LexisNexis® Legal Newsroom
Mealey's Health Law - 9th Circuit: Qui Tam Plaintiffs Cannot Intervene In Criminal Forfeiture Action

SAN FRANCISCO - A Ninth Circuit U.S. Court of Appeals panel on Aug. 10 held that two medical assistants who filed a qui tam lawsuit under the False Claims Act (FCA) against a podiatrist they worked for could not intervene in a criminal forfeiture action brought by the federal government seeking $1.2...

Mealey's Health Law - Doctor Sentenced To 39 Months In Prison For Hospice Fraud Scheme

GREENVILLE, Miss. - The U.S. Department of Justice announced Aug. 10 that a federal judge in Mississippi has sentenced a doctor to 39 months in prison and ordered him to pay $1.9 million in restitution to the Medicare program for referring patients to hospice care when such treatment was not necessary...

Mealey's Health Law - Owner Of 2 Home Health Companies Found Guilty Of Health Care Fraud

HOUSTON - A registered nurse who owned two home health care companies was found guilty on Aug. 10 by a federal jury in Texas of one count of conspiracy to commit health care fraud and four counts of health care fraud for her role in a $20 million Medicare fraud scheme (United States v. Evelyn Mokwuah...

Mealey's Health Law - Podiatrist Sentenced To 90 Months In Prison For Fraudulently Billing Medicare

ST. LOUIS - A federal judge on Aug. 15 sentenced a podiatrist to 90 months in prison and ordered him to pay $6.9 million in restitution for fraudulently billing Medicare for services that were not rendered (United States v. Yev Gray, No. 15cr464, E.D. Mo.).

Mealey's Health Law - 5th Circuit Affirms Doctor's Convictions For Health Care Fraud, Kickbacks

NEW ORLEANS - A Fifth Circuit U.S. Court of Appeals panel on Aug. 17 affirmed a jury's verdict convicting a man of committing health care fraud and paying and receiving kickbacks for approving patients for home health care when they did not need such treatment (United States v. Warren Dailey, No...

Mealey's Health Law - 5th Circuit Finds Woman Was Deliberately Ignorant Of Medicare Fraud Scheme

NEW ORLEANS - A woman was properly convicted and sentenced to 140 months in prison for illegally billing Medicare more than $250,000 for medical equipment for beneficiaries that was not medically necessary, a Fifth Circuit U.S. Court of Appeals panel ruled Sept. 13, finding that she was deliberately...

Mealey's Health Law - Pediatric Firm Can Pursue Federal, State False Claims Act Allegations, Judge Says

NEWARK, N.J. - A firm of pediatric doctors can pursue allegations that a skilled nursing and rehabilitation facility violated the False Claims Act, the New Jersey False Claims Act (NJFCA) and the New York False Claims Act (NYFCA) for unlawfully billing Medicare and Medicaid as primary payers rather than...

Mealey's Health Law - Texas Federal Judge Finds Health Plan Must Cover Weight Loss Surgery

HOUSTON - A health plan beneficiary is owed full coverage for a gastric bypass surgery and a follow-up surgery and care required after she experienced complications, a Texas federal judge ruled Sept. 14, finding that the beneficiary's evidence that she has experienced nausea and vomiting placed her...

Mealey's Health Law - Insurance Fraud Defendants' Emailed Defenses Were Improper, Judge Rules

TRENTON, N.J. - A federal judge in New Jersey on Sept. 19 struck defenses submitted via email by three defendants accused by Government Insurance Co., GEICO Indemnity Co., GEICO General Insurance Co. and GEICO Casualty Co. (collectively GEICO) of submitting approximately $3.3 million in false insurance...

Mealey's Health Law - Insurer Files Answer, Wants Immediate Review Of ACA Lactation Coverage Ruling

SAN FRANCISCO - In a motion seeking interlocutory review, an insurer argues that whether the Patient Protection and Affordable Care Act (ACA) requires an insurer to provide access to lactation services or merely forbids financial barriers to obtaining such services is exactly the type of question the...

Mealey's Health Law - Texas Federal Judge Allows Breach Of Fiduciary Duty Claims To Proceed

SHERMAN, Texas - A Texas federal judge on Sept. 19 refused to dismiss a plaintiff's breach of fiduciary claims arising out of a health care plan's denial of coverage for autism treatments because the fiduciary claims are not disguised benefits claims and the plaintiff alleged sufficient facts...

Mealey's Health Law - Mental Illness Limitation Is Not Valid Under Montana's Mental Health Parity Law

BILLINGS, Mont. - A Montana federal judge on Sept. 20 granted a disability claimant's motion for summary judgment after determining that Montana's mental health parity law requires the plan to provide the claimant with the same benefits for her mental illness as it would if her disability were...

Mealey's Health Law - ACA, UCL Claims Against Health Care Provider Survive In Transgender Case

SAN DIEGO - Allegations that an emergency health care provider touted its compassion toward those with gender dysphoria and then repeatedly referred to a transgender boy as female support his mother's Patient Protection and Affordable Care Act (ACA) and California unfair competition law claims, a...

Mealey's Health Law - Judge Upholds Convictions For Fraud Scheme Involving Urine Drug Screenings

FRANKFORT, Ky. - A federal judge in Kentucky on Sept. 29 affirmed a jury's decision to convict two physicians who owned addiction clinics, as well as the partial owners of a laboratory that conducted screenings for urine drug tests of 17 counts of aiding and abetting one another to commit health...

Mealey's Health Law - 2nd Circuit Finds Denial Of Coverage For Partial Hospitalization Was Supported

NEW YORK - After finding that an insurer did not improperly deny coverage for continued treatment of an insured's anorexia nervosa in violation of the Employee Retirement Income Security Act, the Second Circuit U.S. Court of Appeals on Oct. 2 affirmed a court's ruling that the insurer's decision...

Mealey's Health Law - Woman Sentenced To 1 Year In Prison For Health Care Fraud

NEW ORLEANS - A federal judge in Louisiana on Oct. 13 sentenced a woman to one year and one day in prison and ordered her to pay $536,724 in restitution after she pleaded guilty to one count of health care fraud for misappropriating Medicaid funds received by a pediatric clinic where she worked for her...

Mealey's Health Law - Health Care Fraud Defendant Ordered To Pay $847,016 In Restitution

BOISE, Idaho - A federal judge in Idaho on Oct. 27 ordered a dentist to pay $847,016 in restitution and forfeit $139,769.80 after pleading guilty to 24 counts of health care fraud (United States of America v. Cherie Renee Dillon, No. 16-cr-0037, D. Idaho, 2017 U.S. Dist. LEXIS 178810).

Mealey's Health Law - 4th Circuit: Judge Properly Addressed Materiality Of Couple's Misrepresentations

RICHMOND, Va. - A Fourth Circuit U.S. Court of Appeals panel on Oct. 30 affirmed a federal judge in Virginia's decisions finding a couple guilty of conspiring to commit health care fraud and denying their post-trial motions for acquittal, holding that the judge properly addressed whether misrepresentations...

Mealey's Health Law - Evidence Supported Convictions For Fraud, Kickback Charges, 5th Circuit Says

NEW ORLEANS - A Fifth Circuit U.S. Court of Appeals panel on Nov. 7 upheld convictions of a man and his son who were accused of health care fraud and paying kickbacks to obtain business for their partial hospitalization programs (PHPs), ruling that evidence presented by the government was sufficient...

Mealey's Health Law - Claim Seeking Coverage For Air Ambulance Transport Remanded To Plan Administrator

SACRAMENTO, Calif. - A California federal judge on Nov. 16 remanded an insured's claim seeking coverage for almost $500,000 incurred for the transport of her daughter from a hospital in Mexico to a hospital in Seattle by air ambulance because the plan administrator did not consider all of the available...

Mealey's Health Law - 5th Circuit Vacates $4M Restitution, Forfeiture Order Against Physician Assistant

NEW ORLEANS - A Fifth Circuit U.S. Court of Appeals panel on Nov. 30 overturned a federal judge in Texas' ruling ordering a physician's assistant found guilty of conspiracy to commit insurance fraud to pay $4 million in restitution and forfeiture, holding that the man should be required to reimburse...

Mealey's Health Law - GEICO's Insurance Fraud, RICO Claims Not Subject To Arbitration, Judge Says

CAMDEN, N.J. - A federal judge in New Jersey on Dec. 1 refused to dismiss a lawsuit brought by the Government Employees Insurance Co. (GEICO) over an alleged fraudulent billing scheme by doctors at two orthopedic firms, finding that the insurer's claims under the Racketeer Influenced and Corrupt...

Mealey's Health Law - Dave & Buster's $7.4M ERISA Settlement Denied By New York Federal Judge

NEW YORK - A New York federal judge, in an order filed Dec. 1, declined preliminary approval of a class settlement worth up to $7,425,000 offered by Dave & Buster's Inc. to end claims that the nationwide restaurant/entertainment chain violated the Employee Retirement Income Security Act by reducing...

Mealey's Health Law - Panel Says Plan Participant Could Recover Premiums If There Was A Plan Violation

ST. LOUIS - The Eighth Circuit U.S. Court of Appeals on Dec. 6 reversed and remanded a district court's dismissal of a health care plan participant's claim seeking to recover premiums paid under the plan after determining that a restitutionary claim for premiums under the Employee Retirement...

Mealey's Health Law - Federal Judge: Fusion Surgery Preauthorization Waived Insurer's Later Denial

LOS ANGELES - A health insurer waived the right to deny coverage for vertebrate fusion surgery as experimental when it preauthorized the procedure, albeit with a different device, a federal judge in California held Dec. 12, entering judgment for the plaintiff on her Employee Retirement Income Security...