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Mealey's Health Law - Home Health Agency Administrator Sentenced To 126 Months For Fraud

MIAMI - An administrator of a home health agency was sentenced to 126 months in prison by a federal judge in Florida on Feb. 24, after the defendant was found guilty for his role in a $2.5 million Medicare fraud scheme (United States of America v. Raciel Leon, et al., No. 16cr20476, S.D. Fla.).

Mealey's Health Law - Man Who Posed As Physician As Part Of Fraud Scheme Found Guilty

HOUSTON - A man who posed as a physician as part of a $1.3 million Medicare fraud scheme was found guilty on counts of conspiracy to commit health care fraud, health care fraud and conspiracy to pay health care kickbacks by a federal jury in Texas on March 3 (United States of America v. Nkiru Ibeabuchi...

Mealey's Health Law - Judge Refuses To Dismiss State Farm's Suit Alleging No-Fault Insurance Scheme

DETROIT - A federal judge in Michigan on March 6 denied a motion to dismiss filed by defendants accused by State Farm Mutual Automobile Insurance Co. of submitting false bills under Michigan's No-Fault Automobile Insurance Act for services that were either medically unnecessary or never provided...

Mealey's Health Law - 4th Circuit Reinstates Retaliation Claim In Suit Over Overbilling Clinics

RICHMOND, Va. - A federal judge in Virginia erred in finding that a physical therapist assistant's retaliation claim against his employer should be dismissed, finding that they were not subject to the False Claims Act's (FCA) first-to-file rule, a Fourth Circuit Court of Appeals ruled March 16...

Mealey's Health Law - Judge Finds Jurisdiction Lacking In Insolvent Insurer's Suit Over ACA Payments

ST. LOUIS - An insolvent insurer's suit against the government over its handling of the Patient Protection and Affordable Care Act (ACA) risk corridor and how it offset debts properly belongs before the U.S. Court of Federal Claims, a federal judge in Iowa said March 17 in finding that she lacked...

Mealey's Health Law - Drug Makers, Benefit Managers Hit With Class Suit Alleging Insulin Pricing Scheme

NEWARK, N.J. - Three drug makers and the three largest pharmacy benefit managers have engaged in a pricing scheme to drive up the cost of diabetes insulin - by more than 150 percent in the last five years - in violation of the Racketeer Influenced and Corrupt Organizations Act, the Employee Retirement...

Mealey's Health Law - Judge Nixes Class In Insureds' Suit Claiming Pharmacy Gouged On Generic Drugs

SAN FRANCISCO - The variety of contracts at issue and evidence that at least some of the contracted pharmacy benefit managers (PBMs) understood that a pharmacy's usual and customary rate did not include the rate offered for generic drugs in its membership program defeat a motion for class certification...

Mealey's Health Law - ERISA Not The Vehicle For Health Centers' Suits Against Insurers, 9th Circuit Says

SAN FRANCISCO - Health care centers designated to receive direct payment from a health plan administrator for medical services cannot file suit in federal court under the Employee Retirement Income Security Act because they lack both direct statutory authority and derivative authority through assignment...

Mealey's Health Law - Judge Dismisses ERISA Action Involving Proton Beam Therapy Coverage Denial

BIRMINGHAM, Ala. - A man's Employee Retirement Income Security Act (ERISA) suit impermissibly seeks equitable relief in the face of other available remedies, a federal magistrate judge in Alabama held March 23 (Jeffrey Woodruff v. Blue Cross and Blue Shield of Alabama, et al., 2017 U.S. Dist. LEXIS...

Mealey's Health Law - Judge Trims Some Claims Over Billing For Vein Procedures Due To Pleadings

CHICAGO - A federal judge in Illinois dismissed without prejudice claims from a man that his former employer falsely billed Medicare, Medicaid and other private insurers for endovascular laser therapy (EVLT) procedures that were not medically necessary or done with reused laser fibers, finding that the...

Mealey's Health Law - Judge Hands Insurer Mixed Results In Colorectal Cancer Test Coverage Case

GREENSBORO, N.C. - An insurer received mixed results in its challenge to claims that it failed to properly compensate the developer of a colorectal cancer screening test, with a federal judge in North Carolina dismissing some of the claims on March 27 but largely allowing Employee Retirement Income Security...

Mealey's Health Law - Washington Settles Class Suit Over Denial Of Hepatitis C Medication

SEATTLE - A Washington federal judge on April 10 issued an order granting final approval of a settlement under which the Washington State Health Care Authority (WHCA) has agreed to provide coverage for direct-acting antiviral medications for the treatment of hepatitis C (HCV) for Medicaid enrollees who...

Mealey's Health Law - Failed ACA Insurer Claims HHS Improperly Withholds Reinsurance Funds

COLUMBIA, S.C. - The government is improperly withholding payments from, and setting off debts owed by, a failed South Carolina Patient Protection and Affordable Care Act (ACA) co-operative insurer, illegally placing its own interests before those of policyholders and others entitled to priority, the...

Mealey's Health Law - Judge Affirms Ruling Finding Conflict Between Fraud Defendant And Attorney

BUFFALO, N.Y. - A federal judge in New York on May 12 upheld a magistrate judge's decision finding that an attorney representing a man accused of health care fraud should be removed as his counsel due to a conflict of interest because the government intends to call him as a witness (United States...

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...