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LexisNexis® Mealey's™ Managed Care Liability Legal News
Headline Managed Care Liability Legal News from LexisNexis®

• 6th Circuit: Claim Barred By Limitations Provision In Contract
  CINCINNATI - A Sixth Circuit U.S. Court of Appeals panel on Dec. 2 affirmed that an insurance company was barred by a contractual limitations provision in the health care contract from bringing suit against one of its participants for failing to disclose that her dependent had a pre-existing medical condition (Medical Mutual of Ohio v. k. Amalia Enterprises Inc., et al., No. 07-4422, 6th Cir.; 2008 U.S. App. LEXIS 24327). Full story on lexis.com
• Divided Ohio Appeals Court Says Issues Remain In Fraud Case
  WARREN, Ohio - In a divided opinion, an Ohio appeals court on Nov. 28 reversed summary judgment in favor of a hospital in a fraud suit, saying questions remained as to whether a hospital defrauded a patient by first billing her health insurer and then her automobile insurer for the same medical bills and then reimbursing the health insurer (Annette Hayberg v. Physicians Emergency Service, Inc., et al., No. 2008-10, Ohio App., 11th Dist.; 2008 Ohio App. LEXIS 5179). Full story on lexis.com
• Parties Reach Proposed Settlement; Attorneys Fight Over Fees
  Case name: Ronald Drazin, et al. v. Horizon Blue Cross Blue Shield of New Jersey; Dawn Beye, et al. v. Horizon Blue Cross Blue Shield of New Jersey; See 10/1/08, Page 12. Full story on lexis.com
• Plaintiffs In Fraudulent Drug-Pricing Case Seek $350 Million Settlement
  Case name: New England Carpenters Health Benefits Fund, et al. v. First Databank Inc., et al., See 6/4/08, Page 7. Full story on lexis.com
• Judge Denies Defendant's Motion To Bar Data From Expert Report
  PHILADELPHIA - A Pennsylvania federal judge on Nov. 25 denied a defendant's motion to bar the plaintiff from introducing claims or evidence concerning invalid prescriber identifications, copayment compliance and specialty drug pricing in a breach of contract dispute, saying the data was not an expansion of the plaintiff's complaint, but only a specification of the damages (Southeastern Pennsylvania Transportation Authority v. CaremarkPCS Health, No. 07-2919, E.D. Pa.; 2008 U.S. Dist. LEXIS 96151). Full story on lexis.com
• 2 Defendants Granted Summary Judgment In Reimbursement Dispute
  HOUSTON - A Texas federal judge on Nov. 28 partially granted summary judgment in favor of two defendants in a reimbursement dispute, saying that the decision to deny coverage was not arbitrary (Tenet Healthcare LTD d/b/a Park Plaza Hospital v. UniCare Health Plans of Texas Inc., No. 07-3534, S.D. Texas; 2008 U.S. Dist. LEXIS 96324; See 1/9/08, Page 8). Full story on lexis.com
• Reimbursement Case Remanded; ERISA Does Not Preempt Claims
  LOS ANGELES - A California federal judge on Nov. 7 remanded to state court a case in which two hospitals were suing insurance companies over allegedly wrongful reimbursement payments, saying the defendants could not show that federal law preempted the claims (USC-Kenneth Norris Jr. Cancer Hospital, et al. v. Aetna Health of California Inc., et al., No. 08-3710, C.D. Calif.; 2008 U.S. Dist. LEXIS 94642). Full story on lexis.com
• Kentucky Judge Rules Insurer Cannot Pursue Subrogation Claim
  LOUISVILLE, Ky. - A Kentucky federal judge said Dec. 1 that although an insurance company would be entitled to pursue discovery to prove its entitlement to equitable relief in a subrogation case, it cannot pursue the claim because it failed to intervene and assert its rights (Humana Health Plans Inc. v. Patti Powell, No. 07-385, W.D. Ky.; 2008 U.S. Dist. LEXIS 97165). Full story on lexis.com
• Judge Allows Discovery Of Medicare Member Names, Phone Numbers
  MIAMI - A Florida federal judge on Nov. 14 granted a defendant's motion to compel discovery of Medicare Advantage member names and numbers in a trade violations case, saying the information sought was not protected health information or individually identifying health information (Preferred Care Partners Holding Corp., et al. v. Humana Inc., No. 08-20424, S.D. Fla.; 2008 U.S. Dist. LEXIS 95930; See 11/3/08, Page 18). Full story on lexis.com
• Magistrate Grants Request For Information On Health Insurance Company Mergers
  NEW YORK - A New York federal magistrate judge on Nov. 21 granted a plaintiff's request in an antitrust case for documents relating to government investigations into mergers between health insurance companies, saying the information is relevant (The City of New York v. Group Health Inc., et al., No. 06-13122, S.D. N.Y.; See 5/2/07, Page 18).