Healthcare Legal Research & News
Healthcare
“Channeling” requirement that Provider receive denial of concrete claim for reimbursement before filing for judicial review applied even to PHE Telehealth services. A federal appeals court in the District of Columbia has affirmed the decision of the ...
A deaf patient’s discrimination claim brought under the Patient Protection and Affordable Care Act for failure to provide an interpreter will proceed. The district court properly determined that a deaf man’s claim of discrimination for failure to pro...
District court did not abuse its discretion in finding that the state had met its outreach and information obligations in the decree and corrective action order in connection with action alleging violations in Medicaid program. The U.S. Court of Appe...
Suit was filed more than two years after the tort claim arose and more than four years after the warranty claims arose. Products liability and warranty claims arising from a failed mesh implant were dismissed as time-barred, an Alabama federal distri...
The $10,205 fine against Redwood Healthcare Center was imposed for violating a Medicare participation requirement that prohibits the use of abuse or involuntary seclusion against residents of a skilled nursing facility. The undisputed facts of this c...
A large pharmacy, which is enrolled with Medicaid programs in approximately 23 states, was allowed to add Medicaid enrollment as a basis for membership in their discount programs, even though their proposal would violate the anti-kickback statute and...
Healthcare
Jury instruction to determine whether employee acted within course and scope of employment when she disclosed the patient’s private health information, was erroneous where patient brought a breach of contract claim against the hospital. The Supreme C...
Common law and state statutory affirmative defenses could apply to EMTALA claims, despite it being a strict liability statute. A federal district court in California has denied a patient’s motion to strike the general denials and all affirmative defe...
Medicare Act broadly preempts state law provisions. A federal district court in Illinois dismissed a specialized urine testing laboratory's state law claims against an insurance carrier who had withheld payments to the lab for claims the insurer deni...
A new trial was denied to a hip implant recipient where the evidence and testimony were proper. A district court in Maryland denied a new trial to a woman who claimed injury from a surgically-implanted artificial hip device. At trial, the jury found ...
A report by the OIG found that CMS should act to address states that fail to survey nursing home performance. The HHS Office of the Inspector General (OIG) published a report on their review of CMS oversight of state survey agencies conducting survey...
The report indicates that more than 5 million beneficiaries struggle to afford medications, particularly in minority populations, and recommends Medicare Part D changes to lighten this burden. The Office of Health Policy’s Assistant Secretary for Pla...
Healthcare
TOP STORY: CMS updates deadlines for compliance with vaccine mandate
The only state not currently subject to the mandate is Texas. Health care workers in the 24 states where the U.S. Supreme Court reinstated CMS’ vaccine mandate must have their first shot by February 14 and be fully vaccinated by March 15, according t...
The incarcerated mastermind of the Daraprim price gouging scheme is also banned for life from the pharma industry. The federal district court in New York City has banned Martin Shkreli, the former CEO of Vyera Pharmaceuticals, LLC (Vyera) who is now ...
The magistrate judge recommended denying a health care provider’s motion to dismiss a qui tam suit which alleged improper Medicaid billing, finding that the relator had sufficiently pled her claims to allow the case to move ahead. This suit arises fr...
Court finds that clarification of citizenship at the time of filing of action and at the time the request for removal was filed is an acceptable reason to amend notice of removal past 30-day period. A federal district court in New Jersey denied a mot...
The CMS contractor properly established the effective date for billing privileges of a practitioner, even though the practitioner had begun offering services earlier, as his earlier enrollment applications had been rejected. A CMS contractor correctl...
The small-group insurance market continues to be an important source of health insurance since the implantation of the ACA. The Urban Institute has published the results of a study on current trends in the small-group insurance market for the years 2...
The FDA announced first of its kind approval of monoclonal antibody drug treatment for osteoarthritis pain in cats. The Food and Drug Administration (FDA) announced the approval of Solensia, the first treatment for the control of pain associated with...
Healthcare
Kentucky Supreme Court was predicted to agree that an average person would not deem a COVID-19 mandate to be a tangible deprivation of property. A dentist whose practice lost income during a six-week shutdown for routine visits as mandated by the sta...
Congress gave instructions that were specific for HHS to consider, going beyond Supreme Court requirements. The Ninth Circuit Court of Appeals affirmed the convictions of three individuals who conspired to violate the Anti-Kickback Statute, finding t...
Although Omnicare’s headquarters were in Ohio, there was no location deemed the “center of gravity of the litigation” where the false claims complained of were carried out from 147 pharmacies nationwide. A federal district court in New York has denie...
A suit brought in federal court to challenge an Idaho determination that the adult child caregiver exception to prohibited transfers under Idaho’s Medicaid Asset Transfer Penalty did not apply was dismissed for lack of federal jurisdiction, as a dete...
HRSA updated the Women’s Preventive Services Guidelines in late 2021 to expand preventive coverage for women under the ACA, including adding a provision regarding obesity screening. The Health Resources and Services Administration (HRSA) of the HHS a...
A recent ASPE Brief assesses trends in deductibles among 2017–2021 HealthCare.gov enrollees and discusses the effects of the American Rescue Plan on coverage. An Issue Brief by the Office of Health Policy within HHS’s Assistant Secretary for Planning...
Report finds that workers in thirty-seven states have premiums and deductibles that take up ten percent or more of their income. The Commonwealth Fund has released a state-by-state analysis of healthcare costs in the United States. Although employer ...
Healthcare
TOP STORY: Supreme Court stays injunctions that barred enforcement of CMS vaccine mandate
According to the Court, ensuring that providers take steps to avoid transmitting a “dangerous virus to their patients is consistent with the fundamental principle of the medical profession: first, do no harm.” The U.S. Supreme Court, ruling 5-4, has ...
FCA claims for worthless services billing were not supported. A federal district court in Pennsylvania dismissed a nurse's False Claims Act (FCA) complaint that alleged Medicare and Medicaid billings for services not provided by the healthcare facili...
“Courts in this country have held for over a century that mandatory vaccination laws are a valid exercise of a state’s police powers, and such laws have withstood constitutional challenges.” Refusing to enjoin enforcement of an emergency regulation i...
Ordering 84 million Americans to either obtain a COVID-19 vaccine or undergo weekly medical testing at their own expense, is a “significant encroachment into the lives—and health—of a vast number of employees.” Finding that the states, businesses, an...
Motions to exclude expert testimony in pelvic mesh product liability suit find same results as during multidistrict litigation under law of the case doctrine. Five motions to exclude trial testimony of certain experts in a product liability lawsuit f...
In a final rule effective February 14, 2022, the FDA is revoking the standard of identity for French dressing. In response to a citizen petition, the FDA revokes the FDA’s standard of identity for French dressing. Concluding that the standard no long...
The Department of Justice entered into a settlement agreement with an Ohio home health care agency to settle claims for group setting nursing services improperly submitted to Medicaid as individual services, resulting in greater reimbursement than du...
Guidance clarifies that individuals who purchase over the counter COVID-19 tests (OTC tests) can seek reimbursement from their insurance provider. The Departments of Labor, HHS, and the Treasury (the departments) have addressed frequently asked quest...