Bernard McLaughlin v. Board of Trustees of the National Elevator Industry Health Benefit Plan, No. 14-626, U.S. Sup.).
WASHINGTON, D.C. - The U.S. Supreme Court on Feb. 23 denied certiorari, leaving stand a Third Circuit U.S. Court of Appeals decision holding that the Medicare as a Secondary Payer Act (MSP Act) authorizes the government to seek reimbursement from a settlement a plaintiff receives from a tortfeasor because the funds came from a "primary plan" and that the plaintiff cannot invoke a New Jersey state law to avoid her reimbursement obligations (Cecelia A. Taransky v. Secretary of the U.S. Department of Health and Human Services, et al., No. 14-758, U.S. Sup.).
WASHINGTON, D.C. - The U.S. Supreme Court on Feb. 23 declined to grant certiorari, which left standing an agreement reached in In re Managed Care Litigation that bars several physicians and physician groups from bringing claims against WellPoint Inc. in In re WellPoint, Inc. Out-of-Network "UCR" Rates Litigation under the Racketeer Influenced and Corrupt Organizations Act and the Sherman Act but not from bringing certain claims under the Employee Retirement Income Security Act (Medical Association of Georgia, et al. v. Wellpoint Inc., No. 14-554, U.S. Sup.).
DENVER - A Colorado federal judge on Feb. 20 declined to dismiss antitrust claims in a suit alleging that health insurers conspired with hospitals to drive multiple ambulatory surgical centers out of business (Arapahoe Surgery Center, et al. v. CIGNA Healthcare Inc., et al., No. 13-3422, D. Colo.; 2015 U.S. Dist. LEXIS 20488).
MIAMI - A federal magistrate judge in Florida on Feb. 17 recommended accepting a home health care clinic owner's guilty plea in a $13 million Medicare fraud scheme, finding that the defendant was capable and competent in entering an informed plea (United States of America v. Alexander Lara, No. 15-cr-20029-KMM, S.D. Fla.).
MINNEAPOLIS - A federal judge in Minnesota on Feb. 13 denied a motion filed by a number of chiropractic centers and their owners, seeking dismissal of a lawsuit brought by numerous insurance companies claiming that the defendants submitted fraudulent bills under Minnesota's No-Fault Automobile Insurance Act, finding that the insurers sufficiently pleaded claims under the Racketeer Influenced and Corrupt Organizations Act and Minnesota's Corporate Practice of Medicine Doctrine (CPMD) (Liberty Mutual Fire Insurance Company, et al. v. Acute Care Chiropractic Clinic P.A., et al., No. 14-cv-2651, D. Minn.; 2015 U.S. Dist. LEXIS 17933).
NASHVILLE, Tenn. - A man lacks standing to pursue a suit accusing a government official of fraudulently concocting a fiscal note to torpedo a Tennessee bill blocking implementation of the Patient Protection and Affordable Care Act (ACA), a federal judge held Feb. 18 (Louie E. Johnston Jr. v. Lucien C. Geise, executive director, Tennessee General Assembly's Fiscal Review Commission and JOHN DOE[s], No. 14-1425, M.D. Tenn.).
GRAND RAPIDS, Mich. - Right to Life Michigan's action challenging implementation of the Patient Protection and Affordable Care Act (ACA) contraceptive mandate will proceed after a federal judge lifted his stay of the case on Feb. 17 (Right to Life of Michigan v. Sylvia Mathews Burwell, et al., No. 13-1202, W.D. Mich.).
MIAMI - The 11th Circuit U.S. Court of Appeals on Feb. 13 declined to rehear a Patient Protection and Affordable Care Act (ACA) case, leaving stand a divided panel's conclusion that an orthodontist lacked standing to challenge delayed implementation of the law's employer mandate (Kawa Orthodontics LLP v. Secretary, U.S. Department of the Treasury, et al., No. 14-10296, 11th Cir.).
TACOMA, Wash. - Upon remand by the Ninth Circuit U.S. Court of Appeals, a Washington federal judge on Feb. 13 determined that the supplier of a piece of durable medical equipment used to treat osteoarthritis of the knee was not entitled to the benefits of any of Medicare's "limited liability" provisions (International Rehabilitative Sciences Inc. v. Sylvia M. Burwell, No. 08-5442, W.D. Wash.; 2015 U.S. Dist. LEXIS 18122).
PHILADELPHIA - The accommodation through which those who object to the contraceptive mandate of the Patient Protection and Affordable Care Act (ACA) can avoid providing or paying for the insurance coverage does not burden religious practice, a Third Circuit U.S. Court of Appeals panel held Feb. 11 (Geneva College, et al. v. HHS, et al., 13-3536, Geneva College, Wayne L. Hepler, et al. v. HHS, et al., No. 14-1374, Most Reverend Lawrence T. Persico, et al. v. HHS, et al., No. 14-1376, Most Reverend David A. Zubik, et al. v. HHS, et al., No. 14-1377, 3rd Cir.).
LOS ANGELES - The general manager of a California ambulance company was sentenced to 78 months in prison and ordered to pay $1.3 million in restitution by a federal judge in California on Feb. 9 for his role in a $5.5 million scheme to defraud Medicare (United States of America v. Wesley H. Kingsbury, 12-cr-903, C.D. Calif.).
WASHINGTON, D.C. - An Iowa home health care facility agreed to pay $5.6 million to resolve allegations that it submitted false billing claims to Medicare and Medicaid in violation of the False Claims Act (FCA), the U.S. Department of Justice announced Feb. 10.
LOS ANGELES - A California resident on Feb. 9 filed a class action lawsuit in federal court accusing Anthem Inc. of violating, among other things, the state's unfair competition law (UCL) in failing to safeguard personal information contained on the defendant's information technology (IT) systems after a massive breach of the company's systems (John Doe v. Anthem Inc., et al., No. 15-934, C.D. Calif.).
LOS ANGELES - A California federal judge on Feb. 9 allowed a fraud claim to continue in a health care reimbursement suit, but dismissed three other claims (Mountain View Surgical Center v. CIGNA Health Corp., No. 13-8083, C.D. Calif.; 2015 U.S. Dist. LEXIS 15320).
STANTON, Ky. - In an unpublished opinion, the Kentucky Court of Appeals on Feb. 6 affirmed that a managed care company that had contracted with the Commonwealth of Kentucky breached its contract to provide Medicaid services to state residents by terminating the contract early (Kentucky Spirit Health Plan Inc. v. Commonwealth of Kentucky, et al., Nos. 2014-CA-1050-MR, 2013-CA-1201-MR, Ky. App.; 2015 Ky. App. Unpub. LEXIS 85).
BROOKLYN, N.Y. - A New York federal judge on Feb. 4 declined to dismiss a breach of contract claim but did dismiss claims for negligence and breach of fiduciary duty in a dispute between a home health care company and its billing management company over the preparation and submission of claims (Excellent Home Care Services v. FGA Inc., No. 13-5390, E.D. N.Y.; 2015 U.S. Dist. LEXIS 13351).
WASHINGTON, D.C. - The universal application of the Patient Protection and Affordable Care Act (ACA) individual mandate cannot preclude a constitutional challenge to the law, a local-level politician argues in a Feb. 4 brief to the District of Columbia Circuit U.S. Court of Appeals (Jeffrey Cutler v. United States Department of Health and Human Services, et al., No. 14-5183, D.C. Cir.).
TAMPA, Fla. - The Patient Protection and Affordable Care Act (ACA) contraceptive mandate substantially burdens religious practice, as does requiring objectors to provide details of their insurance carrier to the government, which forces objectors to "become excessively entangled" in the process, a federal judge in Florida held Feb. 3 (Christian and Missionary Alliance Foundation Inc., et al. v. Sylvia Mathews Burwell, et al., No. 14-580, M.D. Fla.; 2015 U.S. Dist. LEXIS 12506).
HOUSTON - A health care provider on Feb. 2 sued an insurance company in a Texas federal court for allegedly failing to properly reimburse the provider for services provided to the defendant's insureds (Grand Parkway Surgery Center v. Health Care Service Corp., et al., No. 15-297, S.D. Texas).
OCALA, Fla. - A Florida federal judge on Jan. 28 vacated a jury verdict in favor of the plaintiff in a Medicare false claims case, saying that the plaintiff failed to present sufficient evidence to the jury that defendant's alleged violation of Florida's licensing laws with respect to the diagnostic procedures performed was a condition of payment (United States of America and State of Florida, ex rel. Charles Ortolano v. Amin Radiology, No. 10-583, M.D. Fla.; 2015 U.S. Dist. LEXIS 9724).