Health Law Reporter Index-Summary

MAINE

– Free care laws not unconstitutional taking (1st Cir.), 1092
– Peer review privilege does not apply to documents in federal gender discrimination suit (D. Me.), 845
– Staff privileges renewal for less than full term did not breach contract (Me.), 1258
– Workers' compensation, hospital may seek balance of charges from employer after Longshore Act liability has been satisfied (Me.), 1126

MALPRACTICE

– Affidavit of merit required, case alleging fall due to medications that caused disorientation dismissed (N.J. Super. Ct. App. Div.), 41
– Ariz., new law raises burden of proof to clear and convincing evidence for suits against emergency room doctors, 1030
– Cardiac scanner testing volunteer owed no duty of due care by staff radiologist who exceeded obligation by warning of danger (Ill. App. Ct.), 262
– Confidentiality breach claim against psychologist is subject to medical malpractice pleading requirements, suit dismissed (Mich. Ct. App.), 301
– Contribution claim against device maker by hospital and anesthesia group allowed (E.D. Mich.), 1230
– Criminal act, physicians and others who provided psychiatric treatment to man who murdered his wife did not voluntary undertake a duty to protect her (Ill.), 1308
– Damages

See DAMAGES

– Ex parte contact with plaintiff's nonparty physicians may not be barred, no HIPAA preemption (Tex.), 805
– Expert witnesses

See EXPERT WITNESSES

– Good Samaritan laws, Ill., doctors who participated in emergency delivery of baby are immune from liability (N.D. Ill.), 192
– Independent medical examination

– – Discovery in automobile accident case, medical malpractice statute of limitations applies to alleged injury (N.Y.), 878
– – Physician-patient relationship implied, expert testimony required (Tenn. Ct. App.), 951

– Ind., assumption of risk defense rejected in medical malpractice action but patient's knowledge can be shown based on understanding of risks from prior procedures (Ind.), 847
– Insurance

See MALPRACTICE INSURANCE

– Jury trials

See JURY TRIALS

– Medical monitoring claim for unapproved device implanted in infant allowed under Del. law (E.D. Pa.), 342; cases certified for immediate appeal, 1228
– Negligent credentialing

– – Assessing medical malpractice claims crucial to process, attorneys say, 789
– – Bankruptcy precludes suit against physician, claims against hospital allowed to proceed (Ohio), 1180
– – Ga., routine credentialing information used by peer review committee not privileged under state law (Ga.), 804

– N.C., governor signs bill raising the reportable level of malpractice payments and moves effective date, 920
– Nursing home duty of care includes both skilled and custodial services, claims allowed (Tenn. Ct. App.), 302
– Patient compensation fund's expert testimony on preexisting risk of harm allowed if relevant to amount of damages (Ind.), 345
– Peer review issues

See PEER REVIEW AND PEER REVIEW ORGANIZATIONS (PROs)

– Pa., “error of judgment” jury instruction no longer allowed (Pa. Super. Ct.), 1231
– Reform

See MALPRACTICE REFORM

– Reporting, NPDB

See NATIONAL PRACTITIONER DATA BANK (NPDB)

– Rocky Mountain Spotted Fever, jury instruction flawed, defense verdict for doctors who failed to diagnose reversed (Ga.), 877
– Statutes of limitations

See generally STATUTES OF LIMITATIONS

– Statutes of repose

See STATUTES OF REPOSE

– Subrogation issues

See SUBROGATION

– Suicide due to psychiatric unit negligence claim may be pursued under custodial care provisions, expert medical testimony not needed (Wis. Ct. App.), 735
– Telemedicine legal issues, 241
– Vicarious liability of hospitals

See HOSPITALS

– Wash. law requiring certificate of merit prior to filing suit ruled unconstitutional (Wash.), 1261
– Workers' compensation, independent medical examination physician liable for failure to diagnose spinal cord injury of patient who died of prescription drug overdose (Ariz. Ct. App.), 567
– Wrongful birth

See WRONGFUL BIRTH

– Wrongful death cases

See WRONGFUL DEATH

MALPRACTICE INSURANCE

– Antitrust, repeal of McCarran-Ferguson Act

See LEGISLATION, FEDERAL, HR 3596, S 1681

– Discovery of existence and extent of liability insurance coverage not allowed (Tenn.), 167
– Payment reporting law signed by Tenn. governor, 535
– Pa. subsidies, hospitals and physicians may pursue claims state failed to fully fund program (Pa. Commw. Ct.), 1060
– Tail coverage when claims-made policy canceled, nursing home must reimburse physician (Mich. Ct. App.), 1412

MALPRACTICE REFORM

– GOP members of House panel push liability reform, 429
– Incentives to states

See LEGISLATION, FEDERAL, HR 3200, HR 3962

– Okla., multifaceted law signed by governor, 735
– President Obama proposal to limit lawsuits and costs

– – Demonstration projects, states eligible for grants, 1266
– – Stakeholders react, 1195

– Recent interest due to health care reform activity, Cong. Research Serv. report, 1412
– Savings to federal programs of over $41B possible, Cong. Budget Off. analysis, 1367
– Wash. law requiring certificate of merit prior to filing suit ruled unconstitutional (Wash.), 1261

MANAGED CARE

See also HEALTH MAINTENANCE ORGANIZATIONS (HMOs)
– Balance billing

See BILLING

– California

– – 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 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 (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

– Dentists' inadequate payment claims against Wellpoint not barred by failure to exhaust administrative remedies (S.D. Fla.), 157
– Exclusion of some chiropractors from panel did not violate state HMO law (Tenn. Ct. App.), 435
– Hawaii Medicaid

– – Mandated enrollment allegedly violates “freedom of choice” provision, claims of disabled children and others allowed (D. Haw.), 700; temporary restraining order denied, 1147; certified question to Haw. Sup. Ct. on contractor eligibility issue, 1373
– – Unsuccessful bidder may not sue state for alleged Medicaid Act violations under federal civil rights statute (9th Cir.), 975

– Incentives to patients by out-of-network provider allegedly interfered with organization's relationship with in-network providers, claim is not preempted (D.N.J.), 556
– N.Y. governor signs comprehensive reform bill, 1052
– Surgery out-of-plan not shown to be medically necessary and superior, denial of reimbursement upheld (U.S., rev den), 1374
– TRICARE, hospitals must seek administrative remedies against contractors before filing suit (3d Cir.), 1210
– UnitedHealth Group Inc.

– – Physicians' out-of-network claims, class action settlement, 3 cases (S.D.N.Y.) (D.N.J.), 97; preliminary approval of settlement delayed by trial court (S.D.N.Y.), 728
– – “Usual, customary, and reasonable” database, N.Y. settlement announced, 98

– W.Va., Medicaid-eligible children may sue program (S.D.W. Va.), 699

MARIJUANA, MEDICINAL USE

– Colo., state health board adopts “significant responsibility” rule after primary caregiver ruling in criminal case (Colo. Ct. App.), 1510
– N.H., governor vetoes bill allowing medical use, 953
– R.I., lawmakers override veto of bill allowing dispensaries, 849

MARKETING

See also ADVERTISING
– Celebrex and Bextra, third-party payers and consumer class action settlement approved (N.D. Cal.), 1401
– Disclosure of gifts and payments to physicians

See LEGISLATION, FEDERAL, S 301

– Discount drug card suit settled (Pa. Commw. Ct.), 185
– Health insurance, standardized disclosure information

See LEGISLATION, FEDERAL, HR 2427, S 1050

– Limited benefit plans, N.Y. fines company and probe continues, 1117
– Off-label use

See OFF-LABEL USE

– Prescription drug data sales ban

– – Access to de-identified health information needed, BNA Analysis & Perspective, 472
– – N.H. law upheld (U.S., rev sought), 431; (rev den), 869
– – Restrictions being considered by states, 216
– – Vt. law barring sale or use of prescriber-identifiable data upheld (D. Vt.), 555; injunction pending appeal denied, 793

– Retail-based clinics

See LIMITED SERVICE CLINICS (LSCs)

– Vytorin and Zetia, settlement of class action alleging buyers misled into paying higher prices (D.N.J.), 1437

MARYLAND

– Clinical integration

– – Program will not trigger FTC challenge, advisory opinion, 487
– – TriState Health Partners conditional approval, new guidance, advisory opinion, 587

– “Effective communication” with deaf patient, Md. hospital settles charges, 1260
– Free hospital care for low-income patients, new law signed by governor, 640
– HCQIA, peer review participants immune under state and federal law, challenge to suspension of privileges fails (4th Cir.), 1227
– Individual health insurance regulations tightened, governor signs new laws on electronic health records, preexisting conditions, and other insurance issues, 696
– Informed consent, claim based on alleged lack of consent where there was failure to disclose treatment risks and alternatives allowed (Md.), 1027
– Wrongful birth of child with Down syndrome, limit on post-majority economic damages denied (D. Md.), 1450

MASSACHUSETTS

– Arbitration of state law employment bias claims, agreement must be clear, female doctor not required to arbitrate (Mass.), 1044
– Average wholesale price inflation of prostrate cancer treatment, $12.9M judgment for BCBS against AstraZeneca affirmed (1st Cir.), 1289
– Billing of inappropriate charges to uncompensated care pool, Boston hospital and community health center agree to pay to settle allegations (D. Mass.), 57
– Boston Medical Center alleges funds to support services to poor diverted to finance health reform coverage law (Mass. Super. Ct.), 970
– DSHs, HHS withdraws appeal of order to correct payments, suit dismissed (D.D.C.), 438
– Executive compensation, attorney general announces increased oversight of nonprofit charitable health organizations, 1200
– Gifts, pharmaceutical companies that follow voluntary industry programs to withhold prescriber data in compliance and device-related training reimbursement allowed, 1016
– Hospital owed no duty of care to police officer injured in accident while responding to earlier incident involving collision caused by patient released while medicated (Mass.), 846
– Medicaid drug pricing cases

– – Mylan Labs. motion to dismiss denied, previous settlement no bar (D. Mass.), 364
– – Teva Inc. settlement (D. Mass.), In Brief, 26

– Medical errors, regulators adopt rules to bar billing for care due to serious reportable events, 660
– Peer review privilege does not bar medical board's discovery of credentialing records in probe of competency (Mass.), 1122
– Probe of relationship between payments by insurers to providers and health care cost increases, 71
– Reproductive health clinic buffer zone law challenge rejected (1st Cir.), 954
– Whistleblowers, Boston neurosurgeon gets nominal jury award (D. Mass.), 243

MDL

See MULTIDISTRICT LITIGATION (MDL)

MEDIATION

See ARBITRATION

MEDICAID

– Ala., mentally retarded applicants who were denied services without proper notice or whose eligibility determinations were delayed may pursue class action against officials (M.D. Ala.), 635
– Antitrust aspects of health information sharing, BNA Analysis & Perspective, 990
– Ariz., injunction requiring state to ensure disabled individuals have access to home- and community-based services reaffirmed (D. Ariz.), 562
– Benchmark-equivalent packages

– – CMS delays implementation of rule, In Brief, 468
– – Effective date of rule allowing states to create alternatives for some beneficiaries delayed, 163

– California

See CALIFORNIA

– Cost-sharing rule delayed, In Brief, 136; CMS reopens comment period, 438
– De-institutionalization of mentally ill, advocacy groups urges more aggressive implementation of Olmstead decision, 874
– Discovery of comments to rule, DHS must produce for pharmacy groups and government may provide average manufacturer price data to Govt. Accountability Office (D.D.C.), 910
– Dual eligibles

See DUAL ELIGIBLES

– Economic stimulus package

– – First disbursement of $15B announced by President Obama, 249
– – Funding for states and health IT

See LEGISLATION, FEDERAL, HR 1, S 1

– – Schumer (D-NY) says states could get as much as $100B, 27
– – Wage cuts for Medi-Cal home care workers

See CALIFORNIA

– Exclusions and terminations

See EXCLUSIONS AND TERMINATIONS

– Expansion part of Senate Fin. Comm. health care reform draft, 828
– Fraud

See MEDICAID FRAUD

– FY2010 budget

– – Cuts to pay for health reform, 277; complete budget submission proposes $309B in savings from reduced spending, 630
– – Resolutions

See LEGISLATION, FEDERAL, HConRes 85, SConRes 13

– Hawaii

See HAWAII

– Health care-related taxes, enforcement delay on hold harmless provision sought, In Brief, 601; delayed until 2010, 873
– HHS Inspector Gen.

– – Annual work plan for FY2010 includes ARRA-mandated reviews, 1340
– – Expects to recover more than $2.4B for first half of 2009, In Brief, 811

– House Democrats' health care reform proposal

See LEGISLATION, FEDERAL, HR 3200, HR 3962

– Idaho, limitations on inpatient psychiatrist treatment reimbursements upheld (Idaho), 1304
– Ill., community integrated living arrangements incorrectly denied to man with cerebral palsy (Ill. App. Ct.), 636
– Ind., state agency should not be held in contempt for alleged violations of consent decree covering eligibility determinations for disabled persons (7th Cir.), 767
– Iowa, upcoding of eye exams determination by state agency erroneous (Iowa), 981
– Kansas

See KANSAS

– La., clinic's claim for reimbursement time-barred (M.D. La.), 1306
– Managed care

See MEDICAID MANAGED CARE

– Medi-Cal

See CALIFORNIA

– Mich., 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
– N.H., suit alleging state agency violates anti-lien provision of Medicaid Act by seeking more than fair share of malpractice settlement allowed to proceed (D.N.H.), 700
– New York

See NEW YORK

– North Carolina

See NORTH CAROLINA

– Okla. agency did not breach contracts with nursing homes, summary judgment for state in pay rates class action (Okla. Dist. Ct.), 666
– “Pay and chase,” issue of sovereign immunity from counterclaims of state intervenors in Caremark FCA suit must be decided (5th Cir.), 1015
– Pa., state cannot condition payment for trauma services by W. Va. DSH on requirement that it be accredited by Pa., temporary restraining order granted (M.D. Pa.), 946; preliminary injunction entered against state officials and agencies, 1372
– Recovery of state's expenses from malpractice award upheld (U.S. rev den), 801
– Rescission of three controversial rules planned by CMS, 601; rescinded, 873
– Special needs trust income must be considered in determining entitlement (2d Cir.), 870
– TennCare

See TENNESSEE

– Texas

See TEXAS

– Va., physician services billed separately so could not be included in DSH “hospital services,” disallowance of claim upheld (D.D.C.), 438
– Voluntary disclosure protocols for revealing compliance problems increasingly being adopted by states, 657
– Washington

See WASHINGTON

– Wellness programs, legal issues analyzed by Cong. Research Service report, 908
– W.Va., Medicaid-eligible children may sue managed care program (S.D.W. Va.), 699

MEDICAID DRUG COVERAGE

– Ala., average wholesale price litigation

– – AstraZeneca, GlasxoSmithKline and Novartis win on appeal, verdict reversed (Ala.), 1400
– – Drug makers settle (Ala. Cir. Ct.), In Brief, 25
– – Sandoz, jury awards $78.4M (Ala. Cir. Ct.), 247
– – Six more drug makers settle (Ala. Cir. Ct.), 687

– Aventis settles steroid-based nasal sprays price allegations, In Brief, 759
– Cal., pharmacy trade groups allege inadequate reimbursement under new average wholesale price changes (C.D. Cal.), 1337
– Ill., average wholesale price litigation

– – Amgen and Immunex Corp. settlement announced (Ill. Cir. Ct.), 940
– – Baxter agrees to pay to settle (Ill. Cir. Ct.), In Brief, 1047

– Iowa prescription drug benefit program, HHS refusal to approve plan amendment upheld (8th Cir.), 1146
– Ky. average wholesale prices

– – Amgen Inc. settles fraud charge (Ky. Cir. Ct.), 365
– – Jury award of $14.7M against AstraZeneca (Ky. Cr. Ct.), 1400

– Massachusetts drug pricing cases

See MASSACHUSETTS

– Multiple source drug rule definition hearing delayed (D.D.C.), 259
– N.Y., pharmacy trade groups allege inadequate reimbursement under new average wholesale price changes (N.D.N.Y.), 1337
– Omnicare settles allegations of overcharges by switching prescriptions, In Brief, 759
– Protonix, Wyeth accused of overcharging by fraudulent price reporting, 2 cases (D. Mass.), 687
– Rebates not paid, drug makers agree to pay to resolve FCA allegations, 1402
– Safety-net hospitals and CMS settle national drug codes reporting suit, 1407
– Texas

– – Overcharging due to improper drug price reports, Alpha Therapeutic Corp. agrees to pay to settle charges (Tex. Dist. Ct.), 1111
– – Risperdal, state attorney general files amended complaint in qui tam suit against makers alleging misrepresentations to state (Tex. Dist. Ct.), 25

– Utah, state recovers $1M from drugmaker Dey, In Brief, 1298
– Washington

– – Pharmacy trade groups allege inadequate reimbursement under new average wholesale price changes (W.D. Wash.), 1337
– – Temporary restraining order halts cut in pharmacy reimbursements for brand-name prescription drugs (W.D. Wash.), 467

– Wisconsin average wholesale drug prices

– – Amgen and Immunex settle allegations (Wis. Cir. Ct.), In Brief, 26
– – Pharmacia Corp., jury finds fraud and awards $9M to compensate state (Wis. Cir. Ct.), 247

MEDICAID FRAUD

– Drug price allegations

See generally MEDICAID DRUG COVERAGE

– Fla., deferred prosecution agreement, Wellcare, In Brief, 593
– Libel claims against state officials by neurologist who successfully defended herself against upcoding claims may proceed (D. Utah), 1366
– Recoveries of nearly $344M reported in FY2008, 1436
– Reduction measures

See LEGISLATION, FEDERAL, S 974, S 975

– State-based Medicaid Fraud Control Units recovered $1.3B in FY2008, 1078

MEDICAID MANAGED CARE

– Hawaii

– Pa. Right-to-Know Law covers Medicaid managed care program provider agreements, disclosure ordered (Pa. Commw. Ct.), 769

MEDICAL DEVICES

– Artificial embolization devices combined, use of unapproved devices does not constitute negligence per se (D.D.C.), 192
– Biofeedback machine, physician sanctioned by medical board for ineffective use to diagnose allergies, expert testimony not needed (Wash.), 766
– Bone growth stimulating devices, whistleblower alleges maker engaged in illegal activity related to osteopathic surgeon's use of unapproved devices (S.D.W. Va.), 184
– Catheters

– – Hospital's suit against C.R. Bard dismissed for lack of proof (E.D. Mo.), 1292
– – Rochester Medical Corp. settles antitrust claims against Tyco/Covidien (E.D. Tex.), 125

– Contribution claim against device maker by hospital and anesthesia group allowed (E.D. Mich.), 1230
– Dental implant designer and adviser not liable for harm to injured patients (La. Ct. App.), 881
– Disclosure of gifts and payments to physicians

See LEGISLATION, FEDERAL, S 301

– Endoscopic Technologies Inc. agrees to pay to settle FCA allegations (S.D. Tex.), In Brief, 970
– Ethics, industry code for interactions with health care professionals still has “opportunities for mischief” according to IG official, 863
– Eye surgery instrument maker's tying suit dismissed for failure to plead price coercion, reconsideration denied (S.D.N.Y.), 1165
– Global increase in business opportunities leads to more FCPA cases, attorneys say, 899
– Guidant Corp., dismissal of private securities fraud putative class action affirmed (7th Cir.), 1453
– HealthTronics and Endocare Inc. merger announced after Endocare-Galil merger fails, 791
– IUDs from Mexico, Medi-Cal suspension of doctor charged with using misbranded devices upheld, rehearing denied (9th Cir.), 136
– Lasers, leg hair removal is not health care, no expert report needed (Tex. App.), 409
– Left ventricular devices competition, Thoratec Corp. and HeartWare Intl. call off merger in response to FTC challenge (FTC), 1043
– Medical body area networks, Fed. Communications Comm'n seeks comments on proposed frequency allocation, 954
– Noncompete clauses, court refuses to limit scope to customers on whom former employee called more than three times, TRO to enforce agreement granted (D. Minn.), 569
– Off-label promotions now being targeted by government investigations, 453
– Orthopedic device makers win dismissal of suit alleging kickbacks and other violations (W.D. Pa.), 425
– Pulse oximeters maker failed to show competitor's bundling agreements had sufficient impact on market, jury award partially vacated (9th Cir.), 1467
– Quest Diagnostics agrees to pay to settle misbranding charges, In Brief, 519
– Training reimbursement permitted under Mass. gift rules, 1016

MEDICAL ERRORS

See also ADVERSE EVENTS; MALPRACTICE
– Disclosure of unanticipated medical outcomes, more hospitals and insurers requiring patients be informed but others dispute policy, 1321
– Fla., wrong-site errors disciplinary action law does not violate physician's rights under state constitution (Fla. Dist. Ct. App.), 698
– IT firms questioned by Grassley (R-Iowa) systems problems, 1471
– Joint Commission

– – Center to identify and measure unsafe health care practices announced, 1207
– – Sentinel Event Alert urges health care leaders to increase error prevention by taking zero-defect approach, 1185

– Mass. regulators adopt rules to bar billing for care due to serious reportable events, 660
– Mo., hospitals not subject to strict liability under state law, product liability claim for cottonoid left in body after surgery dismissed (E.D. Mo.), 1090
– N.H. governor signs new required reporting law, 1064
– N.J., governor signs bill requiring public reporting of hospital adverse events, 1186
– Office practices, doctors urged to adopt quality programs to improve patient safety, 690
– Patient safety and medical liability reform demonstration projects, states eligible for grants, 1266

MEDICAL MARIJUANA

See MARIJUANA, MEDICINAL USE

MEDICAL MONITORING

– Pa. claim for unapproved device implanted in infant allowed (E.D. Pa.), 342; cases certified for immediate appeal, 1228

MEDICAL RECORDS

– Copying fees allowed, hospital may charge claimant seeking information for liability action (Tex. App.), 1184
– Discovery of nonparty medical records not permissible in private litigation (Ohio), 913
– Doctor-patient privilege

See PRIVACY AND CONFIDENTIALITY

– Electronic health records

See ELECTRONIC HEALTH RECORDS

– EMTALA inadequate screening claim, emergency room records of other chest pain patients must be produced (D.N.J.), 528
– Florida Amendment 7, patient's constitutional right of access to adverse medical events records

See FLORIDA

– HIPAA

See HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)

– Mental health records disclosed during discovery in divorce case, claim reinstated (Ill. App. Ct.), 1448
– No waiver when child custody suit evaluation ordered, parent should not have been required to disclose existing privileged mental health records (Pa. Super. Ct.), 406
– Photocopying nursing home resident's medication record for discrimination case not misappropriation of property, reversed and remanded (Okla.), 1256
– Privacy issues

See generally PRIVACY AND CONFIDENTIALITY

– Shredding, N.H. bill introduced, 216
– Tenn., state law claim that hospital failed to turn over complete record requested by parents may proceed (W.D. Tenn.), 1086

MEDICAL TOURISM

– Legal, compliance, and regulatory issues, BNA audioconference, 229
– Risk and legal issues considered, 325

MEDICAL WASTE

– Incinerators, emission standards tightened, final rule, 1267

MEDICARE

– Antitrust aspects of health information sharing, BNA Analysis & Perspective, 990
– Claims records, nonprofit consumer magazine may not obtain documents (D.C. Cir.), 164
– Cost reports

See COST REPORTS

– DME

See DURABLE MEDICAL EQUIPMENT (DME)

– DSH payments

See DISPROPORTIONATE SHARE HOSPITALS (DSHs)

– Dual eligibles

See DUAL ELIGIBLES

– Exclusions and terminations

See EXCLUSIONS AND TERMINATIONS

– Fraud

See MEDICARE FRAUD

– FY2010 budget

– – Cuts to pay for health reform, 277; complete budget submission proposes $309B in savings from reduced spending, 630
– – Readmission rate reductions by “bundling” for post-acute care intended to save, 280
– – Resolutions

See LEGISLATION, FEDERAL, HConRes 85, SConRes 13

– HHS Inspector Gen.

– – Annual work plan for FY2010 includes ARRA-mandated reviews, 1340
– – Expects to recover more than $2.4B for first half of 2009, In Brief, 811

– Hospital payment

See HOSPITAL PAYMENT

– Independent Medicare Advisory Council (IMAC) to set reimbursement rates meets resistance, 1017; opposed by 75 lawmakers, 1047
– Inpatient psychiatric facilities FY2010 rate increase, 603
– Long-term stability, Part A trust fund will be out of money in 2017, report says, 630
– Medicare Advantage

See MEDICARE ADVANTAGE (MA)

– Medigap coverage

See MEDIGAP

– Nurse staffing requirements, claims related to HHS delegation of compliance oversight to Joint Comm'n dismissed (D.D.C.), 102
– Outlier payments

See OUTLIER PAYMENTS

– Outlook 2009, top health law issues, 5
– Part D

See MEDICARE DRUG COVERAGE

– Pay-for-performance

See PAY-FOR-PERFORMANCE PROGRAMS

– Physician-owned hospitals, participation

See SPECIALTY HOSPITALS

– Physician payment

See PHYSICIAN PAYMENT

– Prior qualifying hospital stay, beneficiary who did not spend 3 days in hospital did not qualify for SNF services (U.S., rev sought), 803; (rev den), 874
– Qualified Individual program to assist with Part B premiums extended, 284
– Radiology benefit managers proposed to cut costs, 279
– Reducing pay to providers among health care reform proposals by Senate Fin. Comm. leaders, 658
– Reform

See MEDICARE REFORM

– Secondary payer program

See SECONDARY PAYER PROGRAM

– SNFs

See SKILLED NURSING FACILITIES (SNFs)

– Specialty hospitals, participation

See SPECIALTY HOSPITALS

– Subrogation, reimbursement from insurance settlement allowed (8th Cir.), 166
– Termination of health and welfare fund beneficiary after learning of Medicare eligibility due to ESRD violates MSP law (E.D. Tenn.), 1114
– Trigger, House approves rules package nullifying provision, 27
– Wage index

– – 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

MEDICARE ADVANTAGE (MA)

– Cuts

– – FY2010 proposed budget includes reduction, 277; complete budget submission proposes $309B in savings from reduced spending, 630
– – GOP threatens to delay HHS nominations due to CMS letter ordering plans not to discuss reform legislation in mailings to enrollees, 1298
– – Senate Fin. Comm. defeats attempts to strike, 1298

MEDICARE+CHOICE

– Ed. Note: The name of this program was changed from Medicare+Choice to Medicare Advantage under the Medicare Prescription Drug, Improvement and Modernization Act of 2003.
– Surgery out-of-plan not shown to be medically necessary and superior, denial of reimbursement upheld (U.S., rev den), 1374

MEDICARE DRUG COVERAGE

– Ed. Note: Entries at this heading refer to Medicare Part D unless otherwise indicated.
– Antitrust, institutional pharmacy's price conspiracy claim against merged insurers dismissed (N.D. Ill.), 123
– Copayment subsidy for needy patients by state board would not merit penalties, advisory opinion, 1109
– Doughnut hole

– – Challenge dismissal affirmed, federal question jurisdiction not available (3d Cir.), 1057
– – Gradual closure

See LEGISLATION, FEDERAL, HR 3200, HR 3962

– – Senate Fin. Comm. defeats attempt to add to health care reform bill, 1298

– Erroneous premium refunds to beneficiaries, waiver of repayment denied (D.D.C.), 439
– Negotiated drug prices

See LEGISLATION, FEDERAL, HR 3200, HR 3962

– Part B office drugs proposed for removal from physician fee schedule in 2010, 916; removal does not affect 2010 but expected in future years, 1477

MEDICARE FRAUD

– 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
– Conn. medical clinic agrees to pay to settle billing allegations, In Brief, 129
– “Five principles” to combat, IG testimony, 866
– Geropsychiatric unit admissions of patients with dementia who could not benefit from program, previous public disclosure basis for FCA dismissal (9th Cir.), 655
– Iowa hospital agrees to pay to resolve allegations about financial relationship with physicians, 1141
– Lahey Clinic pays to settle allegations, In Brief, 519
– Okla. orthopedic care providers agree to pay to settle claims (W.D. Okla.), In Brief, 793
– Outlier payments

See OUTLIER PAYMENTS

– Pain management center agrees to pay to settle allegations, In Brief, 1205
– Phoenix physician agrees to pay to settle FCA allegations, In Brief, 828
– Recoveries of nearly $2.3B reported in FY2008, 1436
– Reduction measures

See LEGISLATION, FEDERAL, S 974, S 975

– San Mateo Med. Center qui tam suit settles (N.D. Cal.), 365
– “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

– Upcoding, Fla. physician agrees to pay to settle allegations (M.D. Fla.), 970

MEDICARE PAYMENT ADVISORY COMMISSION (MedPAC)

– Horizontal and vertical integration trends, positive and negative effects considered, 1363

MEDICARE REFORM

– Hospital groups agree to reduction in order to fund health care reform, 942
– Hospitals expect to recoup cuts by increased revenue from expanded health care coverage, 903
– House Democrats' proposal

See LEGISLATION, FEDERAL, HR 3200, HR 3962

– Key to any health reform, Leavitt says, 94
– Senate Fin. Comm. defeats attempts to strip out cuts from health care reform bill, 1298

MEDICARE SECONDARY PAYER PROGRAM

See SECONDARY PAYER PROGRAM

MEDIGAP

– Anti-kickback laws, no sanctions for insurers contracting with hospitals to create preferred provider networks, advisory opinion, 1046
– Genetic nondiscrimination, model regulations, In Brief, 564
– Wis., policy must pay hospital's standard rate after Medicare Part A benefits exhausted (Wis.), 667

MedPAC

See MEDICARE PAYMENT ADVISORY COMMISSION (MedPAC)

MEETINGS

See CONFERENCES AND MEETINGS

MENTAL HEALTH

– Cal., tax to pay for expanded funding for services upheld (Cal. Ct. App.), 1415
– Child custody suit evaluation ordered, parent should not have been required to disclose existing privileged records (Pa. Super. Ct.), 406
– Confidentiality breach claim against psychologist is subject to medical malpractice pleading requirements, suit dismissed (Mich. Ct. App.), 301
– De-institutionalization, advocacy groups urges more aggressive implementation of Olmstead decision, 874
– Dumping of mentally ill patients at “skid row” shelters, Southern Cal. hospital agrees to pay to settle charges (Cal. Super. Ct.), 500
– 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

– Employment of mental health practitioner who was paid “market value” for building does not violate law, advisory opinion, 456
– EMTALA claims of estate of woman murdered by husband 10 days after he was discharged following psychotic episode reinstated (6th Cir.), 468; en banc hearing denied, 984; (U.S., rev sought), 1478
– Idaho, Medicaid limitations on inpatient psychiatrist treatment reimbursements upheld (Idaho), 1304
– Liability, physicians and others who provided psychiatric treatment to man who murdered his wife did not voluntary undertake a duty to protect her (Ill.), 1308
– N.J. governor signs involuntary commitment to outpatient treatment coverage law, 1172
– Parity

– – Democratic senators urge timely release of rule by agencies, 1079
– – Proposed rulemaking, federal agencies seek public comment on economic and regulatory impact of changes, 559; rules delayed until Jan. 2010, 1370
– – Recent law changes discussed by administration officials, 634

– Part D copayment subsidy for needy patients by state board would not merit penalties, advisory opinion, 1109
– Postpartum depression research

See LEGISLATION, FEDERAL, HR 20

– Psychiatric care facilities

See PSYCHIATRIC CARE FACILITIES

– Psychiatrists

See PSYCHIATRISTS

– Psychologist-patient privilege, subpoena to investigate billing practices quashed due to lack of consent by patient (Mich. Ct. App.), 339
– 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
– Records disclosed during discovery in divorce case, claim reinstated (Ill. App. Ct.), 1448
– Residential treatment exclusion may be superseded by state laws, dismissal denied (N.D. Cal.), 1170

MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES

– Adult day care program, expert report required for sexual assault by one patient against another (Tex. App.), 1411
– Ala., mentally retarded Medicaid applicants who were denied services without proper notice or whose eligibility determinations were delayed may pursue class action against officials (M.D. Ala.), 635
– Autism, applied behavioral analysis therapy

See AUTISM

– Community integrated living arrangements incorrectly denied to man with cerebral palsy (Ill. App. Ct.), 636
– Guardians of incompetent patient may not withhold life-saving treatments (Pa. Super. Ct.), 224
– Medicaid benefits termination due to residuary trust, judicial review available because claims “remedial” (10th Cir.), 99
– Nonconsensual elective surgery for mentally retarded adults claims dismissed but question of attempt to obtain consent allowed (D.D.C.), 67
– 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
– Wrongful birth of child with Down syndrome, limit on post-majority economic damages denied (D. Md.), 1450

MERGERS AND ACQUISITIONS

– AHA report seeks more scrutiny of health insurance plan mergers, 621
– BCBS subsidiary's acquisition of for-profit companies, suit by state attorney general dismissed (Mich. Cir. Ct.), 97; attorney general appeals ruling, 188
– Carilion Clinic's acquisition of outpatient clinics harms competition in Roanoke area (FTC), 1011; firm agrees to divest two outpatient clinics, 1361
– CSL Ltd./Talecris Biotherapeutics merger terminated after FTC objection but suits allege collusive conduct with Baxter (N.D. Ill.), 1465
– CVS/Caremark, FTC investigation disclosed, 1497
– Exempla Inc. opposition to transfer of Denver hospitals, 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
– For-profit conversions

See FOR-PROFIT CONVERSIONS

– Forsyth Mem'l Hosp., Medical Park Hosp., and Foundation Health Sys. Corp. merger not bona fide sale, reimbursement denied (D.D.C.), 1503
– HealthTronics and Endocare Inc. merger announced after Endocare-Galil merger fails, 791
– Highmark and Independence Blue Cross merger abandoned, 125
– HIP Health PlanGroup Health Inc., New York City required to produce decisionmaking process documents, motion for reconsideration denied (S.D.N.Y.), 653
– Merck/Schering-Plough, FTC requires dual divestitures (FTC), 1466
– Nonprofit corporate law developments in 2008, BNA Analysis & Perspective, 73
– Old Germantown Hosp. and Albert Einstein Healthcare Network, CMS denial of loss upheld because transaction not bona fide sale (3d Cir.), 733
– Pfizer Inc. and Wyeth, pharmacists allege antitrust and Troubled Asset Relief Program violations (N.D. Cal.), 1140; complaint dismissed, 1396
– Preferred Care Partners may pursue breach of confidentiality agreement claims related to failed negotiations to purchase Humana Inc. (S.D. Fla.), 524
– Provena Hospitals, denial of reimbursement for losses from consolidation upheld (D.D.C.), 1409
– Quality improvement potential will be part of FTC review, official says, 208
– Recent corporate governance developments, BNA Analysis & Perspective, 776
– St. Luke's Hospital/Allentown Osteopathic Medical Center, not bona fide sale for purposes of Medicare reimbursement (D.D.C.), 1339
– Thoratec Corp. and HeartWare Intl. call off merger in response to FTC challenge (FTC), 1043
– Univ. of So. Cal. agrees to buy 2 Tenet hospitals, 229

MEWAs

See MULTIPLE EMPLOYER WELFARE ARRANGEMENTS (MEWAs)

MICHIGAN

– BCBS

See BLUE CROSS AND BLUE SHIELD PLANS (BCBS)

– Confidentiality breach claim against psychologist is subject to medical malpractice pleading requirements, suit dismissed (Mich. Ct. App.), 301
– Contribution claim against device maker by hospital and anesthesia group allowed (E.D. Mich.), 1230
– Discretionary clauses barred, state insurance rules not preempted by ERISA (6th Cir.), 400
– Labor coalition sues public college to force release of information about pharmacy benefits contract with CVS Caremark (Mich. Cir. Ct.), 333
– Malpractice insurance, nursing home must reimburse physician (Mich. Ct. App.), 1412
– 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
– Noncompete provision unenforceable because restrictions terminated with expiration of contract (Mich. Ct. App.), 441
– Psychologist-patient privilege, subpoena to investigate billing practices quashed due to lack of consent by patient (Mich. Ct. App.), 339

MILITARY HEALTH CARE

– EMTALA failure to screen claims against Navy hospital dismissed due to sovereign immunity (E.D. Va.), 103
– Tricare, Okla. orthopedic surgery providers agree to pay to settle fraud claims (W.D. Okla.), In Brief, 793

MINNESOTA

– Antitrust, Lundbeck Inc. pricing practices, 2 cases set for trial (D. Minn.), 1011
– Chemotherapy ordered for 13-year-old whose parents breached parental duties by refusing treatment (Minn. Dist. Ct.), 669
– Genetic privacy law allegedly violated by collecting and storing newborn blood and DNA without parental consent (Minn. Dist. Ct.), 367
– “Groundless claim” not shown, successful defense of trade practices case does not warrant attorney' fees or sanctions (D. Minn.), 942
– Noncompete clauses, court refuses to limit scope to customers on whom former employee called more than three times, TRO to enforce agreement granted (D. Minn.), 569
– 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
– Price fixing, state warned by FTC staff about exemptions for health care cooperatives, 389
– Property tax assessment, nonprofit management affiliate of exempt health care system not exempt for property it owns or leases for use as medical clinic (Minn.), 1095
– Usury, state attorney general sues Allina Health System alleging excessive interest charged on debts (Minn. Dist. Ct.), 142; hospitals agree to reimburse patients charged more than 8 percent interest, 535
– Workers' compensation exclusivity provision bars claims for altercation at retail clinic, nurse practitoner's claims against Medcor Inc. and Target dismissed (D. Minn.), 639

MISSISSIPPI

– EMTALA no basis for removal to federal court of state negligence suit (S.D. Miss.), 1449

MISSOURI

– Abortion, clinics that provide medication but not surgical services may not pursue state claims challenging law requiring ASC licenses because duplicative of federal lawsuit (Mo. Ct. App.), 1127
– Data breach notice law signed by governor, 975
– Delayed or denied payments, state law claims by Mo. physicians against health insurers are governed by ERISA and must be litigated in federal court (S.D. Fla.), 157
– Drug to prevent respiratory disease in children, Mo. specialty pharmacy settles FCA charges, 1110
– HMO violated state rule by charging copayment and coinsurance for single service (W.D. Mo.), 799
– Hospitals not subject to strict liability under state law, product liability claim for cottonoid left in body after surgery dismissed (E.D. Mo.), 1090
– Prompt payment law preempted by ERISA (8th Cir.), 336
– United Healthcare agrees to pay $536,000 in fines and reopen over 50,000 denied chiropractic claims (Mo. Dep't of Ins.), 1172
– Wrongful death, Medicare entitled to reimbursement from insurance settlement (8th Cir.), 166
– Wrongful discharge allegedly due to nurse's refusal to lie on notes, employment-at-will doctrine does not bar suit (Mo. Ct. App.), 244

MONITORING AND MEASUREMENT

– Medical monitoring

See MEDICAL MONITORING

MONTANA

– ERISA, state insurance commissioner can prohibit “discretionary clauses” (9th Cir.), 1441
– Physician-assisted suicide upheld under state constitution, stay denied (Mont. Dist. Ct.), 69
– Staff privileges, radiologist whose status changed to “consulting” entitled to injunction requiring reinstatement due to lack of formal peer review investigation (Mont.), 33
– State regulators reasonably restricted BCBS from excluding coverage for injuries covered by auto or premises liability insurance policies (Mont.), 1335

MORNING-AFTER PILL

See generally CONTRACEPTION

MSP (MEDICARE SECONDARY PAYER PROGRAM)

See SECONDARY PAYER PROGRAM

MULTIDISTRICT LITIGATION (MDL)

– Arbitration, judge in multidistrict litigation cannot vacate pre-transfer ruling, order to compel reinstated (3d Cir.), 1291

MULTIPLE EMPLOYER WELFARE ARRANGEMENTS (MEWAs)

– Employer fund contributions must be based on all wages including holiday and sick leave (D. Conn.), 1500