LexisNexis® Legal Newsroom
Mealey's Health Law - Pennsylvania Panel Affirms Conviction Of Pain Clinic Owner For Fraudulent Billing

PHILADELPHIA - A Pennsylvania Superior Court panel on July 7 affirmed the conviction of a pain clinic owner for conspiracy, theft and insurance fraud after finding that the evidence presented during his trial supported the verdict and that the trial court judge did not err when allowing the Commonwealth...

Mealey's Health Law - 11th Circuit Upholds Pharmacy Owner's 144-Month Sentence For Fraud

ATLANTA - An 11th Circuit U.S. Court of Appeals panel on July 15 found no error in a federal judge in Florida's decision to sentence a pharmacy owner to 144 months in prison, ruling that the judge did not err when finding that the defendant's fraudulent billing of prescription medication to Medicare...

Mealey's Health Law - 2nd Circuit: Health Care Providers Lack Standing To Assert Retaliation Claims

NEW YORK - Health care providers are not beneficiaries of their patients' health insurance plans and, therefore, do not have standing to assert anti-retaliation protections under the Employee Retirement Income Security Act, the Second Circuit U.S. Court of Appeals affirmed July 15 (Henry L. Rojas...

Mealey's Health Law - 3rd Circuit: Judge Did Not Err When Enhancing Sentencing For Fraud

PHILADELPHIA - A federal judge in Pennsylvania did not err when sentencing a woman to 96 months in prison for her role in an insurance fraud scheme that resulted in Medicare and other supplemental insurers paying approximately $1.8 million in false claims, a Third Circuit U.S. Court of Appeals panel...

Mealey's Health Law - Multiemployer Health Fund's Reimbursement Suit Seeks Legal Relief, 8th Circuit Says

ST. LOUIS - A multiemployer health fund is not entitled to equitable relief in the amount it paid in medical benefits to students who were also covered by student accidental medical insurance under the fund's coordination-of-benefits provision pursuant to the Employee Retirement Income Security Act...

Mealey's Health Law - Medicare, Not Employer, Was Primary Provider, South Carolina Federal Judge Says

GREENVILLE, S.C. - A health insurer was not the primary payer for an employee's medical claims because the plan at issue clearly stated that Medicare was the primary payer if an insured received Medicare benefits, a South Carolina federal judge said Sept. 30 (Jennifer Perkins v. US Airways Inc.,...

Mealey's Health Law - Medical Providers Are Not Beneficiaries, 7th Circuit Determines

CHICAGO - Because a number of medical providers alleging that an insurer wrongfully reduced payments on health claims are not beneficiaries to an insurance contract, they are not entitled to allege claims under the Employee Retirement Income Security Act of 1974, the Seventh Circuit U.S. Court of Appeals...

Mealey's Health Law - Health Insurer's Denial Supported By The Record, 2nd Circuit Panel Says

NEW YORK - The Second Circuit U.S. Court of Appeals on Oct. 15 determined that a health benefits insurer did not wrongfully deny a claim for residential treatment because four physicians noted in the administrative record that residential treatment was not necessary (Neil Tansey, et al. v. Anthem Health...

Mealey's Health Law - Vermont, Insurer Square Off Before Top Court Over Preemption Of Reporting Rules

WASHINGTON, D.C. - The State of Vermont and an insurer squared off before the U.S. Supreme Court Dec. 2 in oral arguments over whether the Employee Retirement Income Security Act, as amended by the Patient Protection and Affordable Care Act (ACA), preempts state level collection of health insurance data...

Mealey's Health Law - West Virginia Federal Judge Dismisses Counterclaim In ERISA Preemption Case

WHEELING, W.Va. - A breach of contract counterclaim brought in response to an action seeking a declaration that the Employee Retirement Income Security Act preempts a request for indemnification was dismissed Dec. 10 by a West Virginia federal judge (Ohio Valley Health Services & Education Corporation...

Mealey's Health Law - Insurer Must Provide Hospital Ranking Method In Suit Over New Health Plan

HACKENSACK, N.J. - A New Jersey judge on Dec. 17 granted a motion for expedited discovery brought by a group of hospitals, finding that their requests for documents related to certain hospital-ranking methodology and resulting scores of hospitals that are not parties to the suit are relevant to their...

Mealey's Health Law - ERISA Fiduciary Duty Claims Related To Denial Of Autism Treatment Continue

PORTLAND, Ore - A federal judge in Oregon on Jan. 7 denied a health insurers' motion to dismiss claims alleging that it breached its fiduciary duties under the Employee Retirement Income Security Act by denying coverage for applied behavioral analysis (ABA) therapy for the treatment of autism-related...

Mealey's Health Law - 8th Circuit: Injunctive Relief Not Available In Pharmacies' Suit Against PBM

ST. LOUIS - Compounding pharmacies are not entitled to injunctive relief against a pharmacy benefits manager for denial of claims in violation of the Employee Retirement Income Security Act's claims regulation, the Eighth Circuit U.S. Court of Appeals affirmed Jan. 11 (Grasso Enterprises, LLC, et...

Mealey's Health Law - High Court: Enforcement Of Equitable Lien Against General Assets Is Not Equitable Remedy

WASHINGTON, D.C. - The U.S. Supreme Court ruled 8-1 on Jan. 20 that an employee welfare plan fiduciary may not bring a suit under Employee Retirement Income Security Act Section 502(a)(3) to attach a participant's separate assets when the participant wholly dissipated a third-party settlement on...

Mealey's Health Law - DOJ: California Hospital To Pay $3.2M To Settle Claims Over Illegal Referrals

WASHINGTON, D.C. - The U.S Department of Justice (DOJ) announced Jan. 15 that a California hospital has agreed to pay $3.2 million to resolve allegations that it violated the Stark Law and False Claims Act by maintaining financial arrangements with referring physicians.

Mealey's Health Law - Anthem, Insureds Argue Whether Data Breach Suit Should Be Dismissed

SAN JOSE, Calif. - In respective reply briefs filed Jan. 19, Anthem Inc. and related insurers argued in support of their motions to dismiss a putative class action over a January 2015 breach of Anthem's network, asserting that the plaintiffs did not adequately specify the allegedly breached contractual...

Mealey's Health Law - Aetna Prevails In 1 Wisconsin ERISA Case; Dismissal Denied in Another

MADISON, Wis. - A challenge by the University of Wisconsin Hospitals and Clinics Authority (UWHCA) of an insurer's denial of payment was rejected on summary judgment Jan. 25 by a Wisconsin federal judge in light of an anti-assignment provision in the parties' contract; the same day, UWHCA's...

Mealey's Health Law - Split 6th Circuit Reverses Lifetime Benefits Ruling For Moen Retirees

CINCINNATI - A divided Sixth Circuit U.S. Court of Appeals panel on Feb. 8, based on the U.S. Supreme Court's decision in M&G Polymers USA, LLC v. Tackett (135 S. Ct. 926 [2015]), reversed a district court's ruling in favor of a class of retirees from Moen Inc. who argued that their collective...

Mealey's Health Law - Maryland Woman Pleads Guilty For Forging Prescriptions As Part Of Fraud Scheme

WASHINGTON, D.C. - A Maryland woman pleaded guilty on Feb. 25 to charges of forging prescriptions and being involved with a health care fraud scheme and agreed to pay $16,175 (United States of America v. Claire Elizabeth Rice, No. 14-cr-56, D. D.C.).

Mealey's Health Law - Olympus Pays $646M In Criminal, Civil Penalties For Kickbacks, False Claims

NEWARK, N.J. - Olympus Corp. of the Americas and a Latin America subsidiary will pay $646 million in criminal and civil penalties for paying kickbacks to health care providers to buy its endoscopes and causing false claims to be paid by federal health care programs, according to documents filed March...

Mealey's Health Law - High Court Remands Case Involving Michigan Law Aimed At Raising Medicaid Revenue

WASHINGTON, D.C. - The U.S. Supreme Court on March 7 directed the Sixth Circuit U.S. Court of Appeals to reconsider its ruling that the Employee Retirement Income Security Act does not preempt a Michigan state law established to generate revenue necessary to fund the state's obligations under Medicaid...

Mealey's Health Law - Federal Judge: Tribe Sufficiently States ERISA Claims Against Blue Cross

DETROIT - Claims by a Native American tribe that Blue Cross Blue Shield of Michigan violated the Employee Retirement Income Security Act (ERISA) by overbilling the tribe for services rendered as third-party administrator for tribal members' health care claims survived a motion to dismiss April 27...

Mealey's Health Law - Spouse Lacks Standing To Assert Claims In ERISA Suit, 3rd Circuit Rules

PHILADELPHIA- A spouse lacks standing to assert a claim under the Employee Retirement Income Security Act against his spouse's former employer regarding an alleged failure to timely send notice for health insurance coverage because the spouse was not a beneficiary or participant in the plan, the...

Mealey's Health Law - Durable Medical Equipment Provider Sentenced For Medicare Fraud Scheme

TAMPA, Fla - The owner of a company that provided durable medical equipment was sentenced by a federal judge in Florida on June 13 to 37 months in prison and ordered to pay $$918,402 in restitution for his role in a $2.5 million Medicare fraud scheme (United States of America v. Ubert G. Rodriguez, No...

Mealey's Health Law - Judge Places ACA Health Care Marketplace Co-Op Into Rehabilitation

CHICAGO - An Illinois judge on July 14 placed a Patient Protection and Affordable Care Act (ACA) health care marketplace co-op into rehabilitation because, according to the state's acting director of insurance, the insurer will suffer a $68 million loss due to the actions of Congress and the Centers...