In a somewhat unexpected but highly significant move, United States District Judge David Procter (Northern District of Alabama), who is presiding over the In re Blue Cross Blue Shield Antitrust Litigation (Case No. 2:13-cv-20000, N.D. Alabama), has granted defendants’ request that he certify his ruling that the defendants’ alleged conduct should be assessed under a per se standard (and not … Continue Reading
Category Archives: Healthcare Litigation
Subscribe to Healthcare Litigation RSS FeedPharmacies Accuse Drug Maker of Anticompetitive Contracting to Restrict Biosimilar Market
Walgreens and Kroger have filed an antitrust action in the United States District Court for the Eastern District of Pennsylvania accusing Johnson & Johnson (J&J) of engaging in anticompetitive conduct designed to stymie the growth of biosimilar alternatives to J&J’s Remicade, a biologic drug used to treat certain chronic immune disorders (Walgreen Co. v. Johnson & Johnson, Case … Continue Reading
U.S. Supreme Court Rules That Class Action Waivers Are Enforceable
Employers may require employees to enter into arbitration agreements that waive such employees’ ability to participate in a class or collective action lawsuit, the U.S. Supreme Court ruled this week. In a long-awaited decision that represents a significant victory for employers, the Court in Epic Systems Corp. v. Lewis held that such agreements do not violate the National Labor Relations … Continue Reading
Health Insurers Contend Allergy Test Maker’s Antitrust Claims Make No Economic Sense – Seek Early Dismissal on that Basis
Three health insurers accused of having violated the antitrust laws in Academy of Allergy & Asthma in Primary Care v. Blue Cross Blue Shield of Louisiana, et al. (Eastern District of Louisiana), have filed motions seeking a swift win in the matter prior to the commencement of discovery. In support of their request, Humana, Blue Cross Blue Shield of Louisiana … Continue Reading
Reversal of Fortune: Rhode Island Court Withdraws “Tentative” Decision to Grant Summary Judgment to Health Insurer in Health System Antitrust Case and Sets Matter for Trial
In what was a surprise result, on April 23, Judge William Smith (Chief Judge of the District of Rhode Island) reversed the “tentative” decision he had announced last November, in Steward Health v. Blue Cross & Blue Shield of Rhode Island, which would have granted defendant Blue Cross & Blue Shield of Rhode Island (BCBS-RI) summary judgment on all claims … Continue Reading
Partial Summary Judgment Granted to Plaintiffs in the In re Blue Cross Blue Shield Antitrust Litigation MDL Proceeding
On April 5, United States District Judge David Proctor (N.D. Alabama) granted partial summary judgment to the plaintiffs in the In re Blue Cross Blue Shield Antitrust Litigation, ruling that a network of trademark licensing agreements between the Blue Cross Blue Shield Association and its member insurance companies (referred to as the ‘Blues’), which plaintiffs characterized as “horizontal market allocation … Continue Reading
Outpatient Surgery Center Avoids Dismissal of Antitrust Action Through an Assist from the DOJ
In 2012, Marion Healthcare, an outpatient surgery center in southern Illinois, commenced an antitrust action against Southern Illinois Healthcare (“SIH”), a multi-hospital system operating in the same market. Marion alleged that SIH had negotiated exclusive dealing relationships with several area health insurers, and that these agreements made it difficult, if not impossible, for Marion to compete for surgical patients in … Continue Reading
New Consequences for Unpaid Medicare Overpayments
For years, CMS has had the authority to refuse to enroll new Medicare providers if they or their owners have an unpaid Medicare overpayment, but CMS was not exercising this authority. Now, it appears that CMS is going to start. In January, CMS published Transmittal 1998 announcing that it intends to begin denying provider enrollment applications, or change-of-ownership applications, where … Continue Reading
Has the DOJ Signaled a More Critical Approach to FCA Cases?
Defendants have faced an ever increasing number of qui tam actions, yet the government has historically declined to seek dismissal of those actions where it declined to intervene. On January 10, 2018, the Director of the DOJ Civil Division Commercial Litigation Branch’s Fraud Section issued a memorandum to all DOJ attorneys, including AUSAs, advising them that when declining to intervene … Continue Reading
Florida Federal Court: Escobar Requires Reversal of $348 Million False Claims Act Jury Verdict
The United States District Court for the Middle District of Florida vacated a large jury verdict in a False Claims Act case against the owners and operators of nursing homes because the evidence did not satisfy the materiality standards articulated in the U.S Supreme Court’s 2016 opinion in Universal Health Services v. Escobar.
The court’s thorough and well-written opinion … Continue Reading
AHCA Sees the Light on Nursing Home Generator Rule, Unplugging Challenge
After Hurricane Irma made landfall in Florida, a nursing home in South Florida lost power, and several residents of that nursing home died allegedly as the result of increased temperatures caused by the loss of air conditioning. In the immediate aftermath of this tragic accident, the Agency for Health Care Administration (AHCA) (for nursing homes) and the Department of Elder … Continue Reading
Florida Supreme Court: Referral Sources Can Be Protected By A Non-Compete
Big news for home health agencies and others whose business comes from referral sources: the Florida Supreme Court just held that referral sources are the kind of protectable business interest that will support a non-compete agreement. Home health agencies, like other health care businesses, routinely use non-compete agreements to prevent marketing employees from leaving and going to work for direct … Continue Reading
The Treating Physician: Entitled to Expert Witness Fees at Trial?
When is a treating physician considered an expert witness and therefore entitled to expert witness fees when he testifies at trial? Apparently, the Florida District Courts of Appeal have formulated the typical lawyer response – it depends!… Continue Reading
“Sometimes Wrong, Never in Doubt” – A New Perspective?
Two recent studies of medical malpractice claims highlight how patient complaints may identify those surgeons at greater risk for complications, a significant decrease in paid medical malpractice claims since 1992, and the need for greater understanding of the causes of differences in claims experience across medical specialties.… Continue Reading
Requiring A Flu Shot Over Religious Objections: Risky Business
It’s flu season and many employers, particularly those in healthcare, want to require employees to be vaccinated to minimize the spread of illness. But what happens when an employee refuses on religious grounds?… Continue Reading
When a Discount May be a Kickback
Healthcare providers of all kinds, as well as medical equipment suppliers, have traditionally relied upon discounts as a legitimate means of attracting patients and commercial clients without running afoul of the federal anti-kickback statute (AKS). Congress specifically created the discount “safe harbor” to the AKS years ago based on its policy of encouraging discounts that are properly disclosed as a … Continue Reading
Former Home Health Agency Owner Sentenced to 20 Years for $57MM Medicare Fraud
The US Department of Justice announced that Khaled Elbeblaswy, the former owner and manager three Miami-area home health agencies, was sentenced to 20 years in prison and ordered to pay $36.4 million in restitution for his role in a $57 million Medicare fraud scheme.… Continue Reading
11th Circuit Awards Humana Double Damages Under Medicare Secondary Payer Act
Humana Medical Plan, Inc. v. Western Heritage Insurance Co., case number 15-11436.
Liability insurers beware, as the 11th Circuit held that Medicare Advantage Organizations (MAO) are entitled to the same rights Medicare itself would have in actions against primary payers for reimbursement of conditional healthcare treatment costs. … Continue Reading
Federal Court finds “Systemic Failure” in Processing of Administrative Appeals for Medicare Reimbursement Claims
A win for efficiency: The AHA suit may force shorter adjudication times for Medicare administrative appeals. In 2014, the American Hospital Association (AHA), along with three hospital systems, filed suit against the U.S. Department of Health and Human services, alleging that the lengthy adjudication time for administrative appeals of Medicare claim denials caused severe economic harm. See, American Hospital … Continue Reading
Identifying Overpayments Under the ACA’s 60-Day Rule Creates Additional Uncertainty in Determining False Claims Act Liability
Under the Affordable Care Act (ACA), healthcare providers that receive an overpayment from Medicare or Medicaid are required to report and return the overpayment to the government within 60 days after the date on which the overpayment was identified (commonly referred to as the “60-day rule”). An overpayment retained after 60 days constitutes an “obligation” for purposes of potential False … Continue Reading
Culture of Safety Wins: Federal Patient Safety Law Preempts Amendment 7
Florida’s First District Court of Appeal issued its opinion in the highly watched case of Southern Baptist Hospital of Florida, Inc. v. Charles et al. The First District Court ruled that the federal Patient Safety and Quality Improvement Act of 2005 (PSQIA):
- Expressly preempts any broad discovery rights afforded under Florida’s Amendment 7 for documents meeting the definition of Patient
Can We Talk? Florida Court Rejects Latest Challenge to Med Mal Presuit Authorization Law
In the latest challenge to a Florida law designed to promote early settlement of meritorious medical malpractice claims, the Florida First District Court of Appeal recently rejected a plaintiff’s arguments that 2013 amendments to the law violated the Florida Constitution. See Weaver v. Myers, Case No. 1D14-3178 (Fla. 1st DCA July 21, 2015). The court also summarily rejected the … Continue Reading
Religious Freedom and the Affordable Care Act
The fascinating interplay that weaves between the First and Fifth Amendments to the U.S. Constitution, the Religious Freedom Restoration Act (RFRA) and the Patient Protection and Affordable Care Act (ACA) continues to march on in various jurisdictions around the country, with two recent examples being the United States Supreme Court’s grant of certiorari and remand of a Seventh Circuit case, … Continue Reading
Physicians and Photography Don’t Mix
A gynecologist who secretly photographed and videotaped women’s bodies in the examining room will cost one of the world’s leading medical institutions $190 million. In a damaging blow to its reputation, Johns Hopkins Hospital has agreed to a settlement with more than 8,000 patients of Dr. Nikita Levy, who wore a pen-like camera around his neck to secretly record videos … Continue Reading
