LexisNexis® Legal Newsroom
Mealey's Health Law - Class Action Over Cost Of EpiPens Filed In Minnesota Federal Court

MINNEAPOLIS - A putative class action brought pursuant to the Employee Retirement Income Security Act alleging that pharmacy benefits managers' violation of their fiduciary duty caused the price of a drug used to treat severe, life-threatening allergic reaction to skyrocket was filed June 2 in Minnesota...

Mealey's Health Law - 4th Circuit Panel Affirms Judgment For Michelin Plan On Injection Payment Rulings

RICHMOND, Va. - A Fourth Circuit U.S. Court of Appeals panel on June 13 affirmed the grant of summary judgment to defendants in a case where a plaintiff sued under the Employee Retirement Income Security Act seeking additional reimbursement for a series of steroid knee injections that an orthopedic surgeon...

Mealey's Health Law - Defense Expert Excluded In Case Alleging Illegal Kickbacks For Lab Work

CHARLESTON, S.C. - An expert for health care defendants accused of running kickback schemes cannot testify because his opinion draws on legal conclusions that should be left to the court to decide, is based on unsound methodology and would mislead a jury, a South Carolina federal judge held June 26 in...

Mealey's Health Law - Connecticut Judge Grants Injunction For Union Workers In Medical Coverage Dispute

HARTFORD, Conn. - A Connecticut federal judge on June 27 granted union employees' motion for a preliminary injunction and ordered Honeywell International Inc. to reinstate previously existing medical coverage benefits, saying that the threat of termination and the actual termination of medical coverage...

Mealey's Health Law - Judge: Opioid Possession, Intent To Distribute Charges Preclude Pretrial Release

PHILADELPHIA - A federal judge in Pennsylvania on July 7 denied a motion for pretrial release filed by a man accused of health care fraud, conspiracy to commit and 15 counts of possession of oxycodone with intent to distribute, finding that the nature of the drug trafficking claims showed that no condition...

Mealey's Health Law - Discovery Of Non-ACA Plan Information Denied In Insurer's Dialysis Fraud Suit

WEST PALM BEACH, Fla. - Finding that a health insurer's fraud claims related to kidney dialysis were pleaded only for its Patient Protection and Affordable Care Act (ACA) plans, a Florida federal magistrate judge on July 10 denied in part a motion to compel non-ACA plan information from the dialysis...

Mealey's Health Law - DOJ: Owners Of Psychological Services Companies Sentenced For $25.2M Fraud Scheme

NEW ORLEANS - The owners of two psychological services companies were sentenced by a federal judge in Louisiana for their roles in a $25.2 million Medicare fraud scheme, the U.S. Department of Justice announced July 14 (United States of America v. Rodney Hesson, et al., No. 15-cr-152, E.D. La.).

Mealey's Health Law - Judge Finds Standing In ACA Out-Of-Network Lactation Coverage Suit

WASHINGTON, D.C. - A trio of women successfully allege standing in their class action claiming that an insurer improperly charged them for out-of-network lactation services in violation of the Patient Protection and Affordable Care Act (ACA), a federal judge in the District of Columbia held July 17 ...

Mealey's Health Law - Tribe Wins $8.4 Million Judgment Against Blue Cross For Hidden Plan Fees

BAY CITY, Mich. - A health care plan administrator owes a Michigan Indian tribe more than $8.4 million for violating the Employee Retirement Income Security Act by charging hidden administrative fees for the tribe's employee benefit program but is not liable for any alleged damages related to the...

Mealey's Health Law - DOJ: 3 Companies, Executives To Pay $19.5M For False Billing

CINCINNATI - Three companies and their executives have agreed to pay $19.5 million for allegedly violating the False Claims Act (FCA) by billing Medicare for medically unnecessary rehabilitation therapy and hospice services, the U.S. Department of Justice announced July 18 (United States, ex rel. Trakhter...

Mealey's Health Law - Government Says Failed ACA Insurer Should File Case In Federal Claims Court

COLUMBIA, S.C. - A failed Patient Protection and Affordable Care Act (ACA) co-operative insurer's liquidator should file his lawsuit challenging a federal loan repayment demand in the U.S. Court of Federal Claims, the government says in a July 19 motion filed in South Carolina federal court (Raymond...

Mealey's Health Law - Administrators Cannot Violate Anti-Kickback Law, 3rd Circuit Finds

PHILADELPHIA - A Third Circuit U.S. Court of Appeals panel ruled July 19 that administrators of an outpatient surgical facility cannot be found liable for violating Pennsylvania's insurance fraud statute because the anti-kickback provision of the statute applies only to health care providers (Aetna...

Mealey's Health Law - Judge Dismisses Tribe's ERISA Claims Against Blue Cross Blue Shield

ANN ARBOR, Mich. - A Native American tribe cannot pursue claims that its health care plan administrator violated the Employee Retirement Income Security Act (ERISA) by failing to charge the tribe Medicare-like rates for contracted services at a hospital because the tribe waited too long to sue, a Michigan...

Mealey's Health Law - Judge Denies Chiropractor's Motion To Amend Counterclaims Against Insurer

SEATTLE - A federal judge in Washington on July 27 denied a chiropractor and his practice's motion to amend counterclaims against State Farm Mutual Automobile Insurance Co., finding that the insurer had sufficient reason to report his billing practices to the National Insurance Crime Bureau (NICB...

Mealey's Health Law - Podiatry Firm, Owner Get Fraudulent Billing, Spoliation Claims Dismissed

CHICAGO - A federal judge in Illinois on Aug. 7 granted a motion for summary judgment filed by a podiatry firm and its owner that are accused by a former employee of violating the Illinois Insurance Claims Fraud Protection Act (IICFPA) and illegally destroying medical records, finding that there was...

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...