LexisNexis® Legal Newsroom
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...

Mealey's Health Law - Judge: Insurers Have No Statutory Duty To Pay No-Fault Benefits Claims

DETROIT - A federal judge in Michigan on Dec. 21 granted State Farm Mutual Automobile Insurance Co.'s motion to reconsider and dismissed a health medical practices counterclaims for fraud, civil conspiracy and declaratory relief, finding that pursuant to the Michigan Supreme Court's ruling in...

Mealey's Health Law - California Federal Judge Allows Intervention Into Contraceptive Mandate Suit

SAN FRANCISCO - A religious order has sufficient interests in the outcome of a suit challenging rules broadening the exemptions to the Patient Protection and Affordable Care Act (ACA) contraceptive mandate to permit intervention into the case, a federal judge in California held Dec. 29 (California, et...

Mealey's Health Law - Magistrate Judge Denies Gynecologist's Request For Grand Jury Instructions

BOSTON - A gynecologist accused of wrongfully providing a pharmaceutical drug sales representative access to patients' confidential health information cannot have access to instructions provided to two grand juries, a federal magistrate judge in Massachusetts ruled Jan. 3, holding that the information...

Mealey's Health Law - UnitedHealth, Insureds Battle Over Lactation Coverage Requirements In ACA

SAN FRANCISCO - Insureds create standards for lactation support services the Patient Protection and Affordable Care Act (ACA) does not impose in an attempt to save their suit, an insurance group told a California federal judge on Jan. 5 in support of its motion for summary judgment (Rachel Condry, et...

Mealey's Health Law - New York Federal Judge Dismisses Class Claims Over PBM's Pricing, Allows Amendment

NEW YORK - A New York federal judge on Jan. 5 dismissed Employee Retirement Income Security Act and Racketeer Influenced and Corrupt Organizations Act class claims against the largest pharmacy benefits manager (PBM) and a health insurance provider over prescription pricing, but gave the plaintiffs 21...

Mealey's Health Law - 3rd Circuit Vacates Order Saying GEICO Need Not Pay $2.1M In Pending Claims

PHILADELPHIA - A Third Circuit U.S. Court of Appeals panel on Jan. 10 reversed a federal judge in New Jersey's ruling that allowed the Government Employees Insurance Co. (GEICO) to withhold payment on $2.1 million in pending personal injury protection (PIP) claims submitted by a neurology and rehabilitation...

Mealey's Health Law - United States Says California Abortion Law Governing Licensed Speakers Fails

WASHINGTON, D.C. - Neither pregnancy counseling centers challenging a law requiring that they disclose the availability of abortion services nor the state of California advances the correct standard for analyzing the case, and the law at the heart the case partially fails when properly evaluated, the...

Mealey's Health Law - Aetna Will Pay $17 Million To End Privacy Class Suit By HIV Patients

PHILADELPHIA - Aetna Inc. and related entities (Aetna, collectively) have agreed to pay $17,161,200 to settle privacy claims by more than 13,400 class members whose HIV status was revealed by the insurer through an indiscreet mailing, according to a motion for preliminary approval of a class action settlement...

Mealey's Health Law - Judge Refuses To Remand Fraud Suit For Improper Service To Defendant Doctor

PHILADELPHIA - A federal judge in Pennsylvania on Jan. 12 denied a motion to remand filed by Aetna Inc. and Aetna Health Management LLC, finding that their attempt to provide service to a defendant doctor accused of conspiring to submit claims for an opioid-based pain medication for cancer patients was...

Mealey's Health Law - Judge Chops Fee Request For Tribe's $8 Million Win Over Blue Cross For Hidden Fees

BAY CITY, Mich. - A Michigan Indian tribe that won an $8.4 million award for Blue Cross Blue Shield's charging of hidden administrative fees for the tribe's employee benefit program had its request for attorney fees drastically reduced Jan. 17 by a federal judge, who slashed the fees by 75 percent...