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<title>LexisNexis® Mealey's™ Managed Care Liability Legal News</title>

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<description>Headline Managed Care Liability Legal News from LexisNexis®</description>

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<title>LexisNexis® Headline Managed Care Liability Legal News</title>

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<copyright>Copyright 2008</copyright>

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<title>Florida Appeals Court Reverses Dismissal Of Case Seeking Payment For Services</title>
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<![CDATA[WEST PALM BEACH, Fla. - A Florida appeals court on July 16 reversed a decision dismissing a chiropractor's class action complaint seeking reimbursement for his services, holding that the health plan at issue did not contain an anti-assignment of benefits clause and that more information was needed on the relationship of the claims administrator to the plan provider (Abraham K. Kohl, D.C., individually and Dr. Abraham Kohl, P.A. d/b/a Kohl Chiropractic, on behalf of themselves and all other similarly situated v. Blue Cross and Blue Shield of Florida Inc., et al., No. 4D07-3399, Fla. App., 4th Dist.; 2008 Fla. App. LEXIS 10865). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-15 Mealey's Man. Care Liab. Rep. 1 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Montana Supreme Court Affirms, Reverses Ruling In Denial Of Benefits Case</title>
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<![CDATA[HELENA, Mont. - The Montana Supreme Court on July 17 partially affirmed and partially reversed a lower court's summary judgment ruling in a wrongful denial of benefits case (John and Bonnie Lorang v. Fortis Insurance Co., No. 04-489, Mont. Sup.; 2008 Mont. LEXIS 390). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-15 Mealey's Man. Care Liab. Rep. 2 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Separate Settlements Reached In RICO Class Action</title>
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<![CDATA[Case name: Natalie M. Grider, M.D., et al. v. Keystone Health Plan Central Inc., et al.; See 4/16/08, Page 5. 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-15 Mealey's Man. Care Liab. Rep. 3 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Final Settlement Of $255 Million Reached In Reimbursement Case</title>
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<![CDATA[Case name: Stewart Scharfman, individually and as executor of the estate of his son, Spenser Scharfman, et al. v. Health Net Inc., et al.; Zev and Linda Wachtel, individually and on behalf of their children, Tory, Jesse and Brett Wachtel v. Health Net Inc., et al.; Renee McCoy, individually and on behalf of all others similarly situated v. Health Net Inc., et al.; See 5/21/08 Page 9. 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-15 Mealey's Man. Care Liab. Rep. 4 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Missouri Appeals Court Reverses Decision, Orders Dispute To Arbitration</title>
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<![CDATA[KANSAS CITY, Mo. - In reversing a lower court, a Missouri appeals court on July 15 said that contracts between physicians and insurance companies outlining reimbursement rates required arbitration of the physicians' antitrust allegations (Kansas City Urology, P.A., et al. v. United HealthCare Services, et al., Nos. Wd 67814, WD 67815, Mo. App.; 2008 Mo. App. LEXIS 954). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-15 Mealey's Man. Care Liab. Rep. 5 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>7th Circuit Remands Misrepresentation Case, Finds No Preemption Exists</title>
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<![CDATA[CHICAGO - A Seventh Circuit U.S. Court of Appeals panel on July 31 reversed a lower court and ordered a negligent misrepresentation case remanded to state court, saying the plaintiff health care provider was bringing claims in its own right and not on behalf of the patient and, thus, there was no federal preemption (Franciscan Skemp Healthcare Inc. v. Central States Joint Board Health and Welfare Trust Fund, No. 07-3456, 7th Cir.; 2008 U.S. App. LEXIS 16232). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-15 Mealey's Man. Care Liab. Rep. 6 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Illinois Federal Judge Dismisses Breach Claims, Allows Amendment</title>
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<![CDATA[CHICAGO - An Illinois federal judge on July 24 granted an insurance company's motion to dismiss breach of contract claims against it for allegedly taking preferred provider organization discounts to which it was not entitled but gave the plaintiff the opportunity to amend an unjust enrichment claim (Kathleen Roche, D.C., individually and on behalf of others similarly situated v. Travelers Property Casualty Insurance Co., et al., No. 07-302, S.D. Ill.; 2008 U.S. Dist. LEXIS 57418). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-15 Mealey's Man. Care Liab. Rep. 7 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Appeals Court Affirms ERISA Preempts Claims, Limitations Bar Suit</title>
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<![CDATA[HOUSTON - A Texas appeals court on July 10 affirmed that federal law preempted a health care provider's state law claims seeking reimbursement for services provided to an insured and that the statute of limitations barred the suit (Ambulatory Infusion Therapy Specialist Inc. v. North American Administrators Inc. d/b/a North American Health Plans, et al., No. 01-06-756, Texas App., 1st. Dist.; 2008 Tex. App. LEXIS 5236). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-15 Mealey's Man. Care Liab. Rep. 8 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Reimbursement Case Dismissed; Time Given To Amend Complaint</title>
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<![CDATA[PHILADELPHIA - A Pennsylvania federal judge on July 21 denied a plaintiff's motion to remand his wrongful delay of reimbursement case to state court and dismissed the complaint, but gave the plaintiff time to amend it to cite claims under the Employee Retirement Income Security Act (Michael Brown v. Independence Blue Cross, et al., No. 08-1355, E.D. Pa.; 2008 U.S. Dist. LEXIS 55294). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-15 Mealey's Man. Care Liab. Rep. 9 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>State Appeals Court Affirms Taxation Ruling On HMO Premiums</title>
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<![CDATA[SEATTLE - A Washington appeals court on July 21 affirmed that the City of Seattle incorrectly assessed taxes on premium payments made by a health maintenance organization's customers, but that the city was able to assess business and occupation (B&amp;O) taxes on some of the HMO's revenue despite its ordinance initially containing errors (Group Health Cooperative v. City of Seattle, No. 60301-9-I, Wash. App., Div. 1; 2008 Wash. App. LEXIS 1704). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-15 Mealey's Man. Care Liab. Rep. 10 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Pharmacy Says Reimbursements Wrongly Withheld To Force Price Renegotiations</title>
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<![CDATA[SCRANTON, Pa. - A pharmacy that supplies rare prescription drugs for blood disorders sued an insurance company on July 31 in a Pennsylvania federal court for allegedly withholding reimbursements to force price negotiations and to be able to recommend another provider to a health plan (New Life Home Care Inc., et al. v. Blue Cross Blue Shield of Michigan, et al., No. 08-1438, M.D. Pa.). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-15 Mealey's Man. Care Liab. Rep. 11 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Emergency Department, Association Sue, Say Payments Wrongly Stopped</title>
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<![CDATA[HOUSTON - An emergency department and an associated professional association sued insurance companies on July 29 in Texas federal court, saying the defendants wrongly stopped paying for emergency services provided at the usual and customary rates as required (St. Michael's Emergency Center, et al. v. Aetna Health Management, et al., No. 08-2336, S.D. Texas). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-15 Mealey's Man. Care Liab. Rep. 12 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>California Woman Sues Health Insurer, Says Payments Not Made</title>
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<![CDATA[LOS ANGELES - A California woman on July 14 sued her health insurer in federal court for allegedly failing to pay her medical providers for treatment provided to her as required by her health plan (Phyllis Starkman v. Aetna Health and Life Insurance Co., No. 08-4692, C.D. Calif.). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-15 Mealey's Man. Care Liab. Rep. 13 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Stipulation Of Dismissal Entered In Reimbursement Case</title>
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<![CDATA[DALLAS - U.S. Judge Reed O'Connor of the Northern District of Texas on July 23 entered an order granting a stipulation of dismissal with prejudice of Team Healthcare/Diagnostic Corp.'s reimbursement suit against Aetna Life Insurance Co., Aetna Health Inc. and Aetna Health Management LLC (Team Healthcare/Diagnostic Corp. v. Aetna Life Insurance Co., et al., No. 07-214, N.D. Texas; See 3/5/08, Page 9). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-15 Mealey's Man. Care Liab. Rep. 14 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Medicare Bill Becomes Law</title>
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<![CDATA[WASHINGTON, D.C. - The U.S. Senate and U.S. House on July 15 overrode a veto issued by President Bush earlier in the day, putting into effect a law increasing Medicare reimbursement rates to physicians (See 7/16/08, Page 27). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-15 Mealey's Man. Care Liab. Rep. 15 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>AMA Opposes Insurance Merger</title>
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<![CDATA[WASHINGTON, D.C. - The American Medical Association (AMA) testified July 31 before the Senate Judiciary Committee in opposition to the proposed merger of Pennsylvania insurers Highmark Inc. and Independence Blue Cross (IBC), saying in a new release about the event that it amounts to a monopoly and threatens health care delivery systems across the country. 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-15 Mealey's Man. Care Liab. Rep. 16 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Humana Intends To Acquire Cariten</title>
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<![CDATA[LOUISVILLE, Ky. - Human announced Aug. 4 that it signed a definitive agreement to purchase PHP Cos. Inc. d/b/a Cariten Healthcare from Knoxville-Tenn.-based Covenant Health for approximately $245 million in cash. 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-15 Mealey's Man. Care Liab. Rep. 17 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Judge: Administrator Who Exercises Discretionary Authority Proper Defendant</title>
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<![CDATA[NEWARK, N.J. - A New Jersey federal judge on May 9 held that a third-party administrator can be a proper defendant under the Employee Retirement Income Security Act if the plaintiff can show that the defendant exercised discretionary duty in making claims decisions and also held that a plaintiff cannot bring a claim for breach of fiduciary duty under ERISA when it can bring a claim for recovery of benefits (Wayne Surgical Center, individually and on behalf of all those similarly situated v. Concentra Preferred Systems Inc., No. 06-928, D. N.J.; See 2/6/08, Page 7). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-14 Mealey's Man. Care Liab. Rep. 1 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Dialysis Operators Seek Judgment On Issue Of Obligation To Pay</title>
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<![CDATA[HATO REY, Puerto Rico - The operators of dialysis clinics throughout Puerto Rico on July 1 moved for partial summary judgment on the issue of whether there is an obligation by the commonwealth and managed care organizations (MCOs) to promptly pay Medicaid benefits to Medicaid providers for services provided by them to patients suffering from end-stage renal disease (ESRD) (National Medical Care Inc. v. Secretary of Health of Puerto Rico, et al., No. 04-1812, D. P.R.; See 3/7/07, Page 5). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-14 Mealey's Man. Care Liab. Rep. 2 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<link>http://feeds.feedburner.com/~r/ManagedCareLiabilityLegalNews/~3/338348743/articleSearch.do</link>
<title>Judge Orders Briefing On Issue Of Express Language In Contract</title>
<description>
<![CDATA[EAST ST. LOUIS, Ill. - An Illinois federal judge on June 30 ordered supplemental briefing on the issue of whether the express language of a preferred provider contract precludes a plaintiff provider from prevailing on her breach of contract claim against a payer not a party to the contract in a class action reimbursement dispute (Kathleen Roche, D.C. d/b/a Back Doctors LTD, individually and on behalf of others similarly situated v. Liberty Mutual Managed Care Inc., et al., No. 07-331, S.D. Ill.; 2008 U.S. Dist. LEXIS 49602). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-14 Mealey's Man. Care Liab. Rep. 3 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<link>http://feeds.feedburner.com/~r/ManagedCareLiabilityLegalNews/~3/338348744/articleSearch.do</link>
<title>Declaratory Judgment Sought On Issue Of Payment Responsibility</title>
<description>
<![CDATA[JACKSON, Miss. - A preferred provider organization network operator filed a motion seeking a declaration that one of its third-party administrators is responsible for paying a hospital claim while the administrator says it met its obligations by paying only for covered claims (River Region Medical Corp. d/b/a River Region Health System f/k/a Parkview Regional Medical Center v. American Lifecare Inc., et al., No. 07-36, S.D. Miss.; See 4/2/08, Page 6). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-14 Mealey's Man. Care Liab. Rep. 4 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
</description>
<feedburner:origLink>http://www.mealeysonline.com/mealey/ppv/articleSearch.do?searchTerm=%22%2012-14 Mealeys Man. Care Liab. Rep. 4%20(2008)%20%22&amp;pageLimit=10&amp;pageNumber=0&amp;publication=All+Mealey+Publications%3BMEALEY%3BMEALEY&amp;relativeDateValue=NONE&amp;fromDate=&amp;toDate=&amp;loc=mealeysrss</feedburner:origLink></item>
 
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<link>http://feeds.feedburner.com/~r/ManagedCareLiabilityLegalNews/~3/338348745/articleSearch.do</link>
<title>Texas Judge Remands Reimbursement Case; No Preemption Exists</title>
<description>
<![CDATA[SAN ANTONIO - A Texas federal judge on May 29 granted a plaintiff's motion to amend its complaint to include only claims that were partially paid by the defendant, finding that the inclusion of denied claims was inadvertent, and then remanded the case, holding that there was no preemption issue (Lone Star OB/GYN Associates v. Aetna Health Inc., No. 07-848, W.D. Texas; 2008 U.S. Dist. LEXIS 49083). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-14 Mealey's Man. Care Liab. Rep. 5 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
</description>
<feedburner:origLink>http://www.mealeysonline.com/mealey/ppv/articleSearch.do?searchTerm=%22%2012-14 Mealeys Man. Care Liab. Rep. 5%20(2008)%20%22&amp;pageLimit=10&amp;pageNumber=0&amp;publication=All+Mealey+Publications%3BMEALEY%3BMEALEY&amp;relativeDateValue=NONE&amp;fromDate=&amp;toDate=&amp;loc=mealeysrss</feedburner:origLink></item>
 
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<link>http://feeds.feedburner.com/~r/ManagedCareLiabilityLegalNews/~3/338348746/articleSearch.do</link>
<title>Judge: ERISA Does Not Preempt Claims; Amendment Needed</title>
<description>
<![CDATA[HOUSTON - A Texas federal judge on July 10 held that the Employee Retirement Income Security Act does not preempt a hospital's state law claims seeking reimbursement but that the hospital must replead a breach of contract claim to show a sufficient relationship between the defendant and the company paying the claim (Memorial Hermann Hospital System v. Coventry Health and life Insurance Co., et al., No. 07-3816, S.D. Texas; 2008 U.S. Dist. LEXIS 52928). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-14 Mealey's Man. Care Liab. Rep. 6 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
</description>
<feedburner:origLink>http://www.mealeysonline.com/mealey/ppv/articleSearch.do?searchTerm=%22%2012-14 Mealeys Man. Care Liab. Rep. 6%20(2008)%20%22&amp;pageLimit=10&amp;pageNumber=0&amp;publication=All+Mealey+Publications%3BMEALEY%3BMEALEY&amp;relativeDateValue=NONE&amp;fromDate=&amp;toDate=&amp;loc=mealeysrss</feedburner:origLink></item>
 
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<link>http://feeds.feedburner.com/~r/ManagedCareLiabilityLegalNews/~3/338348748/articleSearch.do</link>
<title>HMO Moves For Judgment, Says All Benefits Received</title>
<description>
<![CDATA[CHICAGO - A health maintenance organization accused of using a uniform "bait and switch" tactic to sell dental insurance plans - in effect promising one plan but delivering another, lesser plan and overcharging members in the process - moved on June 19 for summary judgment, saying the plaintiff received all the benefits to which he was entitled (Ki Kaden, individually and as the representative of a class of similarly situated persons v. First Commonwealth Insurance Company Inc., No. 05-2212, N.D. Ill.; See 3/19/08, Page 16). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-14 Mealey's Man. Care Liab. Rep. 7 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
</description>
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<link>http://feeds.feedburner.com/~r/ManagedCareLiabilityLegalNews/~3/338348749/articleSearch.do</link>
<title>Judge Preliminarily Grants Eating Disorder Settlement</title>
<description>
<![CDATA[Case name: Francis DeVito, et al. v. Aetna Inc., et al.; See 6/4/08, Page 5 Case number: 07-418 Court: D. N.J. 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-14 Mealey's Man. Care Liab. Rep. 8 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
</description>
<feedburner:origLink>http://www.mealeysonline.com/mealey/ppv/articleSearch.do?searchTerm=%22%2012-14 Mealeys Man. Care Liab. Rep. 8%20(2008)%20%22&amp;pageLimit=10&amp;pageNumber=0&amp;publication=All+Mealey+Publications%3BMEALEY%3BMEALEY&amp;relativeDateValue=NONE&amp;fromDate=&amp;toDate=&amp;loc=mealeysrss</feedburner:origLink></item>
 
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<link>http://feeds.feedburner.com/~r/ManagedCareLiabilityLegalNews/~3/338348753/articleSearch.do</link>
<title>Undisclosed Settlement Reached In Denial Of Benefits Case</title>
<description>
<![CDATA[Case name: Harriet McGuiness v. Connecticut General Life Insurance Co., et al., See 2/21/08, Page 23. 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-14 Mealey's Man. Care Liab. Rep. 9 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
</description>
<feedburner:origLink>http://www.mealeysonline.com/mealey/ppv/articleSearch.do?searchTerm=%22%2012-14 Mealeys Man. Care Liab. Rep. 9%20(2008)%20%22&amp;pageLimit=10&amp;pageNumber=0&amp;publication=All+Mealey+Publications%3BMEALEY%3BMEALEY&amp;relativeDateValue=NONE&amp;fromDate=&amp;toDate=&amp;loc=mealeysrss</feedburner:origLink></item>
 
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<title>Undisclosed Settlement Reached In Denial Of Benefits Case</title>
<description>
<![CDATA[Case name: Matthew and Alison Wealcatch v. Blue Cross and Blue Shield of Florida Inc., See 1/24/07, Page 28 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-14 Mealey's Man. Care Liab. Rep. 10 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
</description>
<feedburner:origLink>http://www.mealeysonline.com/mealey/ppv/articleSearch.do?searchTerm=%22%2012-14 Mealeys Man. Care Liab. Rep. 10%20(2008)%20%22&amp;pageLimit=10&amp;pageNumber=0&amp;publication=All+Mealey+Publications%3BMEALEY%3BMEALEY&amp;relativeDateValue=NONE&amp;fromDate=&amp;toDate=&amp;loc=mealeysrss</feedburner:origLink></item>
 
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<link>http://feeds.feedburner.com/~r/ManagedCareLiabilityLegalNews/~3/338348755/articleSearch.do</link>
<title>Law Reducing Medicaid Payments Enjoined From Going Into Effect</title>
<description>
<![CDATA[SAN FRANCISCO - The Ninth Circuit U.S. Court of Appeals on July 11 reversed a lower court order denying an injunction to stop the implementation of a law reducing payments made under the state's Medicaid program by 10 percent and temporarily halted the law from going into effect (Independent Living Center of Southern California, et al. v. Sandra Shewry, director of Department of Health Care Services, state of California, No. 08-56061, 9th Cir.). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-14 Mealey's Man. Care Liab. Rep. 11 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
</description>
<feedburner:origLink>http://www.mealeysonline.com/mealey/ppv/articleSearch.do?searchTerm=%22%2012-14 Mealeys Man. Care Liab. Rep. 11%20(2008)%20%22&amp;pageLimit=10&amp;pageNumber=0&amp;publication=All+Mealey+Publications%3BMEALEY%3BMEALEY&amp;relativeDateValue=NONE&amp;fromDate=&amp;toDate=&amp;loc=mealeysrss</feedburner:origLink></item>
 
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<link>http://feeds.feedburner.com/~r/ManagedCareLiabilityLegalNews/~3/338348756/articleSearch.do</link>
<title>HMO Seeks Dismissal Of Excessive Co-payment Claims; Plaintiff Opposes</title>
<description>
<![CDATA[ST. LOUIS - A health maintenance organization accused of requiring plan participants to pay excessive co-payments has moved to dismiss class actions claims against it, saying the plaintiff has failed to exhaust administrative remedies, while the plaintiff opposes dismissal, saying that he has exhausted administrative remedies (Quinn James v. HMO Missouri Inc ? Blue Choice, No. 07-709, E.D. Mo.; See 2/6/08, Page 9). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-14 Mealey's Man. Care Liab. Rep. 12 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
</description>
<feedburner:origLink>http://www.mealeysonline.com/mealey/ppv/articleSearch.do?searchTerm=%22%2012-14 Mealeys Man. Care Liab. Rep. 12%20(2008)%20%22&amp;pageLimit=10&amp;pageNumber=0&amp;publication=All+Mealey+Publications%3BMEALEY%3BMEALEY&amp;relativeDateValue=NONE&amp;fromDate=&amp;toDate=&amp;loc=mealeysrss</feedburner:origLink></item>
 
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<title>Insurer Seeks Dismissal, Says Claims Preempted; Plaintiff Disagrees</title>
<description>
<![CDATA[TULSA, Okla. - A defendant in a dispute alleging violations of the Consolidated Omnibus Budget Reconciliation Act (COBRA) has moved for dismissal of claims against it, citing preemption and the unavailability of requested relief while the plaintiffs oppose dismissal, saying that the court cannot determine at this point whether the claims are preempted (Martin C. and Michelle D. Whisenhunt, et al. v. DecisionOne Corp., et al., No. 07-535, N.D. Okla.; See 1/23/08, Page 18). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-14 Mealey's Man. Care Liab. Rep. 13 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<feedburner:origLink>http://www.mealeysonline.com/mealey/ppv/articleSearch.do?searchTerm=%22%2012-14 Mealeys Man. Care Liab. Rep. 13%20(2008)%20%22&amp;pageLimit=10&amp;pageNumber=0&amp;publication=All+Mealey+Publications%3BMEALEY%3BMEALEY&amp;relativeDateValue=NONE&amp;fromDate=&amp;toDate=&amp;loc=mealeysrss</feedburner:origLink></item>
 
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<title>Judge Dismisses Breach Suit; HMO Not Automatically Eligible For Contract</title>
<description>
<![CDATA[HONOLULU - A Hawaii federal judge on July 2 dismissed a health maintenance organization's suit for breach of contract after it failed to receive a state managed care contract, holding that the HMO had no "automatic eligibility" to receive the contract (AlohaCare v. State of Hawaii, et al., No. 08-212, D. Hawaii; 2008 U.S. Dist. LEXIS 50837). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-14 Mealey's Man. Care Liab. Rep. 14 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<link>http://feeds.feedburner.com/~r/ManagedCareLiabilityLegalNews/~3/338348759/articleSearch.do</link>
<title>Woman's Suit Alleges Coverage For Surgery Wrongfully Denied</title>
<description>
<![CDATA[JASPER, Ala. - An Alabama woman on July 3 sued her insurer in federal court for allegedly wrongfully denying coverage for gastric by-pass surgery (Beverly Ann Fields v. Blue Cross Blue Shield of Alabama Inc.; No. 08-1186, N.D. Ala.). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-14 Mealey's Man. Care Liab. Rep. 15 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
</description>
<feedburner:origLink>http://www.mealeysonline.com/mealey/ppv/articleSearch.do?searchTerm=%22%2012-14 Mealeys Man. Care Liab. Rep. 15%20(2008)%20%22&amp;pageLimit=10&amp;pageNumber=0&amp;publication=All+Mealey+Publications%3BMEALEY%3BMEALEY&amp;relativeDateValue=NONE&amp;fromDate=&amp;toDate=&amp;loc=mealeysrss</feedburner:origLink></item>
 
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<link>http://feeds.feedburner.com/~r/ManagedCareLiabilityLegalNews/~3/338348760/articleSearch.do</link>
<title>Hospital Sues, Says Claims Underpaid; Case Removed</title>
<description>
<![CDATA[HOUSTON - A Texas hospital has sued an insurer for failing to pay claims as promised; the defendant removed the case to federal court (St. Luke's Episcopal Hospital v. Blue Cross Blue Shield of Texas, a division of Health Care Services Corp., No. 08-1997, S.D. Texas). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-14 Mealey's Man. Care Liab. Rep. 16 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<feedburner:origLink>http://www.mealeysonline.com/mealey/ppv/articleSearch.do?searchTerm=%22%2012-14 Mealeys Man. Care Liab. Rep. 16%20(2008)%20%22&amp;pageLimit=10&amp;pageNumber=0&amp;publication=All+Mealey+Publications%3BMEALEY%3BMEALEY&amp;relativeDateValue=NONE&amp;fromDate=&amp;toDate=&amp;loc=mealeysrss</feedburner:origLink></item>
 
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<link>http://feeds.feedburner.com/~r/ManagedCareLiabilityLegalNews/~3/338348761/articleSearch.do</link>
<title>Denial Of Benefits Case Dismissed</title>
<description>
<![CDATA[HOUSTON - U.S. Judge Lynn N. Hughes of the Southern District of Texas on May 1 dismissed Lance Shearer's wrongful denial of benefits case against Southwest Service Life Insurance Co. for want of jurisdiction (Lance Shearer v. Southwest Service Life Insurance Co., et al., No. 07-1193, S.D. Texas; See 2/6/08, Page 15). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-14 Mealey's Man. Care Liab. Rep. 17 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Dismissal Entered In Denial Of Benefits Case</title>
<description>
<![CDATA[KANSAS CITY, Kan. - Attorneys for Janet Carl on June 13 entered in the U.S. District Court for the District of Kansas a stipulation of dismissal with prejudice, ending her wrongful denial of benefits case against Blue Cross Blue Shield of Kansas (Janet Carl v. Blue Cross Blue Shield of Kansas, No. 08-2133, D. Kan.; See 2/6/08, Page 20). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-14 Mealey's Man. Care Liab. Rep. 18 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<feedburner:origLink>http://www.mealeysonline.com/mealey/ppv/articleSearch.do?searchTerm=%22%2012-14 Mealeys Man. Care Liab. Rep. 18%20(2008)%20%22&amp;pageLimit=10&amp;pageNumber=0&amp;publication=All+Mealey+Publications%3BMEALEY%3BMEALEY&amp;relativeDateValue=NONE&amp;fromDate=&amp;toDate=&amp;loc=mealeysrss</feedburner:origLink></item>
 
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<title>Stay Lifted In Benefits Case</title>
<description>
<![CDATA[LEXINGTON, Ky. - U.S. Judge Jennifer B. Coffman of the Eastern District of Kentucky on April 9 lifted a stay in Mark and Cindy Raugh's wrongful denial of benefits case against CHA HMO Inc. and Humana Inc. (Cindy and Mark Raugh v CHA HMO Inc. d/b/a CHA Health, et al., No. 07-298, E.D. Ky.; See 1/23/08, Page 25). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-14 Mealey's Man. Care Liab. Rep. 19 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<feedburner:origLink>http://www.mealeysonline.com/mealey/ppv/articleSearch.do?searchTerm=%22%2012-14 Mealeys Man. Care Liab. Rep. 19%20(2008)%20%22&amp;pageLimit=10&amp;pageNumber=0&amp;publication=All+Mealey+Publications%3BMEALEY%3BMEALEY&amp;relativeDateValue=NONE&amp;fromDate=&amp;toDate=&amp;loc=mealeysrss</feedburner:origLink></item>
 
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<title>Dismissal Entered In Reimbursement Case</title>
<description>
<![CDATA[CHICAGO - A stipulation of dismissal with prejudice was entered July 1 in the U.S. District Court for the Northern District of Illinois, ending Dr. Hansel M. DeBartolo's reimbursement case against CIGNA Healthcare of Illinois Inc. and Northwest Airlines Inc., according to the docket (Dr. Hansel M. DeBartolo v. CIGNA Healthcare of Illinois Inc., et al., No. 08-287, N.D. Ill.; See 1/23/08, Page 23). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-14 Mealey's Man. Care Liab. Rep. 20 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<feedburner:origLink>http://www.mealeysonline.com/mealey/ppv/articleSearch.do?searchTerm=%22%2012-14 Mealeys Man. Care Liab. Rep. 20%20(2008)%20%22&amp;pageLimit=10&amp;pageNumber=0&amp;publication=All+Mealey+Publications%3BMEALEY%3BMEALEY&amp;relativeDateValue=NONE&amp;fromDate=&amp;toDate=&amp;loc=mealeysrss</feedburner:origLink></item>
 
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<title>Suit Seeking Data Dismissed</title>
<description>
<![CDATA[BROOKLYN, NY - U.S. Judge Allyne R. Ross of the Eastern District of New York on July 7 dismissed without prejudice a case brought by a trustee of an employer benefit plan against the plan's former administrator for failing to provide requested information (Mark Schienberg, as trustee of the GNY Automobile Dealers Health and Welfare Trust v. Connecticut General Life Insurance Co., No. 08-649, E.D. N.Y.; See 2/21/08, Page 24). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-14 Mealey's Man. Care Liab. Rep. 21 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<feedburner:origLink>http://www.mealeysonline.com/mealey/ppv/articleSearch.do?searchTerm=%22%2012-14 Mealeys Man. Care Liab. Rep. 21%20(2008)%20%22&amp;pageLimit=10&amp;pageNumber=0&amp;publication=All+Mealey+Publications%3BMEALEY%3BMEALEY&amp;relativeDateValue=NONE&amp;fromDate=&amp;toDate=&amp;loc=mealeysrss</feedburner:origLink></item>
 
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<title>Case Stayed Pending Review</title>
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<![CDATA[SHREVEPORT, La. - U.S. Judge James Trimble of the Western District of Louisiana on June 5 stayed Benjamin Blanchard's wrongful denial of benefits case against Louisiana Health Service and Indemnity Co. d/b/a Blue Cross and Blue Shield of Illinois pending the exhaustion of administrative remedies (Benjamin Blanchard v. Louisiana Health Service and Indemnity Co. d/b/a Blue Cross and Blue Shield of Illinois, No. 08-353, W.D. La.; See 4/2/08, Page 24). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-14 Mealey's Man. Care Liab. Rep. 22 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Wrongful Denial Of Benefits Case Dismissed</title>
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<![CDATA[DETROIT - U.S. Judge Paul V. Gadola of the Eastern District of Michigan on May 29 signed an order stipulating to the dismissal without prejudice of Mickey Badalamenti's wrongful denial of benefits case against Blue Cross Blue Shield of Michigan and Blue Care Network of Michigan d/b/a BCBSM / Blue Cross Blue Shield of Michigan (Mickey Badalamenti, on behalf of himself and all others similarly situated v. Blue Cross Blue Shield of Michigan, et al., No. 08-11299, E.D. Mich.; See 4/2/08, Page 22). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-14 Mealey's Man. Care Liab. Rep. 23 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Case Remanded To State Court</title>
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<![CDATA[PORTLAND, Maine - U.S. Judge George Z. Singal of the District of Maine on May 27 signed an order remanding Janice Gallagher's wrongful denial of benefits case to the Sagadahoc County Superior Court (Janice Gallagher v. CIGNA HealthCare of Maine Inc., et al., No. 07-162, D. Maine.; See 4/2/08, Page 18). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-14 Mealey's Man. Care Liab. Rep. 24 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Case Stayed Pending Review Of Other Case</title>
<description>
<![CDATA[DETROIT - U.S. Judge Patrick J. Duggan of the Eastern District of Michigan on June 20 granted to a motion to stay all proceedings in a class action case for breach of fiduciary duty pending a decision by the Sixth Circuit U.S. Court of Appeals in Anthony DeLuca v. Blue Cross Blue Shield of Michigan (No. 08-1085; See 2/6/08, Page 22) given the substantial similarity between the cases (Eugene Loren, et al. v. Blue Cross and Blue Shield of Michigan, No. 05-74908, E.D. Mich.; See 4/2/08, Page 15). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-14 Mealey's Man. Care Liab. Rep. 25 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>UnitedHealth To Settle Backdating Claims</title>
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<![CDATA[MINNEAPOLIS - UnitedHealth Group Inc. (UNH) on June 25 reached a settlement in principle to pay investors $895 million to settle federal securities law claims against the health maintenance organization and several current and former executive officers and directors for participating in an alleged stock options backdating scheme, according to documents filed in the U.S. District Court for the District of Minnesota (In re UnitedHealth Group Inc. PSLRA Litigation, No. 06-1691, D. Minn.). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-14 Mealey's Man. Care Liab. Rep. 26 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Medicare Bill Gets Approval</title>
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<![CDATA[WASHINGTON, D.C. - The U.S. Senate on July 9 passed 69-30 a bill that will put off cuts in Medicare payments to doctors. 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-14 Mealey's Man. Care Liab. Rep. 27 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>New Jersey Governor Signs Health Bill</title>
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<![CDATA[TRENTON, N.J. - New Jersey Gov. Jon S. Corzine on July 7 signed legislation mandating health care coverage for all of the state's children and expanding the state's FamilyCare program to cover an additional 25,000 lower-income adults within one year. 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-14 Mealey's Man. Care Liab. Rep. 28 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Judge: Same Pay Not Required For Podiatrists, Medical Doctors</title>
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<![CDATA[WATERBURY, Conn. - In granting summary judgment in favor of health insurer, a Connecticut state judge on June 6 held that state law does not require that podiatrists receive the same payment as medical doctors for providing the same services (Connecticut Podiatric Medical Association, et al. v. Health Net of Connecticut Inc., No. X01CV054005900S, Conn. Super.; 2008 Conn. Super. LEXIS 1459). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-13 Mealey's Man. Care Liab. Rep. 1 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Appeals Court Affirms Treatment Not Experimental</title>
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<![CDATA[SAN FRANCISCO - A California appeals court on June 17 affirmed that a health plan was collaterally estopped from asserting that a provider's services were experimental, thus not covered, because a prior administrative proceeding held to the contrary (California Physicians' Services v. Aoki Diabetes Research Institute, No. A118410, Calif. App., 1st. Dist.; 2008 Cal. App. LEXIS 922). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-13 Mealey's Man. Care Liab. Rep. 2 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Alabama Judge Certifies Reimbursement Class Action</title>
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<![CDATA[MONTGOMERY, Ala. - An Alabama federal judge on June 17 certified as a class action a case brought by independent pharmacies against a pharmacy benefit manager (PBM) company in a reimbursement dispute (Eufaula Drugs Inc., et al. v. TDI Managed Care Services Inc., et al., No. 05-293, M.D. Ala.; 2008 U.S. Dist. LEXIS 46423; See 1/24/07, Page 7). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-13 Mealey's Man. Care Liab. Rep. 3 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Reimbursement Case Remanded; No ERISA Preemption</title>
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<![CDATA[NEW ORLEANS - A Louisiana federal judge on June 18 granted a hospital's request to remand its reimbursement suit to state court, holding that the claims asserted were independent of the Employee Retirement Income Security Act and, thus, were not preempted (Omega Hospital v. Blue Cross Blue Shield of Alabama, No. 08-1530, E.D. La.; 2008 U.S. Dist. LEXIS 47473). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-13 Mealey's Man. Care Liab. Rep. 4 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Medicare Settlement Calls for Injunctive Relief, Program Changes</title>
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<![CDATA[Case name: Xiufang Situ, et al. v. Michael O. Leavitt; See 2/7/07, Page 13 Case number: 06-2841 Court: N.D. Calif. 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-13 Mealey's Man. Care Liab. Rep. 5 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Final Approval Granted In $2.4 Million Settlement With 3 Insurance Companies</title>
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<![CDATA[Case name: Rick Love, M.D., et al. v. Blue Cross and Blue Shield Association, et al.; See 5/7/08, Page 12 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-13 Mealey's Man. Care Liab. Rep. 6 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Denial Based On Pre-existing Condition Exclusion Affirmed</title>
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<![CDATA[CINCINNATI - A panel of the Sixth Circuit U.S. Court of Appeals on June 23 affirmed a decision finding that a health insurer properly denied coverage based on a pre-existing condition exclusion and properly canceled the policy due to failure to pay premiums (Linda L. LoCoco v. Medical Savings Insurance Co., No. 07-3973, 6th Cir.; See 2/6/08, Page 10). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-13 Mealey's Man. Care Liab. Rep. 7 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Probability Of Monopoly Power In Diagnostic Imaging Market Not Shown</title>
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<![CDATA[SAN FRANCISCO - The Ninth Circuit U.S. Court of Appeals on May 20 ruled that diagnostic imaging services, which asserted attempted monopolization claims against a network of hospitals and physicians, failed to create a genuine issue of material fact as to whether there were barriers to entry and expansion in the diagnostic imaging market (East Portland Imaging Center, et al. v. Providence Health System-Oregon, et al., Nos. 06-35394, 06-35449, 9th Cir.; 2008 U.S. App. LEXIS 10984; See 4/5/06, Page 20). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-13 Mealey's Man. Care Liab. Rep. 8 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Judge Declines To Reconsider Denial Of Class Status</title>
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<![CDATA[EAST ST. LOUIS, Ill. - An Illinois federal judge on June 18 denied a motion to reconsider an earlier decision declining to grant class action status in a policyholders' suit against an insurance company for allegedly wrongfully requiring the switch of health insurance polices (Greg Cima, et al. v. WellPoint Health Networks Inc., et al., No. 05-4127, S.D. Ill.; 2008 U.S. Dist. LEXIS 47203; 4/2/08, Page 11). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-13 Mealey's Man. Care Liab. Rep. 9 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Vermont Judge: State Tax Law Does Not Bar Challenge</title>
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<![CDATA[BURLINGTON, Vt. - A Vermont federal judge on June 17 held that a state tax act does not bar a research organization's challenge to a fee imposed on prescription drug manufacturers' products (IMS Health Inc., et al., v. William H. Sorrell, as attorney general of the state of Vermont; Pharmaceutical Research and Manufacturers of America v. William H. Sorrell, as attorney general of the state of Vermont, No. 07-188, 07-220, D. Vt.; 2008 U.S. Dist. LEXIS 47454). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-13 Mealey's Man. Care Liab. Rep. 10 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Judge: Employer Violated COBRA By Not Providing Notice</title>
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<![CDATA[PHILADELPHIA - A Pennsylvania federal judge on June 12 held that an employer violated the Consolidated Omnibus Budget Reconciliation Act (COBRA) by not notifying an employee out on workers' compensation that the method for making his health insurance contributions had changed or that his health care coverage had been terminated (Michael J. Aquilino Jr. v. Solid Waste Services Inc., et al., No. 07-928, E.D. Pa.; 2008 U.S. Dist. LEXIS 47168). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-13 Mealey's Man. Care Liab. Rep. 11 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Denial Of Benefits Claims Dismissed Against Plan Administrator, Reviewer</title>
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<![CDATA[CORPUS CHRISTI, Texas - A Texas federal judge on June 17 granted summary judgment in favor of a health plan administrator and denied judgment in favor of an independent review organization based on the issue of res judicata in a wrongful denial of benefits suit but in a separate opinion determined that claims against the review organization were preempted (Deborah L. Kinnison v. Humana Health Plans of Texas Inc., et al., No. 07-381, S.D. Texas; 2008 U.S. Dist. LEXIS 47289; U.S. Dist. LEXIS 47352; See 2/6/08, Page 8). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-13 Mealey's Man. Care Liab. Rep. 12 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Certiorari Denied In Denial Of Benefits Case</title>
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<![CDATA[WASHINGTON, D.C. - The U.S. Supreme Court on June 27 denied a petition for writ of certiorari in a case that sought review of whether the wrong standard of review was used in a denial of benefits case (Michael Geddes, et ux. v. United Staffing Alliance Employee Medical Plan, et al., No. 06-1458, U.S. Sup.; See 6/18/08, Page 17). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-13 Mealey's Man. Care Liab. Rep. 13 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Indiana Woman Sues, Seeks Injunction Requiring Health Coverage</title>
<description>
<![CDATA[INDIANAPOLIS - An Indiana woman on June 18 sued her health insurer and health plan in federal court, saying she was wrongfully denied coverage for a transplant that would cure the tumors she has in her liver; she also has sought a preliminary injunction requiring the reinstatement of her treatment (Judith Reiman v. Anthem Insurance Companies Inc., et al., No. 08-830, S.D. Ind.). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-13 Mealey's Man. Care Liab. Rep. 14 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>New York Woman Sues, Says Coverage Wrongly Denied</title>
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<![CDATA[NEW YORK - A New York woman on June 13 sued her health insurers in federal court for allegedly wrongly denying coverage for procedures involved in treating her cleft palate (Kim and Glenn Kaufman v. UnitedHealth Group Inc., et al., No. 08-5401, S.D. N.Y.). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-13 Mealey's Man. Care Liab. Rep. 15 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Suit Says Coverage Wrongfully Terminated; Case Removed</title>
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<![CDATA[COLUMBUS, Ohio - An Ohio couple sued the husband's former employer and health insurer in state court after their Consolidated Omnibus Budget Reconciliation Act (COBRA) health coverage was canceled for nonpayment of premiums by the company; the defendants removed the case to federal court, saying federal law completely preempted the claims (Robert J. Wade Jr., et al. v. Farrel Printing Corp., et al., No. 08-633, S.D. Ohio). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-13 Mealey's Man. Care Liab. Rep. 16 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>U.S. Supreme Court: ERISA Insurer's Dual Role Creates Conflict Of Interest</title>
<description>
<![CDATA[WASHINGTON, D.C. - The U.S. Supreme Court on June 19 ruled in a divided decision that an Employee Retirement Income Security Act long-term disability benefits plan insurer that both evaluates and pays claims acts under a conflict of interest and that the conflict should be considered as a factor in determining whether the plan administrator abused its discretion in denying benefits (MetLife [Metropolitan Life Insurance Company] and Long Term Disability Plan for Associates of Sears, Roebuck and Company v. Wanda Glenn, No. 06-923, U.S. Sup.; See April 2008, Page 8). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-13 Mealey's Man. Care Liab. Rep. 17 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Judge Allows Amended Complaint In MDL</title>
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<![CDATA[MIAMI - U.S. Judge Federico A. Moreno of the Southern District of Florida on May 22 granted a request by plaintiffs in the managed care multidistrict litigation to file a sixth amended complaint to address changes since settlement was reached with the majority of the Blue Cross companies (In Re Managed Care Litigation, Master File 00-1334-MD-MORENO; Rick Love, M.D., et al. v. Blue Cross and Blue Shield Association, et al., No. 03-21296, S.D. Fla.; See 5/7/08, Page 9). 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-13 Mealey's Man. Care Liab. Rep. 18 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Medicare Payments To Physicians Reduced</title>
<description>
<![CDATA[WASHINGTON, D.C. - The U.S. Senate on June 26 failed to pass S.B. 3101, which would have avoided payment cuts to physicians under Medicare. 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-13 Mealey's Man. Care Liab. Rep. 19 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Blue Cross Waives Copays For Generics</title>
<description>
<![CDATA[PHILADELPHIA - Independence Blue Cross (IBC) on June 19 announced that it will waive copays and coinsurance on 75 generic drugs that are used to treat common chronic conditions for a limited time. 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-13 Mealey's Man. Care Liab. Rep. 20 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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<title>Humana To Acquire Metcare Health Plans</title>
<description>
<![CDATA[LOUISVILLE - Humana Inc. on June 30 announced that it has signed a definitive agreement to purchase Metcare Health Plans Inc., a wholly owned subsidiary of Metropolitan Health Networks Inc. based in West Palm Beach, Fla., for an estimated $14 million. 
<a href="http://www.lexis.com/research/xlink?canceldest=form&amp;keyenum=25271&amp;keytnum=0&amp;searchtype=get&amp;search=12-13 Mealey's Man. Care Liab. Rep. 21 (2008)&amp;view=full&amp;ORIGINATION_CODE=00144" target="_blank">Full story on lexis.com</a>]]>
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