LexisNexis® Legal Newsroom
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...

Mealey's Health Law - 7th Circuit Upholds Fraud Sentences For Medical Office Manager, Billing Agent

CHICAGO - A federal judge in Illinois did not err when sentencing a home health care office manager and billing specialist following their convictions for health care fraud and conspiracy to commit health care fraud, a Seventh Circuit U.S. Court of Appeals panel ruled Jan. 19, holding that the reasoning...

Mealey's Health Law - 11th Circuit Upholds Couple's Conviction For $12M Insurance Fraud Scheme

ATLANTA - An 11th Circuit U.S. Court of Appeals panel on Jan. 23 refused to vacate a couple's convictions and sentences for a $12 million insurance fraud scheme that involved their clinics overcharging Universal Health Care Insurance Co. for treatment of patients with HIV, finding that the judge...

Mealey's Health Law - Judge Finds Vague ERISA Claims Don't Put Insurer On Notice Of Claims

ATLANTA - A hospital's general references to Employee Retirement Income Security Act plans is not sufficiently specific to put a health care insurer on notice of the claims against it, and requiring at least a summary of the number of plans in question would not hamper judicial efficiency, a federal...

Mealey's Health Law - Spine Center's ERISA Claims Survive Dismissal, Federal Judge Says

TRENTON, N.J. - A medical provider has a valid assignment of Employee Retirement Income Security Act benefits, and it is too early in its litigation against an insurer to determine if its claims seek duplicative recovery, a federal judge in New Jersey held Feb. 2 (University Spine Center v. Anthem Blue...

Mealey's Health Law - Doctor Pleads Guilty To Fraudulent Billing, Dispensing Controlled Substances

BOWLING GREEN, Ky. - A doctor pleaded guilty on Feb. 5 in Kentucky federal court to intentionally distributing and dispensing controlled substances outside the course of professional practice and submitting fraudulent bills to Medicare and Medicaid and agreed to serve eight years in prison (United States...

Mealey's Health Law - Surgeon Sentenced To 196 Months In Prison For Fraudulent Billing Scheme

NEW YORK - A surgeon who was found guilty of one count of health care fraud, three counts of making false statements related to health care matters and two counts of money laundering was sentenced by a federal judge in New York on Feb. 7 to 196 months in prison and ordered to pay $7.2 million in restitution...

Mealey's Health Law - Aetna Says California Investigation Based On 'Out Of Context' Comments

SACRAMENTO, Calif. - Lawyers took deposition comments from a medical claims reviewer out of context to create trial and media leverage, Aetna Inc. says in a Feb. 14 response to an announcement that California would investigate the insurer's claims processing.

Mealey's Health Law - Judge Rejects Indiana's Challenge To ACA Employer Mandate

INDIANAPOLIS - Res judicata and U.S. Supreme Court precedent require judgment in favor of the federal government in a state's and school district's attack on the Patient Protection and Affordable Care Act (ACA) employer mandate, a federal judge in Indiana held Feb. 14 (Indiana, et al. v. Internal...

Mealey's Health Law - Judge Dismisses UCL Claim In Health Insurance Benefit Assignability Case

LOS ANGELES - While not preempted by ERISA, substance abuse providers' California unfair competition law (UCL) claim alleging that insurers misrepresented the assignability of health insurance benefits falls short of pleading an injury for standing purposes, a California federal judge held May 1...

Mealey's Health Law - Employers Escape Transgender Discrimination Case; ACA Claim Dismissed

MADISON, Wis. - Direct employers are not subject to liability in a case alleging discrimination against transgender individuals in the provision of health insurance, but claims against the providers of that insurance may proceed, and the plaintiffs can amend their Patient Protection and Affordable Care...

Mealey's Health Law - Judge Remands Suit Against Health Provider, Shows Concern Over ERISA's Fairness

BOSTON - A man's suit against a provider who allegedly misled him regarding potential insurance coverage for his daughter's mental health treatments in an effort to trump up prices does not implicate ERISA at this stage, a federal judge in Massachusetts held May 14 in remanding the case (Samuel...

Mealey's Health Law - 3rd Circuit: Anti-Assignment Provision Bars ERISA Health Insurance Suit

PHILADELPHIA - Anti-assignment provisions in health insurance contracts are enforceable and bar a provider's Employee Retirement Income Security Act suit, the Third Circuit U.S. Court of Appeals held May 16 (American Orthopedic & Sports Medicine v. Independence Blue Cross Blue Shield, et al....

Mealey's Health Law - Court: UCL Claim Escapes ERISA Preemption, But Not Summary Judgment

LOS ANGELES - Intentional tort claims escape ERISA preemption, but the failure to allege that insurance defendants denied payments specifically to assist a competing provider dooms a chiropractic care provider's unfair competition law (UCL) claim, a California appeals court held in an opinion published...

Mealey's Health Law - Amici Warn Of Domino Effect, Higher Health Costs If ERISA Preemption Ruling Stands

WASHINGTON, D.C. - An Oklahoma Supreme Court ruling finding an insured's suit against a provider outside ERISA's preemption powers could topple the first domino in a chain leading to higher prices for health care generally, an amicus curiae group warns the nation's top court in a June 4 brief...

Mealey's Health Law - 9th Circuit: Mental Health Law Mandates Inpatient Room And Board Coverage

SAN FRANCISCO - Health insurance plans covering room and board for medical and surgical procedures must do so for inpatient mental health stays as well under federal law, a Ninth Circuit U.S. Court of Appeals panel held June 6 in reinstating an Employee Retirement Income Security Act action (Danny P...

Mealey's Health Law - Judge Denies General Practitioner's Motion To Vacate Fraud Conviction

SAN JOSE, Calif. - A federal judge in California on June 8 denied a general practitioner's motion for acquittal on charges of health care fraud, finding that the spreadsheets and explanation of benefit (EOB) documents presented by the government constituted sufficient evidence showing that the doctor...

Mealey's Health Law - Medicare Doesn't Preempt Breach Of Contract Claims By Hospital Group, Judge Says

LOS ANGELES - Medicare doesn't preempt a hospital group's breach of contract action alleging that an insurer downcoded claims in an effort to underpay on bills, a federal judge in California held June 22 (Prime Healthcare Services Inc. v. Humana Insurance Co., et al., No. 16-1097, C.D. Calif...

Mealey's Health Law - Supreme Court Sees Challenge To Abortion Disclosure Law As Likely To Prevail

WASHINGTON, D.C. - Crisis pregnancy centers are likely to prevail on the merits of their challenge to a California law imposing certain disclosures on similar providers, a 5-4 majority of the U.S. Supreme Court held June 26 (NIFLA, et al. v. Xavier Becerra, et al., No. 16-1140, U.S. Sup.).

Mealey's Health Law - Judge Won't Reconsider Remand Of Liquidation Action Featuring ACA Insurer

CHICAGO - A liquidation procedure involving a Patient Protection and Affordable Care Act (ACA) nonprofit health insurer is exactly the type of proceeding where Congress defers to states, a federal judge in Illinois held July 2 in once again finding that the case should be remanded (Melissa Dowling v...

Mealey's Health Law - Health Insurer UCL Claims Lack Specifics; Anti-Assignment Provision Bars Action

SANTA ANA, Calif. - Anti-assignment provisions preclude a plastic surgery center's suit challenging denial of health insurance claims, and the provider lacks the necessary specificity to plead California unfair competition law (UCL) claims, an insurer says July 16 in asking a California federal judge...

Mealey's Health Law - Health Insurer, Employer Say Providers, Not Patient, Authored ERISA Complaint

TRENTON, N.J. - An amended complaint largely "regurgitates" allegations previously rejected as insufficient and was likely authored not by the plaintiff, but the health care providers dismissed from the case, a health insurer and employer argue in a July 16 brief seeking dismissal of ERISA...