WASHINGTON, D.C. - A home-care association with at least one member denied reimbursement from Medicare has standing to challenge Patient Protection and Affordable Care Act (ACA) rules and need not exhaust administrative remedies first given the unlikelihood of success, a District of Columbia federal judge held Jan. 6 (National Association for Home Care & Hospice Inc. v. Sylvia Mathews Burwell, secretary, U.S. Department of Health and Human Services, et al., No. 14-950, D. D.C.; 2015 U.S. Dist. LEXIS 477).
CARSON CITY, Nev. - Members of a health maintenance organization who seek medical monitoring for potential exposure to blood-borne diseases may maintain negligence claims against the HMO, the Nevada Supreme Court ruled Dec. 31, finding in a case of first impression under Nevada law that "a plaintiff may state a cause of action for negligence with medical monitoring as the remedy without asserting that he or she has suffered a present physical injury" (Susan Sadler, et al. v. PacifiCare of Nevada Inc., No. 62111, Nev. Sup.; 2014 Nev. LEXIS 133).
PHILADELPHIA - A panel of the Third Circuit U.S. Court of Appeals on Dec. 31 affirmed the sentence given to a radiologist who pleaded guilty to illegally paying physicians to refer their patients to his facility so he could obtain more reimbursement from Medicare and Medicaid (United States of America v. Ashokkumar Babaria, No. 14-2694, 3rd Cir.; 2014 U.S. App. LEXIS 24656).
BATON ROUGE, La. - In a Dec. 29 unpublished opinion, a Louisiana appeals court reversed a summary judgment opinion granting a permanent injunction to halt the termination of a health care clinic's Medicaid provider agreement, saying the plaintiff failed to meet its required prima facie showing of irreparable harm (Midtown Medical v. The Department of Health & Hospitals, et al., Nos. 2014 CA 0530 c/w 2014 CA 0531 c/w 2014 CA 0532, La. App., 1st Cir.; 2014 La. App. Unpub. LEXIS 792).
WASHINGTON, D.C. - A federal judge in the District of Columbia on Dec. 29 granted a preliminary injunction to enjoin the U.S. Department of Health and Human Services (HHS) from recouping any federal disproportionate-share hospital (DSH) funds provided to two pediatric teaching and research hospitals based on a state's noncompliance with a new Medicaid funding rule (Texas Children's Hospital, et al. v. Sylvia Burwell, secretary, United States Department of Health and Human Services, et al., No. 14-2060, D. D.C.; 2014 U.S. Dist. LEXIS 177644).
RICHMOND, Va. - A Fourth Circuit U.S. Court of Appeals panel on Dec. 19 upheld a jury's verdict finding a dermatologist guilty of 13 counts of health care fraud and affirmed a judge's sentencing of the defendant, holding that the evidence presented during the trial supported the jury's decision (United States of America v. Allen G. Saoud, No. 14-4288, 4th Cir.; 2014 U.S. App. LEXIS 24002).
SALT LAKE CITY - The government's loss of computer data from a women's health care clinic operated by a woman accused of defrauding Medicare by coaching illegal aliens to apply for benefits under the Baby Your Baby (BYB) program warrants the dismissal of her indictment, a federal judge in Utah ruled Dec. 12, ruling that the loss of the information prevents the defendant from defending herself (United States of America v. Larohnda Dennison, No. 13CR805DAK, D. Utah; 2014 U.S. Dist. LEXIS 173303).
WASHINGTON, D.C. - In denying a petition for writ of certiorari, the U.S. Supreme Court on Dec. 15 left standing a Ninth Circuit U.S. Court of Appeals decision reversing a lower court's decision denying Planned Parenthood of Arizona's motion for a preliminary injunction and remanding the case with instructions for the district court to issue the injunction in a case seeking to enjoin enforcement of an Arizona law prohibiting the use of certain drugs to induce abortions (Planned Parenthood of Arizona Inc., et al. v. William Humble, director of the Arizona Department of Health Services, No. 14-284, U.S. Sup.).
WASHINGTON, D.C. - The U.S. Supreme Court on Dec. 15 invited the solicitor general to weigh in on whether the court should grant review of a divided Second Circuit U.S. Court of Appeals ruling that the Employee Retirement Income Security Act preempts Vermont's health care data collection law as applied to a self-funded ERISA benefit plan (Alfred J. Gobeille v. Liberty Mutual Insurance Company, No. 14-181, U.S. Sup.).
WASHINGTON, D.C. - A pro-life employer and the government filed supplemental briefs on Dec. 10 in the District of Columbia federal court on the impact of a recent District of Columbia Circuit U.S. Court of Appeals ruling on the Patient Protection and Affordable Care Act (ACA) contraceptive mandate (March for Life, Jeanne F. Monahan and Bethany A. Goodman v. Sylvia M. Burwell, et al., No. 14-1149, D. D.C.).
MIAMI - A nursing assistant was sentenced by a federal judge in Florida on Dec. 8 to 150 months in prison and ordered to pay $18.2 million in restitution for participating in a $200 million scheme to fraudulently bill Medicare for mental health services (United States v. Rodolfo Santaya, No. 14-cr-20052, S.D. Fla.).
NEW HAVEN, Conn. - A federal judge in Connecticut on Dec. 8 dismissed a class action lawsuit over the denial of Medicare benefits, holding that Medicare patients do not have standing to sue if Medicare denies a health care claim, but then Medicaid ends up paying the claim (Carolyn Hull v. Sylvia Burwell, No. 14-801, D. Conn.; 2014 U.S. Dist. LEXIS 169538).
BIRMINGHAM, Ala. - A federal judge in Alabama on Dec. 4 declined to dismiss False Claims Act (FCA) claims brought against the operator of 60 hospice facilities for allegedly submitting fraudulent claims to Medicare for people who were not eligible to receive hospice benefits, saying genuine issues of material fact exist (United States of America v. AseraCare Inc., et al., No. 12-245, N.D. Ala.; 2014 U.S. Dist. LEXIS 167970).
DENVER - A disability insurer did not act arbitrarily or capriciously by terminating benefits under the any-reasonable-occupation disability standard of a plan governed by the Employee Retirement Income Security Act, despite a contrary determination by the Social Security Administration (SSA) under the SSA all-occupation disability standard, the 10th Circuit U.S. Court of Appeals affirmed Dec. 3 (Christy M. Liebel v. Aetna Life Insurance Co., No. 14-6046, 10th Cir.).
SAN FRANCISCO - A long-term disability plan governed by the Employee Retirement Income Security Act properly offset a firefighters' workers' compensation settlement, but remand is necessary to determine the amount of salary continuation benefits that the plan can properly offset under the plan terms, the Ninth Circuit U.S. Court of Appeals ruled Dec. 2 in an unpublished opinion (David Barboza v. California Association of Professional Firefighters, et al., Nos. 12-17439 and 13-16652, 9th Cir.).
OKLAHOMA CITY - A federal judge in Oklahoma on Dec. 3 modified an order enjoining the implementation of the Patient Protection and Affordable Care Act (ACA) contraceptive mandate, expanding it to prevent the government from interfering with insurers or third-party administrators (The Catholic Benefits Association LCA, et al. v. Sylvia M. Burwell, et al., No. 14-240, W.D. Okla.).
MIAMI - An orthodontics company lacks standing to challenge the delay in implementing the Patient Protection and Affordable Care Act (ACA)'s employer mandate, a divided 11th Circuit U.S. Court of Appeals panel held Dec. 2 (Kawa Orthodontics LLP v. Secretary, U.S. Department of the Treasury, et al., No. 14-10296, 11th Cir.).
BOSTON - A panel of the First Circuit U.S. Court of Appeals on Dec. 1 affirmed that the "first-to-file" rule barred a False Claims Act (FCA) suit alleging that a pharmaceutical company defrauded federal Medicaid and Medicare programs (United States, ex rel. Ven-A-Care of The Florida Keys Inc. v. Baxter Healthcare Corp. v. Linnette Sun, et al., Nos. 13-1732, 13-2083, 1st Cir.; 2014 U.S. App. LEXIS 22564).
ATLANTA - A disability plan participant's cause of action under the Employee Retirement Income Security Act based on the termination of his benefits accrued when the participant had reason to know that the claims administrator clearly repudiated his claim for benefits, the 11th Circuit U.S. Court of Appeals ruled Nov. 25 in concluding that the participant's complaint was time-barred (Don L. Witt v. Metropolitan Life Insurance Co., et al., No. 14-11349, 11th Cir.; 2014 U.S. App. LEXIS 22321).
GRETNA, La. - A Louisiana appeals court on Nov. 25 vacated a trial court's decision granting a hospital summary judgment and denying class certification in a wrongful billing suit, saying a recent state Supreme Court decision established that the plaintiffs had a private right of action under the state's Billing Act (Nell Ladieu, et al. v. Jefferson Parish Hospital Service District No. 2 d/b/a East Jefferson General Hospital, No. 14-CA-449, La. App., 5th Dist.; 2014 La. App. LEXIS 2824).
WASHINGTON, D.C. - Restaurants, retail food establishments and vending machines with more than 20 locations will need additional nutritional labeling under rules finalized by the U.S. Food and Drug Administration on Nov. 25 in compliance with the Patient Protection and Affordable Care Act (ACA).
WASHINGTON, D.C. - The U.S. House of Representatives on Nov. 21 filed suit in the District of Columbia federal court against Sylvia Burwell, the U.S. Department of Health and Human Services (HHS) and others over implementation of the Patient Protection and Affordable Care Act (ACA) (United States House of Representatives v. Sylvia Mathews Burwell, et al., No. 14-1967, D.D.C.).
CEDAR RAPIDS, Iowa - The government on Nov. 18 responded to two religious schools' argument that Hobby Lobby was not an implicit endorsement of the Patient Protection and Affordable Care Act (ACA) accommodation allowing religious objectors to avoid paying for contraceptive insurance coverage as a means of ensuring insurance coverage while protecting religious rights (Dordt College and Cornerstone University v. Sylvia Burwell, et al., No. 14-2726, 8th Cir.).
OKLAHOMA CITY - An Oklahoma federal judge on Nov. 19 enjoined application of the Patient Protection and Affordable Care Act (ACA) contraceptive mandate against Hobby Lobby Stores Inc. but limited his judgment to the regulation as it existed at the time of the Supreme Court's ruling on the issue (Hobby Lobby Stores Inc., et al. v. Kathleen Sebelius, et al., No. 12-1000, W.D. Okla.).
DETROIT - The government may not enforce the Patient Protection and Affordable Care Act (ACA) contraceptive mandate against a privately held for-profit company, a Michigan federal judge held Nov. 17 (M & N Plastics Inc., et al. v. Sylvia Burwell, et al., No. 13-14754, E.D. Mich.).