Health Law Reporter Index-Summary

CAHs

CALIFORNIA

– Abortion, injunction denied against Oakland “bubble” ordinance creating buffer zone around people seeking access to reproductive health clinics (N.D. Cal.), 1377
– AndroGel, FTC and state allege generic companies colluded with branded drug maker to delay competition (C.D. Cal.), 153; transferred to more convenient forum, 488
– Anti-assignment of benefits provision does not violate state unfair competition law (Cal. Ct. App.), 595
– Anti-SLAPP law, peer review body's suspension of privileges “official proceeding,” to avoid dismissal cardiologist must show likelihood of success on merits (Cal. Ct. App.), 340
– Avastin approved for ovarian cancer after coverage decision reversed (Cal. Super. Ct.), 338
– Burden of proof, hospital peer review committee erred in ruling anesthesiologist had to prove she did not mishandle controlled substances (Cal. Ct. App.), 844
– Capitation agreement between unlicensed corporation and HMO is illegal and cannot be enforced by doctor who provided services (Cal. Ct. App.), 107
– Children's and other health care cuts, governor's line-item vetoes of budget items called violation of state constitution, 1086
– Claims processing

– – Attorney general opens probe on how health plans review and pay claims, nurses' union researchers find 22 percent denial rate, 1215
– – PacifiCare hearing announced and market conduct probe begins, 835

– Driving under influence arrests, nexus sufficient to allow disciplinary action for physician's off-duty conduct (Cal. Ct. App.), 1175
– Drug statutory price ceilings, class certification rejected in county's overcharging suit against companies (N.D. Cal.), 686
– Emergency services

– – Balance billing, state managed care rules restricting for emergency room care upheld (Cal.), 62; ruling expected to spur class actions against providers who billed for unreimbursed amounts, 253
– – Charges for Kaiser members, jury trial ends in split verdict (Cal. Super. Ct.), 256
– – EMTALA, psychiatric emergency room release of patient who committed suicide days later, inadequate screening claim fails (Cal. Ct. App.), 1059
– – ERISA does not preempt state law requiring health plans to pay providers (Cal. Ct. App.), 633
– – Underpayment alleged, hospital's claims against plan administrator and external review organization may proceed (E.D. Cal.), 1151

– Eye care, state restrictions on opticians working in same locations as optometrists and ophthalmologists not subject to strict scrutiny, case remanded (9th Cir.), 736
– H1N1 virus

– – N95 respirators, nurse's union files Cal-OSHA complaint alleging inadequate supply, 967
– – Preparations inadequate according to survey by nurses' union, 1217

– Health insurance coverage mandates vetoed by governor, 1405
– Home care workers, wage cuts proposed

– – Am. Recovery and Reinvestment Act violation, CMS opinion, 637
– – Preliminary injunction halts planned cuts (N.D. Cal.), 872; Fresno County may not be dismissed from suit, 1447; emergency stay denied but appeal expedited (9th Cir.), 1447

– In-house referral practices subject of antitrust suit by hospital (Cal. Super. Ct.), 763
– Infertility treatment, state law does not require insurer to provide full coverage (Cal. Ct. App.), 976
– Kickbacks for use of companies' joint replacement products, claims alleging state unfair competition law violated by scheme allowed (N.D. Cal.), 1204
– Kidney transplants, Kaiser Permanente agrees to pay five patients to settle allegations of substantial delays and inadequate care, 534
– Liquidated damages, claim for alleged violation of confidentiality agreement unenforceable because award must be reasonably related to actual harm (Cal. Ct. App.), 139
– Managed care

– – Autism treatment policy, public interest group threatens suit if plans allowed to reclassify as “educational,” 293; state agency informs plans they may not categorically deny particular treatments and says rulemaking will follow, 371
– – Consumer group asks court to order state managed care agency to require autism treatment coverage (Cal. Super. Ct.), 907
– – Gender as rating factor allowed under state law, suit seeks to end practice and proposed legislation would eliminate provision allowing women to be charged more for coverage (Cal. Super. Ct.), 160
– – Medi-Cal plan seeks to overturning ruling it may not delegate to subcontractors risk of paying for emergency providers for those moved to managed care (Cal. Super. Ct.), 1222
– – Regulators issue rules on timely access to nonurgent care, 189

– Medi-Cal

– – Adult day health care, injunction stops cuts (N.D. Cal.), 1257
– – Average wholesale price changes, pharmacy trade groups allege inadequate reimbursement (C.D. Cal.), 1337
– – Clinical labs allegedly overcharged, state attorney general joins lawsuit (Cal. Super. Ct.), 394
– – Dental and other optional benefits eliminated, suit by nonprofit community clinics fails (Cal. Super. Ct.), 872
– – Due process, lengthy suspension of radiologist during fraud probe no violation (Cal. Ct. App.), 945
– – Emergency room physicians file proposed class action over alleged inadequate payments (Cal. Super. Ct.), 163
– – Home care workers, wage cuts proposed

See Home care workers, wage cuts proposed, this heading

– – L.A. Care seeks to overturning ruling plans may not delegate to subcontractors risk of paying for emergency providers for those moved to managed care (Cal. Super. Ct.), 1222
– – Matching funds increase, governor signs bill to increase hospital reimbursement rates, 1408
– – Optional benefits cuts, Gray Panthers plan emergency appeal after denial of preliminary injunction (N.D. Cal.), 1223
– – Pharmacy payment cuts barred by injunction (C.D. Cal.), 296
– – Providers have standing under Medicaid Act to challenge fee cuts (U.S., rev sought), 499; (rev den), 841; reimbursement rates may not be cut and preliminary injunction made retroactive (9th Cir.), 943; injunction upheld, 1085
– – Reimbursement rate cuts, provider groups seek to block implementation (C.D. Cal.), 162; stay blocks cuts during appeal (9th Cir.), 499
– – San Mateo Med. Center qui tam suit settles (N.D. Cal.), 365
– – Suspension of doctor charged with using misbranded medical devices upheld, rehearing denied (9th Cir.), 136
– – Working disabled participation extension for those temporarily unemployed, 1408

– Medical Board furloughs and funds transfer, physicians sue governor (Cal. Super. Ct.), 1405
– Mentally ill patients dumped at homeless shelters, Southern Cal. hospital agrees to pay to settle charges (Cal. Super. Ct.), 500
– Overtime, nurse's FLSA claim for different base hourly rates for 12-hour shifts fails (9th Cir.), 1445
– Peer review action lasting nearly 9 years, summary judgment for hospital denied, ruling on doctor's due process allegations deferred (E.D. Cal.), 1307
– Penalties

– – Hospitals fined for patient risks and licensing noncompliance, 346; announcement of fines against 13 more hospitals, 706; penalties against 11 hospitals announced, 1310
– – Medical records, Kaiser hospital fined for breach of privacy, 662; fine of $187,000 for second patient privacy violation, 974
– – Nursing home cited and fined for patient death due to inadequate care, 801
– – Rescission, Anthem Blue Cross agrees to pay fine and offer coverage to rescinded policyholders, 220
– – SNFs, $100,000 fine after probe finds inadequate care led to death, 1447

– Pregnancy discrimination, dental assistant fired because she could not take X-rays of patients, claim rejected (Cal. Ct. App.), 1435
– Privacy

– – Kaiser's Bellflower Hospital fined for medical records breach, 662; fine of $187,000 for second patient privacy violation, 974
– – Over 800 breaches reported in first five months of 2009, 973

– Psychiatrist not liable for deaths of people killed by patient who exhibited no violent tendencies (Cal. Ct. App.), 531
– Radiation overexposure during computed tomography scans, putative class action against GE Healthcare and subsidiary (Cal. Super Ct.), 1479
– Radio frequency ablation treatment for lung cancer, negligence in making benefit determination claim reinstated against plan administrator (Cal. Ct. App.), 524
– Res ipsa loquitur

– – Drains placed in cancer patient's body by two separate physicians acting independently, refusal to give instruction affirmed (Cal. Ct. App.), 1029
– – Infant found to be missing one kidney after surgery, claims against surgeons reinstated (Cal. Ct. App.), 226

– Rescission

– – Anthem Blue Cross agrees to pay fine and offer coverage to rescinded policyholders in agreement with state regulators, 220; temporary stay in suit by Los Angeles city attorney (Cal. Ct. App.), 694
– – Bills to curb passed by lawmakers, 1215
– – Blue Shield settles enforcement action with state regulator, 64
– – Directed verdict against couple who stipulated after Blue Shield gave up claims against them (Cal. Super. Ct.), 727
– – Health Net announces tentative settlement, 2 cases (Cal. Super. Ct.), 220; preliminary approval of settlement with hospitals and final approval of class action settlement, 693
– – Legislation to curb vetoed by governor, 1405
– – Notice allegedly misleading, Los Angeles suit against Anthem Blue Cross may proceed (Cal. Super. Ct.), 160; motion to stay while Anthem appeals earlier ruling denied, 557; Cal. physicians file amicus brief (Cal. Ct. App.), 1116
– – Stringent requirements for underwriting in proposed rule released by state agency, 763

– Residency requirement for prenatal care for low-income patients is unconstitutional (Cal Super. Ct.), 26
– Residential mental health treatment exclusion may be superseded by state laws, dismissal denied (N.D. Cal.), 1170
– San Francisco ordinance requiring employee health care expenditures by local business preempted by ERISA, restaurant group brief arguing for en banc review accepted (9th Cir.), 64; rehearing en banc denied, 330; emergency stay sought (U.S., application filed), 399; (application for stay denied), 433; (U.S., rev sought), 761; city opposes review (brief filed), 1144; Solicitor General brief sought (order), 1332
– “Skid Row” recruiting for unnecessary treatment

– – Co-owner and former board chairman pleads guilty (C.D. Cal.), 866
– – Former hospital executive pleads guilty (C.D. Cal.), 396
– – Hospital co-owner arrested in fraud scheme (C.D. Cal.), 154

– Spouse lacks standing to sue health insurer for fraud for allegedly misrepresenting terms of policy (Cal. Ct. App.), 526
– Staff privileges

– – Denial, hearing available to physician despite his failure to cooperate, hearing officer lacked authority to dismiss appeal (Cal.), 470
– – Suspension for failure to designated acceptable “covering” physician without notice improper, reinstatement ordered (Cal. Ct. App.), 1053

– Tax to pay for expanded mental health services funding upheld (Cal. Ct. App.), 1415
– Translated materials and oral interpretation for limited English-speaking policyholders required under new state rules, 462
– “Usual and customary” rates, suits allege Anthem Blue Cross uses flawed or manipulated database information, 2 cases (Cal. Super. Ct.) (C.D. Cal.), 1050
– Vicarious liability for treatment denial, attorneys discuss implications of state court decision, 558
– Workers' compensation fund did not violate state antitrust law by use of BCBS to handle claims (Cal. App. Ct.), 1213

CANCER

– ADA

– – Survivor denied accommodation and fired, Equal Employment Opportunity Comm'n and hospital agree to settle (W.D. Pa.), 653
– – Treatment ongoing, termination letter assumed clerk was too sick to work, settlement approved (D. Md.), 1013

– Avastin approved for ovarian cancer after coverage decision reversed (Cal. Super. Ct.), 338
– Breast cancer

See BREAST CANCER

– Cervical, statute of repose does not bar lawsuit alleging Pap smears misread over multiple years (N.D. Ill.), 225
– Drains placed in patient's body by two separate physicians acting independently, refusal to give res ipsa loquitur instruction affirmed (Cal. Ct. App.), 1029
– Hodgkin's disease, chemotherapy ordered for 13-year-old whose parents breached parental duties by refusing treatment (Minn. Dist. Ct.), 669
– Leukemia patient's bone marrow transplant was not experimental, welfare plan ordered to pay (N.D. Ohio), 254; refusal to pay was not arbitrary, ruling reversed (6th Cir.), 1209
– Lost chance of survival jury instruction error, verdict for plaintiff reversed in suit alleging negligent failure to notify patient and doctors of diagnosis (Tex.), 772
– Mont., state constitution supports patient's right to physician-assisted suicide, stay denied (Mont. Dist. Ct.), 69
– Ovarian cancer undetected, requirement for certificate of merit prior to filing malpractice suit ruled unconstitutional (Wash.), 1261
– Patient assistance program, nonprofit group can help needy patients pay cost-sharing amounts for advanced diagnostic testing for colon cancer without risking penalties, advisory opinion, 686
– Radio frequency ablation treatment for lung cancer, negligence in making benefit determination claim reinstated against plan administrator (Cal. Ct. App.), 524
– State hospital immune from certain antitrust and consumer claims by physician alleging oncology services monopoly (W.D. Wash.), 1394
– Supplemental insurance policy requires payment of actual charges not billed charges (11th Cir.), 1474
– Taxol, Bristol-Myers settles charges of violating earlier antitrust suits by failing to report patent litigation deals to states, 26
– Yale-New Haven Hospital agrees to pay to settle allegations of medically unnecessary hospital admissions for radiation treatment patients, 903
– Zoladex, average wholesale price inflation of prostrate cancer treatment, $12.9M judgment against AstraZeneca affirmed (1st Cir.), 1289

CARDIOLOGY

– Anti-kickback laws

– – Cardiologists' access to outpatient testing unit allegedly tied to revenues generated for hospital, claim allowed to proceed (S.D. Ohio), 93; request to certify interlocutory appeal denied, 328; motion to dismiss denied, 656
– – Univ. of Medicine and Dentistry of New Jersey, cardiologists settle kickbacks for referrals allegations, In Brief, 1298; medical school agrees to pay to settle kickback charges, 1367

– Antitrust, cardiothoracic surgeons challenge exclusive contract between competing practice group and hospital, Sherman Act claims reinstated (2d Cir.), 897
– Artificial embolization devices combined, use of unapproved devices does not constitute negligence per se (D.D.C.), 192
– Atrial fibrillation off-label treatment, Endoscopic Technologies Inc. agrees to pay to settle FCA allegations (S.D. Tex.), In Brief, 970
– Cal. anti-SLAPP law, peer review body's suspension of privileges “official proceeding,” to avoid dismissal cardiologist must show likelihood of success on merits (Cal. Ct. App.), 340
– Cardiac care “report cards,” N.J. did not violate law in changing way it required licensed providers to report morality data (N.J. Super. Ct. App. Div.), 108
– Cardiac catheterization

– – Gainsharing, hospital's agreement to share savings will not lead to penalties, advisory opinion, 901
– – Stark law claims of cardiologists and labs dismissed due to potential for indirect administrative challenge (D.D.C.), 517

– Cardiac scanner testing volunteer owed no duty of due care by staff radiologist who exceeded obligation by warning of danger (Ill. App. Ct.), 262
– CON, individuals who received unauthorized cardiac treatments may not bring claim alleging violations (S.C.), 753
– Elective angioplasty demonstration project, community hospitals without on-site cardiac surgery facilities may participate (N.J. Super. Ct. App. Div.), 1199
– Guidant Corp., dismissal of private securities fraud putative class action affirmed (7th Cir.), 1453
– Open-heart surgery utilizing technique in which body is cooled, parents of infants who died may not subpoena morbidity and mortality evidence studies (E.D. Pa.), 705
– Unnecessary procedures alleged, when U.S. fails to intervene FCA deadline is not extended and equitable tolling does not apply (U.S., rev den), 827
– Vascular surgeon's privileges revoked, hospital immune from damages under HCQIA and state peer review law (Tenn. Ct. App.), 1476

CATHOLIC HOSPITALS

– Abortion issues

See generally ABORTION

– Contraception issues

See generally CONTRACEPTION

– Exempla Inc. opposition to transfer of Denver facilities, binding arbitration set, 71; sale would violate state nonprofit law, arbitrator says, 774; Exempla hospitals will be transferred to Catholic health system, 1152; Exempla board approves transfer, 1414
– Ill., charity care, oral arguments on tax exemption for Provena Covenant Med. Center (Ill.), 1310
– Unionization, guidance aims for “fair process,” BNA Special Report, 884

CAUSATION

See also EXPERT WITNESSES
– Emotional distress, hospital employee whose health records were accessed by fellow workers may not recover damages due to failure to prove emotional injury (Iowa), 702
– Expert reports to establish standard of care

See TEXAS

– Key expert proof submitted months after judge's deadline, exclusion upheld (9th Cir.), 502; (U.S., rev sought), 919
– Res ipsa loquitur

– – Ala., expert testimony required in case alleging injury from steroid epidural (Ala.), 704
– – Drains placed in cancer patient's body by two separate physicians acting independently, refusal to give instruction affirmed (Cal. Ct. App.), 1029
– – Infant found to be missing one kidney after surgery, claims against surgeons reinstated (Cal. Ct. App.), 226
– – Ky., object left behind during surgery, per se liability theory abandoned in favor of res ipsa (Ky.), 566; rehearing denied, 1182
– – N.J., instruction not required in case of burned nerve root during thermal energy disectomy (N.J.), 986
– – Wash., malpractice claims against surgeon after scalpel blade left inside patient during knee surgery do not require expert testimony (Wash. Ct. App.), 1264

CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS)

– Govt. Accountability Off. says CMS should revise methodology for identifying poorly performing nursing homes, 1303

CERTIFICATE OF NEED (CON)

– Fla. governor signs law extending expiration dates and authorizing second renewal for rural hospitals, 722
– Ky., show cause hearing urged on termination of hospital reproductive health services prior to merger with Catholic hospital (Ky.), 1233
– S.C., individuals who received unauthorized cardiac treatments may not bring CON claim (S.C.), 753
– Tenn., nursing homes moratorium signed by governor, 908

CHARITY CARE

– Corporate governance

See CORPORATE GOVERNANCE

– Grassley (R-Iowa) criticizes hospitals that seem to do little to justify tax-exempt status, 641
– Health care reform requirements criticized, 651
– Illinois

See ILLINOIS

– Me., free care laws constitutional (1st Cir.), 1092
– Mandatory standard

– – AHA criticizes proposal to codify requirements for tax-exempt status, 724
– – Baucus (D-Mont) reform bill omits minimum but Grassley (R-Iowa) proposal raises concerns, 1247; Grassley does not offer amendments as part of markup, 1344; further action, see LEGISLATION, FEDERAL, S 1796
– – New tax code section likely outcome of Senate Fin. Comm. bill, aides tell AHLA group, 1378
– – Opposed by Senate Fin. Comm. minority counsel, 349
– – Risk to viability of tax-exempt hospitals, advocacy groups tell Senate Fin. Comm., 738

– Md. governor signs new law requiring free hospital care for low-income patients, 640
– Nonprofit corporate law developments in 2008, BNA Analysis & Perspective, 73
– Ohio Hospital Care Assurance Program, DSH funding unavailable for participating hospitals (U.S., rev den), 466
– State uninsured pricing statutes cause hospitals to refine intake and billing procedures, 513
– Tax-exempt hospitals vary greatly in provision, IRS study due out soon, 110

CHILDBIRTH

See PREGNANCY AND CHILDBIRTH

CHILDREN'S HEALTH CARE

– Abortion, parental consent

See generally ABORTION

– Autism

See AUTISM

– Cal., governor's line-item vetoes of budget items called violation of state constitution, 1086
– Celexa and Lexapro allegedly marketed for pediatric patients, U.S. intervenes in whistleblower suits, 2 cases (D. Mass.), 283
– Chemotherapy ordered for 13-year-old whose parents breached parental duties by refusing treatment (Minn. Dist. Ct.), 669
– Death nearly two years after open-heart surgery on infant, proffered expert testimony on negligent act by surgeon not scientifically reliable (E.D. Pa.), 1149
– Drug to prevent respiratory disease in children, Mo. specialty pharmacy settles FCA charges, 1110
– Early hearing detection and intervention

See LEGISLATION, FEDERAL, HR 1246

– Eating disorders treatment

– – Horizon Blue Shield of N.J. agrees to expand coverage, settlement of 2 class actions approved (D.N.J.), 556
– – Out-of-network providers, denial of coverage for daughter's residential care upheld (S.D.N.Y.), 370

– Emergency services

See LEGISLATION, FEDERAL, HR 479

– EMTALA inadequate screening claim allowed, child died of intestinal infection and dehydration after discharge from hospital emergency department which failed to follow procedures on assessing condition (N.D. Ind.), 470
– False drug screen results for newborn, hospital may not be immune under state child abuse reporting law due to alleged failure to correct error quickly (N.D. Ind.), 39
– In-school dentistry, FTC staff urges La. legislature to reject bill prohibiting, 589
– Inpatient psychiatric hospital agrees to pay to settle FCA claims (E.D. Pa.), In Brief, 553
– Jury biased during selection process, verdict on behalf of child severely disabled following surgery to correct birth defect overturned (N.J.), 1028
– Kidney missing after surgery on infant, claims against surgeons reinstated (Cal. Ct. App.), 226
– Medical monitoring claim for unapproved device implanted in infant allowed (E.D. Pa.), 342; cases certified for immediate appeal, 1228
– Medical records requested by parents, state law claim that hospital failed to turn over complete record may proceed (W.D. Tenn.), 1086
– MediKids health insurance program

See LEGISLATION, FEDERAL, HR 194

– Noncompete clauses, geographic scope and duration not unreasonable, group practice entitled to injunctive relief against pediatrician (Ga. Ct. App.), 411
– N.C. Medicaid, claims of behaviorally and developmentally disabled children whose benefits were allegedly reduced or terminated illegally allowed to proceed (E.D.N.C.), 466
– Open-heart surgery utilizing technique in which body is cooled, parents of infants who died may not subpoena morbidity and mortality evidence studies (E.D. Pa.), 705
– Ovation Pharmaceuticals sued by FTC and state attorney general for alleged attempt to eliminate competition in drug for premature infants, 2 cases (D. Minn.), 23
– Overtime claims for employees of N.Y. Foundling Hosp. fail, nonprofit organization not covered by FLSA (2d Cir.), 1118
– Parents of deceased infant may pursue wrongful death claims although mother did not list claims in bankruptcy, father's motion to substitute based on statute of limitations erroneously denied (Tenn. Ct. App.), 848
– Paxil clinical trial, criminal charges reinstated against drug investigator for failing to adhere to FDA recordkeeping and reporting requirements (5th Cir.), 210
– Pediatric hematology group's antitrust suit survives dismissal based on pending appeal in state court (D. Haw.), 91
– Peer review materials are not discoverable in dual federal/state action (S.D. Tex.), 300; inappropriate screening and transfer claims rejected, 875; responsible third party designation of settling hospital proper in malpractice suit against doctor, 1507
– Premature infant drug monopoly alleged, copy of assignment from direct purchaser belatedly submitted sufficient to establish standing (D. Minn.), 1433
– Residential mental health treatment exclusion may be superseded by state laws, dismissal denied (N.D. Cal.), 1170
– Rocky Mountain Spotted Fever, jury instruction flawed, defense verdict for doctors who failed to diagnose reversed (Ga.), 877
– School-based care

– – Administrative and transportation services, rescission of controversial rules planned by CMS, 601; rescinded, 873
– – N.Y. state and New York City agree to pay to settle false claims allegations, In Brief, 969

– Settlements, seal denied in case creating special needs trust for minor, confidentiality preempted by public's right of access to court records (S.D.W. Va.), 1509
– Sexual assault of 6-year-old patient by hospital employee, jury verdict against insurer affirmed (Ark.), 301
– Tenn., early periodic screening, diagnosis, and treatment of Medicaid-eligible children, injunction requiring state officials to provide remains in force (M.D. Tenn.), 1305
– Vision care

See LEGISLATION, FEDERAL, HR 577

– Wash., temporary restraining order halts Medicaid funding cuts to in-home care for disabled children (W.D. Wash.), 912; state agrees to restore services, 1407
– W.Va., Medicaid-eligible children may sue managed care program (S.D.W. Va.), 699
– Wrongful birth

See WRONGFUL BIRTH

CHINA

– Foreign Corrupt Practices Act, risk of prosecution due to demand for bribes, 899

CHIROPRACTIC SERVICES

– Anti-kickback law, chiropractors' association may advertise and provide referrals without penalties, advisory opinion, 1297
– Exclusion from managed care organization panel did not violate state HMO law (Tenn. Ct. App.), 435
– Expert reports to establish standard of care, chiropractor not qualified to give opinion on causation in suit against chiropractor (Tex. App.), 193
– Ga. informed consent requirements do not apply to chiropractors (Ga.), 773
– PPO contract, chiropractor may pursue claims alleging insurer failed to do anything to steer patients to her practice (S.D. Ill.), 403
– United Healthcare agrees to pay $536,000 in fines and reopen over 50,000 denied chiropractic claims (Mo. Dep't of Ins.), 1172
– United Healthcare allegedly denied or delayed payments, ERISA claims of group of medical providers and plan participants allowed (D. Ariz.), 597

CHRONIC AND TERMINAL ILLNESS

– Chronic pain research, education, and training

See LEGISLATION, FEDERAL, HR 756

– Hospice care

See HOSPICE CARE

– Medical homes, Senate committee hears testimony, 129

CIAs

See CORPORATE INTEGRITY AGREEMENTS (CIAs)

CIVIL PROCEDURE

– Pleading

See PLEADING

CLAIMS PROCESSING

– Allstate settles nationwide class action related to medical billing review system's allegedly incorrect calculations for auto and homeowner claims (Ill. Cir. Ct.), 1115
– California

– – Attorney general opens probe on how health plans review and pay claims, nurses' union researchers find 22 percent denial rate, 1215
– – PacifiCare hearing on improper handling announced and state begins market conduct probe, 835

– Claims processor allegedly interfered with contractual relations, hospital's suit not preempted by ERISA (E.D. Cal.), 187
– Delay or denial, state law claims by Mo. physicians against health insurers are governed by ERISA and must be litigated in federal court (S.D. Fla.), 157
– Dueling claims about assurances require trial for dispute between hospital and insurer (E.D. La.), 433
– Explanation of benefits allegedly fraudulent, dismissal of RICO claim affirmed (8th Cir.), 336; (U.S., rev sought), 1021; (rev den), 1333
– Medicare claims records, nonprofit consumer magazine may not obtain documents (D.C. Cir.), 164
– Physical therapy or chiropractic treatment payments allegedly denied or delayed by United Healthcare, ERISA claims of group of medical providers and plan participants allowed (D. Ariz.), 597
– Prompt payment

– – Ga. fines United Healthcare and subsidiaries, 1501
– – Mo. law preempted by ERISA (8th Cir.), 336

– P.R. dental surgeons' claims handling suit against insurance companies should not have been remanded, Class Action Fairness Act may apply (1st Cir.), 1473
– Recovery audit contractors

See RECOVERY AUDIT CONTRACTORS (RACs)

– Underpayment alleged, hospital's claims against plan administrator and external review organization may proceed (E.D. Cal.), 1151
– UnitedHealthcare companies fined by Colo. for violations concerning individual coverage plans, 1371
– Usual, customary, and reasonable charges database

See DATABASES AND DATA BANKS

CLASS ACTIONS

– Aetna Inc., securities action alleging misrepresentations to conceal underpricing to gain market share dismissed (E.D. Pa.), 850
– Allstate settles nationwide class related to medical billing review system's allegedly incorrect calculations for auto and homeowner claims (Ill. Cir. Ct.), 1115
– Autism applied behavior analysis therapy coverage denied as experimental, class certification denied (E.D. Mich.), 461
– Balance billing, ruling that state managed care rules restrict for emergency room care expected to spur suits against providers who billed for unreimbursed amounts, 253
– Beckton Dickinson & Co. announces settlement of direct purchasers' antitrust suit (D.N.J.), 589; health care plaintiffs object to settlement and seek injunction, 625
– Catheters antitrust claims against C.R. Bard dismissed for lack of proof (E.D. Mo.), 1292
– Celebrex and Bextra marketing, third-party payers and consumer settlement approved (N.D. Cal.), 1401
– Charity care

– – Advocate Health Care agrees to implement free and discounted uninsured patient care plan (Ill. Cir. Ct.), 151
– – Overcharges alleged, court approves settlement between Ill. hospitals and undetermined class (Ill. Cir. Ct.), 106

– Database on “usual, customary, and reasonable” charges

– – AMA files claims against Aetna and CIGNA over out-of-network fees, 2 cases (D.N.J.), 219
– – Wellpoint sued by AMA and several state medical groups (C.D. Cal.), 434

– Disabled adults, temporary restraining order bars eliminating services but class certification denied (W.D. Wash.), 982
– Discounts, suit by subscribers seeking negotiated rates after exceeding annual benefit amounts cannot proceed without preferred providers, dismissed (W.D. Wash.), 800
– Drugs and pharmaceuticals

– – Avastin approved for ovarian cancer after coverage decision reversed (Cal. Super. Ct.), 338
– – Average wholesale price publications, revised settlement of suit against First DataBank Inc. and Medi-Span approved (D. Mass.), 363; pharmacy industry attempt to overturn settlement fails (1st Cir.), 1202
– – Direct buyers have standing to raise claims in cases involving patents declared unenforceable due to inequitable conduct (2d Cir.), 1394
– – Formularies, drugs with no generic version placed in highest copayment tier no violation of plan, proposed ERISA suit dismissed (E.D. Pa.), 833
– – Johnson & Johnson Remicade and Procrit average wholesale price inflation claims dismissal, trial court failed to adequately explain rationale, reversed and remanded (1st Cir.), 1290
– – K-Dur 20, class of potassium supplement direct purchasers certified to pursue antitrust claims (D.N.J.), 55
– – Premature infant drug monopoly alleged, copy of assignment from direct purchaser belatedly submitted sufficient to establish standing (D. Minn.), 1433
– – Statutory price ceilings, class certification rejected in county's overcharging suit against companies (N.D. Cal.), 686
– – Vytorin and Zetia, settlement of class action alleging buyers misled into paying higher prices (D.N.J.), 1437

– Eating disorders treatment, Horizon Blue Shield of N.J. agrees to expand coverage, settlement of 2 suits approved (D.N.J.), 556
– “Filed rate” doctrine bars fiduciary duty breach suit against AARP trust for approving premium rates (S.D.N.Y.), 1443
– Health IT stimulus provisions challenged on due process and privacy grounds (S.D.N.Y.), 906
– Health Net announces tentative rescission suit settlement, 2 cases (Cal. Super. Ct.), 220; preliminary approval of settlement with hospitals and final approval of class action settlement, 693
– HealthSouth, Ernst & Young settlement of securities class action approved (N.D. Ala.), 442; bar order against former CEO affirmed and rejection of untimely bid to opt out of bondholder class affirmed (11th Cir.), 883
– Joint implants, financial incentives to surgeons alleged, court dismisses civil claims against Stryker Orthopoaedics and Smith & Nephew Corp. (D.N.J.), 212
– Mentally retarded Medicaid applicants who were denied without proper notice or whose eligibility determinations were delayed may pursue class action against officials (M.D. Ala.), 635
– Mich., Medicaid officials must consider whether beneficiaries currently receiving Family Independence Program benefits qualify under disability-related category before terminating benefits, injunction granted (E.D. Mich.), 701
– Nurses' wages

– – Albany hospitals and RNs seek approval of proposed antitrust settlement (N.D.N.Y.), 327
– – Chicago-area wage suppression suit denied class certification (N.D. Ill.), 1324
– – Detroit hospitals and RNs seek court approval of settlement (E.D. Mich.), 423
– – Unionized hospital is not entitled to dismissal of claims by RNs (E.D. Mich.), 424

– Nursing homes, Okla. agency did not breach contracts, summary judgment for state in Medicaid pay rates suit (Okla. Dist. Ct.), 666
– Plasma derivative protein therapies, class actions allege Baxter and Victoria engaged in anticompetitive conspiracy (N.D. Ill.), 1465
– PPO allegedly promised incentives, Ill. physician group denied certification (C.D. Ill.), 158
– P.R. dental surgeons' claims handling suit against insurance companies should not have been remanded, Class Action Fairness Act may apply (1st Cir.), 1473
– Quest Diagnostics improper billing claims, certification denied (D.N.J.), 211
– Radiation overexposure during computed tomography scans, suit against GE Healthcare and subsidiary (Cal. Super Ct.), 1479
– Sanctions against HMO and its lawyers in underpayment suit vacated (3d Cir.), 1211
– Securities fraud

See generally SECURITIES

– Uninsured or “self-pay” patients overcharging alleged, claims may not be pursued on class basis (Ala.), 1266
– UnitedHealth Group Inc. agrees to pay to settle physicians' out-of-network claims, 3 cases (S.D.N.Y.) (D.N.J.), 97; preliminary approval of settlement delayed by trial court (S.D.N.Y.), 728
– Wash., Medicaid disabled rehabilitation therapy cuts enjoined (W.D. Wash.), 1222; negotiations continue, 1407

CLINICAL LABORATORIES

– Cal., labs allegedly overcharged Medicaid, state attorney general joins lawsuit (Cal. Super. Ct.), 394
– CLIA certification, revocation for sending samples to another laboratory upheld, review petition denied (10th Cir.), 754
– Competitive bidding demonstration project injunction kept intact although Congress repealed statute (S.D. Cal.), 440
– Reusable blood tube holders ban upheld (D.C. Cir.), 463
– Unbundling alleged, Horizon BCBS sues out-of-network diagnostic lab alleging fraudulent health insurance claims (N.J. Super. Ct.), 939

CLINICAL TRIALS

– Billing, auditing, and monitoring, BNA audioconference, 45
– Colo., governor signs new law requiring health insurance plans to cover routine patient care for participants, 635
– Contract research organizations (CROs), BNA audioconference, 230
– Criminal charges reinstated against drug investigator for failing to adhere to FDA recordkeeping and reporting requirements (5th Cir.), 210

CMS

See CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS)

COBRA (HEALTH CARE COVERAGE CONTINUATION)

– N.Y. governor signs law extending coverage and requiring health plans to offer coverage to unmarried young adults under parent's policy, 1052
– Notice required even where there is retirement coverage (W.D. Va.), 30
– Special enrollment right

See LEGISLATION, FEDERAL, S 1

– Subsidy

– – Economic stimulus

See LEGISLATION, FEDERAL, HR 1

– – Temporary, for involuntarily terminated employees discussed by administration officials, 634

CODING

– Safety-net hospitals and CMS settle national drug codes reporting suit, 1407
– Transition to ICD-10 delayed until 2013, final rule, 95
– Upcoding

– – Fla. physician agrees to pay to settle allegations (M.D. Fla.), 970
– – Iowa, eye exams determination by state agency erroneous (Iowa), 981
– – Psychotherapy telephone consultations used billing code for face-to-face sessions, insurer's termination of plan participants on the basis of fraud was arbitrary (D.N.J.), 1051

COLLECTIVE BARGAINING

– Ed. Note: This heading covers pre-ratification conduct and issues. For ratification and post-ratification conduct and issues, see COLLECTIVE BARGAINING AGREEMENTS.
– Caritas Christi system

– – Agrees to remain neutral in organizing drives by Local 1199 of SEIU, 135
– – Norwood Hosp., units voted for representation by SEIU local, 1371
– – St. Elizabeth's Med. Center in Boston votes for SEIU representation, 497

– Catholic hospitals unionization guidance aims for “fair process,” BNA Special Report, 884
– Discharge for union organizing

– – Claim dismissed, Natl. Labor Relations Bd. has exclusive jurisdiction (Ky.), 126
– – Public hospital, doctors' retaliation and equal protection claims survive motion to dismiss (N.D. Ill.), 208

– Employee Free Choice Act, Outlook 2009, 5
– Heartland-University of Livonia, Mich., nursing home ordered to resume bargaining with SEIU (E.D. Mich.), 497; settlement, 1119
– Interns and residents at St. Barnabas Hosp., representation election ordered (NLRB Reg. Dir.), 732
– Kingsbridge Heights Rehabilitation and Care Center, interim injunction over unfair labor practices against SEIU affiliate workers affirmed (2d Cir.), 697
– Labor law rights notices required of federal contractors and subcontractors, AHA and human resources group ask Labor Dep't to change text, 1218
– Natl. Union of Healthcare Workers

– – Catholic Healthcare West facilities in Cal., NLRB region director dismisses petition seeking representation election, 404
– – Certified as bargaining agent for Sequoias Portola Valley ALF workers and Hospital Housekeeping Sys. workers at Los Alamitos hospital, 1371
– – Doctors Med. Center, San Pablo, Cal., caregivers vote for NUHW representation, 698
– – Fresno in-home health care workers will vote whether to continue with United Healthcare Workers-West or switch, 560; Fresno workers vote by narrow margin to keep United Healthcare Workers-West, challenge expected, 839
– – Kaiser Permanente facilities in Cal., petition for representation election dismissed, SEIU currently represents workers, 497
– – North American Healthcare recognizes as bargaining agent for nursing home workers, 404
– – Petitions seeking to represent workers at Cal. hospitals and nursing homes filed, 162
– – Representation petition filed for workers employed by subcontractors, 257

– Nurses

See NURSES AND NURSING

– Overtime refusal by hospital housekeepers and linen aides requires prior notice (9th Cir.), 1084
– “Perfectly clear” successor does not apply to new owner of Cal. nursing home, NLRB ruling reversed (D.C. Cir.), 909
– Picketing discharges were illegal, NLRB reversed (2d Cir.), 837
– Plant rule doctrine, NLRB ordered to reconsider reinstatement of home health aides who struck (2d Cir.), 663
– Snell Island SNF required to bargain with UFCW following representation election (2d Cir.), 836; authority of 2-member NLRB questioned (U.S., rev sought), 1301
– Stanford Univ. and affiliated health care facilities pacts with SEIU ratified, 1219
– Two-member NLRB rulings

– – Circuits split on authority to issue decisions and orders (D.C. Cir.) (7th Cir.), 598
– – NLRB authority upheld (2d Cir.), 836; (U.S., rev sought), 1301

– United Healthcare Workers-West

– – Executive board asks for vote to disaffiliate from SEIU, 66
– – Labor Dep't dismisses members' complaints alleging SEIU unjustly imposed trusteeship on local, 1174
– – Stanford Univ. health care facility pact with ratified, 1219

– Virginia Mason Med. Center illegally withdrew recognition during certification year (9th Cir.), 293

COLLECTIVE BARGAINING AGREEMENTS

– Addus HealthCare and SEIU renew contract containing neutrality agreement allowing union to organize home health care workers, 257
– Bayonne Med. Center pact with Health Professional and Allied Employees approved, 839
– Daughters of Charity Hosp./United Healthcare Workers, five contracts ratified, 1475
– Enloe Med. Center, SEIU-United Healthcare Workers-West members ratify first contract, 33
– FLSA, paramedics and emergency medical technicians in NYC not entitled to back pay for gap hours worked between shift and overtime because contract provides for compensation (S.D.N.Y.), 1475
– Forum Health wins contract concessions from SEIU after filing bankruptcy, 1119
– Kaleida Health, SEIU/United Healthcare Workers East in Buffalo, NY ratify contract, 66
– League of New York City-area hospitals and SEIU announce talks on modifying agreement due to economic downturn, 560; tentative agreement to modify contract, 977
– Multiemployer pension and welfare fund contributions must be based on all wages including holiday and sick leave (D. Conn.), 1500
– Nurses

See NURSES AND NURSING

– Ohio wage freeze accepted by SEIU 1199, 839
– Rhode Island Hospital, Teamsters contract ratified, 497

COLLEGES AND UNIVERSITIES

– Mich. college sued by labor coalition seeking to force release of information about PBM contract (Mich. Cir. Ct.), 333
– Student health plans

– – N.Y., Aetna agrees to pay to settle investigation into reimbursement rates, 159
– – Tex., Aetna agrees to pay to resolve state investigation into failure to pay out-of-network claims (Tex. Dist. Ct.), 190

COLORADO

– Autism spectrum disorders, governor signs bill requiring coverage by group health insurance policies, 765
– Binding arbitration set in Exempla Inc. opposition to transfer of Denver hospitals, 71; sale would violate state nonprofit law, arbitrator says, 774; Exempla hospitals will be transferred to Catholic health system, 1152; Exempla board approves transfer, 1414
– Clinical trials, governor signs new law requiring health insurance plans to cover routine patient care for participants, 635
– HMOs will be allowed to offer limited benefit plans, governor signs new law, 559
– Insurance portability study bill signed by governor, 559
– Liens for medical assistance, new law codifies practice, 559
– Medical marijuana, state health board adopts “significant responsibility” rule after primary caregiver ruling in criminal case (Colo. Ct. App.), 1510
– Monopolization claims of nephrologist denied staff privileges after hospital recruited another physician as exclusive provider rejected (10th Cir.), 1323
– Provider fee on hospitals to expand federal match and cover uninsured persons, governor signs new law, 571
– UnitedHealthcare companies fined by state insurance agency for violations concerning individual coverage plans, 1371
– Whistleblower law and ADEA suit filed by nurses alleging termination due to reporting unsafe conditions (D. Colo.), 968
– Wrongful birth of healthy child claim allowed after physician fails to terminate unwanted pregnancy (Colo. Ct. App.), 341

COMMERCE CLAUSE

– Dormant, Cal. restrictions on opticians working in same locations as optometrists and ophthalmologists not subject to strict scrutiny, case remanded (9th Cir.), 736

COMMUNITY CENTERS

– Essential for improved care, witnesses tell House committee, 593

COMPARATIVE EFFECTIVENESS

– Patient-Centered Outcomes Research Institute

See LEGISLATION, FEDERAL, S 1213

– Research, economic stimulus package funding

See LEGISLATION, FEDERAL, HR 1, HR 598

COMPLIANCE PROGRAMS

– Failure to avoid liability, experts discuss ways to improve protection, 1287
– N.Y., mandate begins Oct. 1, boards expected to oversee quality of care, 1041

COMPUTERS

– Computer-assisted knee replacement surgery “investigational” label abused discretion, insurer liable for claim (E.D. La.), 1442
– Private e-mails on company laptop, home health care agency not entitled to read e-mails between former employee and her attorney in sexual harassment case (N.J. Super. Ct. App. Div.), 898

COMPUTERS AND COMPUTER EQUIPMENT

– Electronic health records

See ELECTRONIC HEALTH RECORDS

– Internet

See INTERNET

CON

See CERTIFICATE OF NEED (CON)

CONFERENCES AND MEETINGS

– ABA

– – Annual meeting, 1080
– – Health Law Section, 495
– – Natl. Inst. on Health Care Fraud, 654
– – Section of Taxation, 634
– – Washington Healthcare Summit, 1440

– AHLA

– – Annual meeting, 863; 866; 899; 914
– – Compliance programs teleconference, 1287
– – Form 990 reporting requirements, audioconference, 572
– – Hospital Law Inst., 208
– – Inhouse Counsel Program, 821
– – Inst. on Medicare and Medicaid Payment Issues, 427
– – Physicians Law Inst., 195
– – PSOs teleconference, 179
– – Tax conference, 1378
– – Vicarious liability, audioconference, 558

– AMA

– – Annual meeting, 797
– – House of Delegates, 832

– American Ass'n for Homecare Washington Legislative Conf., 725
– American Health Information Mgmt. Ass'n, 1142; 1152
– Assessing Malpractice Claims in Credentialing, Horty Springer & Mattern, 789
– BNA audioconferences

– – Clinical Trials Billing, Auditing, and Monitoring Strategies for 2009 and Beyond, 45
– – Economic Stimulus Package: HIPAA Amendments and Health IT funding, 350
– – Health Care Fraud

– – – Gearing up for Enforcement Directions for 2009, 45
– – – Preparing for the Fight of Your Life, Anatomy of a Prosecution, 45

– – Medical Tourism: From Idea to Implementation, 229; 325
– – Planning for a Post-Levine World: Implications and Strategies for Manufacturers, U.S. Consumers and the Courts, 572
– – Sponsor-CRO Relationships: Managing Risk, 230
– – 2009 False Claims Act Amendments: Implications for the Health Care Community, 811; 968; 1013

– D.C. Bar Taxation Section, 306
– Families USA, health care reform conference, 155
– Georgetown Law nonprofit governance conference, 923
– Health Care Compliance Ass'n audioconference on voluntary disclosures, 657
– Intl. Found. of Employee Benefit Plans webcast, 333
– National Govs. Ass'n, 249

– – State Alliance for E-Health, 289

– Tax Exempt and Government Entities councils, 195
– Wash. Nonprofit Legal & Tax Conf., 349
– White & Williams LLP, health care summit, 690
– Workgroup for Electronic Data Interchange, 595

CONFIDENTIALITY

See PRIVACY AND CONFIDENTIALITY

CONFLICTS OF INTEREST

– Dual-role administrators

– – Benefit claims review standards, new approach as courts adjust to Glenn decision, 53
– – Conflict only “one factor,” termination of disability benefits upheld (4th Cir.), 60
– – De novo review inconsistent with Glenn but denial of disability benefits improper (2d Cir.), 59

– Joint Commission medical staff standard working draft under review, 1429
– Medical review organizations (MROs), state rules allowing providers to challenge independence upheld (N.J. Super. Ct.), 140

CONGRESS, U.S.

– Ed. Note: This heading is used for administrative actions only. For coverage of legislation by bill number, see LEGISLATION, FEDERAL. For information on measures not yet assigned bill numbers, see relevant subject headings.
– Harkin (D-Iowa) to chair Senate Health, Education, Labor and Pensions Comm., 1205
– Kirk sworn in to fill seat of Kennedy (D-Mass), 1298

CONNECTICUT

– Abortion-related services, challenge by state attorney general to HHS rule barring action against health care workers who refuse to participate joined by other states (D. Conn.), 109
– Assisted suicide, physicians seek declaratory judgment that state law does not prohibit prescribing drugs to mentally competent, terminally ill patients who want to die with dignity (Conn. Super. Ct.), 1375
– BCBS may have violated breach notification law after loss of confidential unencrypted data on physicians, state attorney general says, 1499
– Certificate of good faith filed after transfer of malpractice case from federal court in another state timely (D. Conn.), 1265
– Public hospital records are not protected by peer review privilege in freedom of information law proceedings (Conn.), 1123
– Taxation

– – Property tax, majority of SNF facility is not exempt because not dedicated exclusively to long-term care for elderly (Conn.), 411
– – State tax costs, mandamus petition filed by 27 hospitals seeking to reopen cost reports dismissed due to failure to exhaust administrative remedies (D.D.C.), 348

– Zyprexa unapproved uses marketing, attorney general announces settlement (E.D.N.Y.), In Brief, 1298

CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT (COBRA)

See COBRA (HEALTH CARE COVERAGE CONTINUATION)

CONSTITUTION, U.S.

– Abortion issues

See generally ABORTION

– Access to courts, Wash. law requiring certificate of merit prior to filing medical malpractice lawsuit ruled unconstitutional (Wash.), 1261
– Commerce clause

See COMMERCE CLAUSE

– Due process

See DUE PROCESS

– Eleventh Amendment

See ELEVENTH AMENDMENT

– Equal protection

See EQUAL PROTECTION

– First Amendment

See FIRST AMENDMENT

– Fourteenth Amendment

See FOURTEENTH AMENDMENT

– Participation in 12-step program, medical license suspension precludes claims related to board requirement (U.S., rev den), 841
– Separation of powers

See SEPARATION OF POWERS

– Seventh Amendment

See JURY TRIALS

– Supremacy clause, state peer review privilege invoked by medical school director who refused to provide information to another hospital does not violate law (11th Cir.), 703; (U.S., rev sought), 1341
– Thirteenth Amendment

See THIRTEENTH AMENDMENT

CONSUMER PROTECTION

– Antitrust issues

See ANTITRUST

– Celebrex and Bextra marketing, third-party payers and consumer class action settlement approved (N.D. Cal.), 1401
– Joint implants, financial incentives to surgeons alleged, court dismisses civil claims against Stryker Orthopoaedics and Smith & Nephew Corp. (D.N.J.), 212
– Long-term care insurance

See LEGISLATION, FEDERAL, S 1177

– N.Y., managed care reform bill signed along with continuation of coverage extension and option for young adults to continue under parents' policy, 1052
– Nursing Home Compare website, state attorneys general urge HHS to suspend quality rating system, 1220
– Nursing home operators allegedly misrepresented level and quality of care, state consumer law claims dismissed (W.D. Wash.), 465
– Physician rankings

– – Natl. Comm. for Quality Assurance reviews efforts of health plans to meet settlement compliance standards, 31
– – Tex. BCBS plan agrees to stop using cost-based doctor rating system under deal with state attorney general (Tex. Dist. Ct.), 496

– Privacy and security

– – Commercial online personal medical records vendors, FTC issues breach notification requirements, 749
– – Data disposal

– – – CVS Caremark settles FTC and HHS charges related to disposal of sensitive information in open dumpsters (FTC), 250; pharmacist group urges FTC to continue investigating privacy violations, 397
– – – LoCost Rx Inc. reaches agreement with Ind. Pharmacy Bd., Walgreens cases pending, 795

– – Medicare claims records, nonprofit consumer magazine may not obtain documents (D.C. Cir.), 164
– – Notices for breaches of electronic health information proposed by FTC, 521

– Reforms

See LEGISLATION, FEDERAL, HR 3962

– State hospital immune from certain antitrust and consumer claims by physician alleging oncology services monopoly (W.D. Wash.), 1394
– Uninsured persons

See UNINSURED PERSONS

– “Usual, customary, and reasonable” charges database

See DATABASES AND DATA BANKS

– Vytorin and Zetia, settlement of class action alleging buyers misled into paying higher prices (D.N.J.), 1437
– Wash., consumer law does not apply to surgery-related losses (Wash.), 1309

CONTINGENT WORKERS

See TEMPORARY EMPLOYEES

CONTRACEPTION

– Health care workers who refuse to participate

– – Challenge to HHS rule barring retaliation by Conn. attorney general joined by other states (D. Conn.), 109
– – La. protection law signed by governor, 988
– – “Right of conscience” rule under review, opponents pleased by possible rescission, 304; HHS proposes rescission, 347
– – Wash. rule requires pharmacies to fill all prescriptions including for Plan B, preliminary injunction barring enforcement vacated and reconsideration ordered (9th Cir.), 952; panel rehearing granted but en banc denied, 1481

– IUDs from Mexico, Medi-Cal suspension of doctor charged with using misbranded medical devices upheld, rehearing denied (9th Cir.), 136
– Ky., show cause hearing urged on termination of hospital reproductive health services prior to merger with Catholic hospital (Ky.), 1233

CONTRACTS AND CONTRACTORS

– Call hours excessive, trial court ordered to reduce amount of award to physician (Ark. Ct. App.), 1480
– Capitation agreement between unlicensed corporation and HMO is illegal and cannot be enforced by doctor who provided services (Cal. Ct. App.), 107
– Corporate practice of medicine

– – Ariz. licensing law allows nonphysicians to operate outpatient treatment center (Ariz. Ct. App.), 43
– – Business services agreements between orthodontists and Orthodontic Centers of Am. are illegal and unenforceable (5th Cir.), 42
– – Emergency room doctors organization lacks standing to challenge TeamHealth contracts (Tex. App.), 169
– – N.Y. no-fault automobile insurance law, provider license need not be fraudulent to be ineligible for payment (N.Y. Sup. Ct.), 346
– – Tex. law does not create private cause of action, dismissal of suit by emergency room doctors against hospital system upheld (Tex. App.), 1031

– Doctor's tortious interference claim may proceed due to question of whether hospital followed own bylaws in summary suspension after adverse patient incident (D.D.C.), 1338
– ERISA issues

See ERISA

– Federal subcontractor, hospitals receiving payments for services to U.S. government employees must comply with employment discrimination requirements (DOL ARB), 756
– Foreign nurse employment agreement not unconscionable (Tenn. Ct. App.), 1168
– Health IT vendor contracts shift liability to providers, journal article says, 460
– Ill. physician trying to prevent partners from forcing him to liquidate his partnership interest did not establish Anti-Kickback Act cause of action (7th Cir.), 882
– Increased liability for contractors and subcontractors

See LEGISLATION, FEDERAL, HR 1788, S 386, S 458

– Independent contractors

– – Abortion training for medical residents advocate may pursue claims against officials and individuals who allegedly conspired to have his employment terminated (D. Ariz.), 391
– – Anesthesiologist's ADA claim rejected due to failure to prove he was employee of hospital (N.D. Ind.), 181
– – Clinic must satisfy IRS levy to recover taxes owed by physician (S.D. Miss.), 377
– – Vicarious liability of hospitals

See HOSPITALS

– Joint operating agreement, Cincinnati alliance and Christ Hospital reach separation agreement, 107
– Liquidated damages, claim for alleged violation of confidentiality agreement unenforceable because award must be reasonably related to actual harm (Cal. Ct. App.), 139
– Medicaid managed care, unsuccessful bidder may not sue state for alleged Medicaid Act violations under federal civil rights statute (9th Cir.), 975
– Medically underserved areas, doctor who failed to serve entire term must repay funds from DHS and Natl. Health Serv. (D. Utah), 1063
– Noncompete clauses

See NONCOMPETE CLAUSES

– Pay rate in provider agreement violation alleged, state law claims not preempted by ERISA (5th Cir.), 1113
– Physician recruiting agreements

See PHYSICIANS

– PPO contract, chiropractor may pursue claims alleging insurer failed to do anything to steer patients to her practice (S.D. Ill.), 403
– RACs

See RECOVERY AUDIT CONTRACTORS (RACs)

– Sexual harassment claim basis for temporary placement agency's cancellation of OB/GYN's assignment, tortious interference claim against hospital may proceed (D. Me.), 1091
– Staff privileges issues

See STAFF PRIVILEGES

– Underpayment alleged, hospital's claims against plan administrator and external review organization may proceed (E.D. Cal.), 1151
– Venue change to transfer lease breach case to La. where involuntary hospital bankruptcy case pending (D. Minn.), 1198
– Vicarious liability of hospitals

See HOSPITALS

CONVERSIONS

See FOR-PROFIT CONVERSIONS

COPAYMENTS AND DEDUCTIBLES

– Drugs with no generic version placed in highest copayment tier no violation of plan, proposed ERISA class action dismissed (E.D. Pa.), 833
– HMO violated state rule by charging copayment and coinsurance for single service (W.D. Mo.), 799
– Part D copayment subsidy for needy patients by state board would not merit penalties, advisory opinion, 1109
– Subrogation and credit for copayments, challenge to health plan lien on third-party settlement rejected due to failure to exhaust administrative remedies (N.D. Cal.), 1212

COPYRIGHTS

– Ratings of health care providers subject to protection, motion to dismiss infringement claim denied (D. Colo.), 917

CORPORATE GOVERNANCE

– Directors under scrutiny to oversee quality of patient care, attorneys advise, 821
– Executive compensation

See EXECUTIVE COMPENSATION

– Financial data from health insurance companies sought by House committee, 1141
– IRS continuing focus on monitoring good governance, commissioner says, 923
– Joint Commission medical staff standard working draft under review, 1429
– Joint Commission Sentinel Event Alert urges health care leaders to increase error prevention by taking zero-defect approach, 1185
– N.Y., compliance program mandate begins Oct. 1, boards expected to oversee quality of care, 1041
– Nonprofit corporate law developments in 2008, BNA Analysis & Perspective, 73
– Outlook 2009, top health law issues, 5
– Payroll taxes collected but not paid, former hospital CEO ordered to pay $1.9M (M.D. Fla.), 1095
– Recent developments, BNA Analysis & Perspective, 776
– Training materials for IRS agents provide valuable guidance, attorneys say, 1009

CORPORATE INTEGRITY AGREEMENTS (CIAs)

– Quality monitors, IG soliciting responses from organizations, 1402

COST OF HEALTH CARE

– Comparative effectiveness

See COMPARATIVE EFFECTIVENESS

– GPOs savings study, In Brief, 607
– HMO and PPO market concentration effect varies, GAO report, 1198
– Legal issues in achieving quality and cost efficiency, BNA Analysis & Perspective, 740
– Malpractice reform proposed by President Obama to limit lawsuits and costs, 1195
– Rangel (D-NY) says lowering costs would mean subsidy cuts, 1205
– Retail-based clinics

See LIMITED SERVICE CLINICS (LSCs)

– Uninsured persons

See UNINSURED PERSONS

COST REPORTS

– Asset test is not mandatory, reimbursement for bad debts allowed (D.D.C.), 1177
– False claims

See FALSE CLAIMS

– Forsyth Mem'l Hosp., Medical Park Hosp., and Foundation Health Sys. Corp. merger not bona fide sale, reimbursement denied (D.D.C.), 1503
– Old Germantown Hosp. and Albert Einstein Healthcare Network merger, CMS denial of loss upheld because transaction not bona fide sale (3d Cir.), 733
– Provena Hospitals, denial of reimbursement for losses from consolidation upheld (D.D.C.), 1409
– St. Luke's Hospital/Allentown Osteopathic Medical Center merger not bona fide sale for purposes of Medicare reimbursement (D.D.C.), 1339
– State tax costs, mandamus petition filed by 27 hospitals seeking to reopen reports dismissed due to failure to exhaust administrative remedies (D.D.C.), 348
– Wage index

– – CAHs reasonably excluded from calculation by HHS Sec'y, decision below reversed (D.C. Cir.), 1259
– – Calculation allegedly incorrect, magistrate recommends remand of action filed by hospitals due to lack of reviewable final action by CMS (D.D.C.), 408
– – Fringe benefits should be attributed to wages, ruling upheld for all but postage costs (D.C. Cir.), 983

– Wife of rehabilitation company owner liable for signing and certifying reports (E.D. Mich.), 1077

COVENANTS NOT TO COMPETE

See NONCOMPETE CLAUSES

COVERAGE AND REIMBURSEMENT POLICIES

– Air ambulance coverage denial not arbitrary (S.D. Ohio), 730
– Authorization for treatment, state law claim not preempted by ERISA (9th Cir.), 1208
– Autism

See AUTISM

– Avastin approved for ovarian cancer after coverage decision reversed (Cal. Super. Ct.), 338
– Boston Medical Center alleges state funds to support services to poor diverted to finance health reform coverage law (Mass. Super. Ct.), 970
– Cal. governor vetoes coverage mandates, 1405
– COBRA

See COBRA (HEALTH CARE COVERAGE CONTINUATION)

– Colo., governor signs new law requiring health insurance plans to cover routine patient care for clinical trial participants, 635
– Computer-assisted knee replacement surgery “investigational” label abused discretion, insurer liable for claim (E.D. La.), 1442
– Congenital deformity of jaw, coverage for surgery may be mandated by state law (D. Or.), 1170
– Denial documentation, administrator fined for failure to provide (W.D. Ark.), 221
– DSHs

See DISPROPORTIONATE SHARE HOSPITALS (DSHs)

– Dual eligibles

See DUAL ELIGIBLES

– Eating disorders treatment

– Excess skin removal after obesity surgery, denial as not medically necessary upheld (6th Cir.), 291
– Former plan participant who failed to convert to individual policy has no ERISA claim for benefits (W.D. Va.), 29
– Gender as rating factor allowed under Cal. law, suit seeks to end practice and proposed legislation would eliminate provision allowing women to be charged more (Cal. Super. Ct.), 160
– Gender reassignment surgery, state Medicaid agency's refusal to cover procedure not unconstitutional (W.D.N.Y.), 980
– Idaho, Medicaid limitations on inpatient psychiatrist treatment reimbursements upheld (Idaho), 1304
– Illegal acts, lack of driver's license and car insurance do not bar coverage for injuries from auto accident (6th Cir.), 1252
– Illegal alien ineligible for state brain injury program (Fla. Dist. Ct. App.), 161
– Independent Medicare Advisory Council (IMAC) to set reimbursement rates meets resistance, 1017; opposed by 75 lawmakers, 1047
– Infertility treatment, state law does not require insurer to provide full coverage (Cal. Ct. App.), 976
– Mass. probe of relationship between payments by insurers to providers and health care cost increases, 71
– Medi-Cal

See generally CALIFORNIA

– Mont. regulators reasonably restricted insurer from excluding coverage for injuries covered by auto or premises liability insurance policies (Mont.), 1335
– Neurofeedback therapy denial justified by nonmedical services exclusion (5th Cir.), 253
– N.J. governor signs autism screening and therapy, maternity services, and mental health treatment laws, 1172
– N.Y. governor signs law requiring health plans to offer coverage to unmarried young adults under parent's policy, 1052
– Or., telemedicine and brain injury coverage laws signed by governor, 835
– Out-of-network providers

– – Assignment of benefits, new Fla. law requires insurers to pay providers directly, 801
– – Bayonne Hosp. alleges Horizon BCBS used unlawful tactics to deter patients from using emergency room (D.N.J.), 1019
– – Behavioral health insurance plan does not cover nonemergency residential treatment for drug and alcohol abuse at a noncontracted center (9th Cir.), 1049
– – Dentists' inadequate payment claims against Wellpoint not barred by failure to exhaust administrative remedies (S.D. Fla.), 157
– – Dialysis, MSP law is not violated by lower reimbursement rates (N.D. Ga.), 255
– – Dueling claims about assurances require trial for dispute between hospital and insurer (E.D. La.), 433
– – Ingenix database use, N.Y. attorney general investigation

See generally NEW YORK

– – Negligent misrepresentation that knee treatment was in-network expense, state claim is not preempted by ERISA (S.D. Ohio), 731
– – Non-network hospitals sued by Horizon BCBS over waivers of charges to patients and related counterclaim filed, 3 cases (N.J. Super. Ct.), 729
– – PPO participant not entitled to full benefits for knee surgery (N.D. Cal.), 159
– – Rockefeller (D-WVa) calls for probe of reimbursement methods, 429; letter to insurers seeks more information, 458
– – Student health plans, Aetna agrees to pay to resolve state investigation into failure to pay out-of-network claims (Tex. Dist. Ct.), 190
– – Surgery out-of-plan not shown to be medically necessary and superior, denial of reimbursement upheld (U.S., rev den), 1374
– – UnitedHealth Group Inc. agrees to pay to settle physicians' claims, 3 cases (S.D.N.Y.) (D.N.J.), 97; preliminary approval of settlement delayed by trial court (S.D.N.Y.), 728
– – “Usual and customary” rates, suits allege Anthem Blue Cross uses flawed or manipulated database information, 2 cases (Cal. Super. Ct.) (C.D. Cal.), 1050

– Pay rate in provider agreement violation alleged, state law claims not preempted by ERISA (5th Cir.), 1113
– Personal care services, Wash. law cutting payments to those who care for relatives does not violate ADA and Medicaid Act, injunction denied (W.D. Wash.), 1120; stayed pending appeal, 1407
– Plan acted arbitrarily when it refused to enroll participant's disabled adult son (N.D. Ill.), 437
– Preapproved gastric bypass surgery coverage denied, participant's claim for damages and extracontractual relief denied (E.D. Wis.), 1444
– Preexisting conditions

– – Discrimination ban

See LEGISLATION, FEDERAL, HR 3962

– – Md. law signed by governor, 696

– Prior qualifying hospital stay, Medicare beneficiary who did not spend 3 days in hospital did not qualify for SNF services (U.S., rev sought), 803; (rev den), 874
– “Purging” of small businesses that are costly to insure

– – Investigation by House panel, 1169
– – Rockefeller (D-Wis) asks CIGNA to explain, 1079

– Radio frequency ablation treatment for lung cancer, negligence in making benefit determination claim reinstated against plan administrator (Cal. Ct. App.), 524
– Residential mental health treatment exclusion may be superseded by state laws, dismissal denied (N.D. Cal.), 1170
– Retroactive reinstatement of employer's coverage is equitable remedy allowed under ERISA (10th Cir.), 1081
– Student health plans

See COLLEGES AND UNIVERSITIES

– Supplemental insurance policy requires payment of actual charges not billed charges (11th Cir.), 1474
– TennCare, restrictions on eligibility determinations lifted (M.D. Tenn.), 100
– Termination, former plan participant may pursue claims that he was wrongfully terminated on basis that employer misrepresented his eligibility for coverage (S.D.N.Y.), 435
– Termination of health and welfare fund beneficiary after learning of Medicare eligibility due to ESRD violates MSP law (E.D. Tenn.), 1114
– “Turbocharging” allegations, impact of inflated patient treatment costs by N.J. corporation not immediate cause of reduced Medicare reimbursements to plaintiff hospitals (3d Cir.), 66
– United Healthcare

– – Colo. fines companies for violations concerning individual coverage plans, 1371
– – Ga., fines for delayed payments, 1501
– – Mo., company agrees to pay $536,000 in fines and reopen over 50,000 denied chiropractic claims (Mo. Dep't of Ins.), 1172

– Vicarious liability for treatment denial, attorneys discuss implications of state court decision, 558
– Wash., Medicaid nursing home reimbursement rate cut in amended state budget, temporary restraining order halts cuts (W.D. Wash.), 982; CMS seeks information on per diem payments, 1407

CRIMINAL PROSECUTION

– Abortion, Va. “partial birth infanticide” law upheld (4th Cir.), 861
– Bribery and fraud, conviction of former HealthSouth official upheld, but former Ala. governor entitled to re-sentencing after one mail fraud count dropped (11th Cir.), 364; appeals by both defendants, 2 cases (U.S., rev sought), 1110
– Clinical trials, charges reinstated against drug investigator for failing to adhere to FDA recordkeeping and reporting requirements (5th Cir.), 210
– Conn., physicians seek declaratory judgment that state law does not prohibit prescribing drugs to mentally competent, terminally ill patients who want to die with dignity (Conn. Super. Ct.), 1375
– Conspiracy complaints against joint implant makers dismissed due to business practice reforms, 4 cases (D.N.J.), 457
– Deferred prosecution agreements

– – House Judiciary Comm. hearing, 864
– – Oversight

See LEGISLATION, FEDERAL, HR 1947

– – Wellcare, In Brief, 593

– FCA, increase in civil cases may mean more criminal cases, speaker tells AHLA, 863
– HIPAA, physician and two former employees of Little Rock, Ark., hospital plead guilty to misdemeanor privacy violations, 3 cases (E.D. Ark.), 974; sentences of probation and fines, 1440
– Identity theft

See IDENTITY THEFT

– “Indentured servant,” prosecution of immigrant nurses and their attorney barred (N.Y. Sup. Ct.), 141
– Medical marijuana, Colo. health board adopts “significant responsibility” rule after primary caregiver ruling in criminal case (Colo. Ct. App.), 1510
– Patient records allegedly stolen for credit card scam, medical records administrator charged (S.D. Fla.), 726
– Patient's right to refuse treatment does not justify battering emergency room personnel (Wis. Ct. App.), 774
– Quest Diagnostics agrees to pay to settle misbranding charges, In Brief, 519
– RN disqualified from holding certain posts because of felony conviction, no due process violation (Minn. Ct. App.), 24
– “Skid Row” recruiting for unnecessary treatment

– Zyprexa, Eli Lilly agrees to pay $1.4B criminal fine to settle allegations of promoting off-label use (E.D. Pa.), 127

CRITICAL ACCESS HOSPITALS (CAHs)

– Community benefits standard revision being considered by IRS would exempt CAHs, 810
– Wage index, CAHs reasonably excluded from calculation by HHS Sec'y, decision below reversed (D.C. Cir.), 1259