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Mich. Appeals Court Affirms, Reverses Class Order In Reimbursement Suit
DETROIT - A Michigan appeals panel on April 18 partially affirmed and partially reversed class certification in a suit alleging that a health insurer failed to properly reimburse chiropractors...
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New Jersey Federal Judge Recuses Self From Reimbursement Class Suit
NEWARK, N.J. - A New Jersey federal judge on April 15 recused himself from a class action multidistrict litigation case involving a dispute over out-of-network reimbursement rates, saying he had a...
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New Jersey Federal Judge Declines To Recuse Self From Reimbursement Suit
NEWARK, N.J. - A New Jersey federal judge on April 15 declined to recuse himself from a case in which health plan participants are suing a health care insurer for using flawed data to calculate the...
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11th Circuit: Participant's Benefits-Denial And Disclosure Claims Fail
ATLANTA - A plan insurer's calculation of benefits due to a participant for his out-of-network surgery was not wrong under the plan terms, and the insurer did not violate the Employee Retirement Income...
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Federal Judge Dismisses 4 Defendants In Payment Dispute; 7 Defendants Remain
NEWARK, N.J. - A New Jersey federal judge on April 17 dismissed claims against four health care payers in a reimbursement dispute, saying that either the defendants were not subject to the Employee...
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Federal Judge Upholds Benefit Denial Despite Faulty Administrative Claims...
MEMPHIS, Tenn. - A health insurance plan administrator's denial of benefits was not arbitrary and capricious, even though the administrator gave three different reasons for the denial at different...
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New York Federal Judge Dismisses Copay Dispute For Lack Of Standing
NEW YORK - A New York federal judge on April 19 dismissed a health care copayment dispute, finding that the plaintiff lacked standing to bring her claims (Marianne Gates v. United Healthcare Insurance...
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Wisconsin Court Affirms, Reverses Award Judgment In Health Care Bill Suit
WAUSAU, Wis. - A Wisconsin appeals court on April 2 partially affirmed and partially reversed a dispute seeking payment for medical bills from a health care provider after the provider failed to obtain...
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Texas Supreme Court: Providers Cannot Assert Pay Violation Against HMO
AUSTIN, Texas - The Texas Supreme Court on April 19 held that health care providers could not assert a prompt-pay violation against a health maintenance organization because it had contracts only with...
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Oklahoma Federal Judge Declines To Dismiss Prescription Drug Payment Suit
OKLAHOMA CITY - An Oklahoma federal judge on April 18 denied a motion to dismiss a breach of contract claim related to the payment for prescription drugs, saying that the court had personal...
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California Federal Judge Dismisses Conspiracy Claims Against Kaiser, Union
SAN DIEGO - A hospital system failed to allege that a managed care organization and its related entities conspired with a labor union to exclude competition in the markets for emergency and acute care...
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Ark. Federal Judge Declines To Dismiss Wrongful Rescission Of Health Policy Suit
JONESBORO, Ark. - An Arkansas federal judge on April 18 denied a health insurer's motion to dismiss a wrongful rescission of a health insurance policy, saying the plaintiff pleaded a plausible claim...
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9th Circuit: Medicare Does Not Allow Insurer To Recover Survivor's Benefits
SAN FRANCISCO - A Ninth Circuit U.S. Court of Appeals panel on April 19 affirmed that a private Medicare Advantage Organization (MAO) plan cannot sue a plan participant's survivors for reimbursement of...
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6th Circuit Denies Medicaid Appeal As Moot, Affirms Denial Of Bond Motion
CINCINNATI - A Sixth Circuit U.S. Court of Appeals panel on April 24 dismissed as moot an appeal challenging an order granting a temporary injunction in a Medicaid provider dispute and affirmed the...
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6th Circuit Affirms Decision In Medicaid Payment Dispute
CINCINNATI - A Sixth Circuit U.S. Court of Appeals panel on April 22 affirmed that the U.S. Department of Health and Human Services secretary's decision to omit waiver-expansion population patients...
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Supreme Court Denies Review Of 7th Circuit Indiana Medicaid Dental Care Dispute
WASHINGTON, D.C. - The U.S. Supreme Court on April 22 denied a writ of certiorari to the Indiana Family and Social Services Administration's appeal of a federal appeals court decision requiring the...
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California Federal Judge Allows Medicaid Claims To Continue
OAKLAND, Calif. - A California federal judge on April 26 declined to dismiss a federal and state False Claims Act case brought against a nonprofit health center for alleged Medicaid violations (United...
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Judge Finds 'Expense Incurred' Applies To Insured's Medicare-Adjusted Amount
BEAUFORT, S.C. - A health insurance provider properly reimbursed its insured for the actual amount paid to a medical provider after adjustments were made by Medicare, a South Carolina federal judge...
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4th Circuit Affirms Health Care Fraud Conviction Against Doctor
RICHMOND, Va. - The Fourth Circuit U.S. Court of Appeals on April 23 affirmed a federal jury conviction of a Maryland cardiologist for health care fraud, saying there was sufficient evidence that he...
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Va. Provider Must Repay Medicaid For Services By Unqualified Workers
RICHMOND, Va. - The Virginia Court of Appeals on April 16 affirmed a trial court order granting summary judgment to the Virginia Department of Medical Assistance Services (DMAS) ordering the Family...
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