Health Law Reporter Index-Summary

CAHs

CALIFORNIA

– ACOs, Cal. Med. Ass'n recommendations, 1554
– Antitrust

– – Nurses' wage-fixing suits, summary judgment for hospitals in overtime suit (Cal. Ct. App.), 1633
– – Pass-on defense, direct purchaser can recover for illegal price-fixing (Cal.), 971; remanded for trial (Cal. Ct. App.), 1268
– – State regulatory authority no bar to Los Angeles city attorney's claims against health plans and insurers (Cal. Ct. App.), 99

– Arbitration, patient's agreement binding on wrongful death claimants, no right to jury trial (Cal.), 1233
– Autism applied behavior analysis therapy coverage class action reinstated (Cal. Ct. App.), 177
– Bacterial meningitis, first fines under new standard, 619
– Balance billing for emergency room costs, state law breach alleged (S.D. Cal.), 1747
– Certified registered nurse anesthetists without physician supervision, doctors sue state (Cal. Super. Ct.), 216; state action upheld, 1470
– Chief executives of hospitals asked to report on serious patient incidents, 1608
– Clinical laboratories, Laboratory Corp. of America acquisition of Westcliff Med. Lab. challenged (FTC), 1690
– Corporate practice of medicine doctrine, bill to extend pilot program attract doctors to rural communities, 993
– Debt collector's medical data disclosure to consumer credit agencies, Fair Credit Reporting Act preemption (Cal. Ct. App.), 211
– Diabetic beneficiary, insurer liability for failure to pay for medically necessary items (N.D. Cal.), 1322
– Elder abuse, SNF employee job records subject to discovery (Cal. Ct. App.), 652
– Emergency room bills of indigent residents, county must pay (Cal. Super. Ct.), 1038
– Fair share laws, San Francisco ordinance requiring employee health care expenditures by local business, Solicitor General urges denial of review (U.S., brief filed), 771; (response brief filed), 832; (rev den), 901; summary judgment for city and county (N.D. Cal.), 1173
– High-risk insurance pool, pre-existing conditions, new law, 939
– Hospitals fined for patient risks and licensing noncompliance, 191; fines of 7 hospitals announced, 543; fines for 12 hospitals, 1607; almost $800,000 in fines for privacy breaches at 7 facilities, 1667
– Libel, union postcard claim hospital linens dirty, proof of malice required (Cal. Ct. App.), 1064
– Licensing

– – Chiropractor, “excessive treatment” discipline by licensing board (U.S., rev den), 1659
– – Costs and time increase, medical board comprehensive investigations, 1532
– – Furloughs of medical board staff upheld (Cal. Super. Ct.), 387
– – Insulin injections by unlicensed school staff (Cal. Ct. App.), 839; review granted (Cal.), 1387
– – Internet posting of disciplinary information about former physician (Cal. Ct. App.), 606
– – Medical board's revocation of doctor's license without oral and written argument reversed (Cal. Ct. App.), 310
– – Passing score for physician exam must be established (Cal. Ct. App.), 341
– – Revival of disciplinary action settled by stipulation 5 years ago refused (Cal. Ct. App.), 386

– Managed care

– – Fines for violations of prompt payment and fair pay laws, 1656
– – Patient care standards, Medicare Advantage preempts state laws (Cal.), 413
– – Stop-loss claims, Anthem agrees to pay hospitals, 1656
– – Timely access to nonemergency care rules, 145

– Medi-Cal

– – Adult day care, preliminary injunction bars changes to eligibility criteria (N.D. Cal.), 346
– – Drug pricing, Teva agrees to pay, 1022
– – Drug reimbursement rate cuts

– – – Natl. Ass'n Chain Drug Stores, preliminary injunction denied (9th Cir.), 571
– – – Pharmacists, preliminary injunction upheld (9th Cir.), 343; (U.S., rev sought), 573; cases pending at beginning of new term, 1307

– – FQHCs and rural health centers entitled to reimbursement until CMS approves state plan amendment (E.D. Cal.), 1492
– – Home care workers, preliminary injunction bars wage cuts (9th Cir.), 345; class certified (N.D. Cal.), 876
– – Hospitals with distinct SNFs units, reimbursement limits and rate freezes (Cal. Ct. App.), 1247; review denied (Cal.), 1659
– – Inpatient psychiatric care for jailed youths, restoration of benefits after release (Cal. Super. Ct.), 685
– – Neonatal intensive care

– – – Audit finds excess payments (Cal. Ct. App.), 102
– – – Reimbursement rate (9th Cir.), 102

– – Noncontract hospitals, injunction bars rate cuts (9th Cir.), 775; (U.S., rev sought), 1282; cases pending at beginning of new term, 1307
– – Reimbursement rate cut injunctions upheld, 2 cases (U.S., rev sought), 343; solicitor general input requested, 751; Medicaid provider groups oppose review, 1176; cases pending at beginning of new term, 1307
– – Simi Valley Hosp., FCA settlement (C.D. Cal.), 1553

– Notice, state tort claims requirements apply to EMTALA violations case against public hospital (S.D. Cal.), 946
– Nursing homes

– – Regulator criticized for reducing fines, 874
– – Staffing, Skilled Healthcare Group settlement (Cal. Super. Ct.), 1281; approved by court, 1707

– Opticians cannot provide services in same location as optometrists and ophthalmologists (E.D. Cal.), 694
– PacifiCare Health Sys., record fines sought by state insurance regulatory agency, 1355
– Peer review

– – Action lasting nearly 9 years, dismissal of doctor's due process claims (E.D. Cal.), 877
– – Attorney fee provision (Cal. Ct. App.), 1287
– – Surgeon with hand tremor, federal bias and retaliation claims go forward despite state proceedings (E.D. Cal.), 507

– Physician rankings, doctors sue Blues plan over online program (Cal. Super. Ct.), 1295
– Premium increases

– – Aetna withdraws 19 percent rate hike due to miscalculations, 905
– – Anthem Blue Cross 39 percent increase, Sebelius seeks public explanation, 213; rate hike postponed to allow state review, 242; request for rate increase withdrawn, 645; state audit of claims data, 681
– – Financial records of largest insurers subpoenaed by state Atty. Gen., 310

– Public Employment Relations Board has exclusive authority over county hospital's complaint against union (Cal. Ct. App.), 32
– Radiation overdoses

– – Computed tomography scans, hospitals report following device specifications, 1147
– – Mandatory reporting bill being considered by governor, 1364; signed by governor, 1397

– Recruiting agreement, suit seeking loan repayment from neurosurgeon belongs in state court (E.D. Cal.), 188; rehearing to clarify ruling, 693
– Religious health care facility not exempt from compliance with state discrimination and disability access laws (S.D. Cal.), 726
– Rescission

– – Breach of contract and unfair trade practices, state law claims (Cal. Ct. App.), 456
– – ERISA does not apply, suit belongs in state court (N.D. Cal.), 242
– – Health insurers' trade group sues to block new rules (Cal. Super. Ct.), 1244; hearing set, 1465
– – Health Net shareholder derivative suit (Cal. Super. Ct.), 110
– – Insurance Dept. regulations effective Aug. 18, 1138
– – Los Angeles may proceed with unfair competition and false advertising claims (Cal. Super. Ct.), 308
– – Material misrepresentations, state Insurance Code interpretation (Cal. Ct. App.), 142
– – Restricted, governor signs bill, praise from physicians' group, 1465
– – State regulatory authority no bar to Los Angeles city attorney's claims against health plans and insurers (Cal. Ct. App.), 99

– Shoulder injury, fired cardiac sonography technician may pursue disability claims (E.D. Cal.), 378
– “Skid Row” recruiting for unnecessary treatment

– – Consent judgment (C.D. Cal.), 134; Intercare Health Sys. joins settlement, 769
– – Former CEO sentenced to prison and restitution (C.D. Cal.), 1275
– – Hospital executive pleads guilty (C.D. Cal.), 236
– – Prison sentence for former co-owner of hospital (C.D. Cal.), 273

– SNF fined, death of patient after choking, 281
– Staff privileges

– – Reappointment denied based on waiting period, injunction restores privileges (Cal. Ct. App.), 347
– – State-run hospital denial of reappointment application reasonable (Cal. Ct. App.), 311

– Statutes of limitations, one-year professional negligence time bar applies to fall claim against hospital (Cal. Ct. App.), 915
– Strategic Lawsuit against Public Participation Law

– – Physician's claims based on summary suspension and denial of reapplication, no violation (Cal. Ct. App.), 1660
– – Slander and other tort claims against physician not barred (Cal. Ct. App.), 252

– Taxation, providers of in-home support services subject to sales tax, new law, 1569
– Univ. of Cal./CNA, RNs barred from striking (Cal. Super. Ct.), 838; injunction issued, 873
– Vaccinations, veto of bill requiring insurers to reimburse entire cost of childhood and adolescent vaccines, 1386

CANADA

– IUDs not approved by FDA, Tex. Atty. Gen. seeks injunction (Tex. Dist. Ct.), 1497

CANCER

– Antitrust, biotech treatment tying allegations, direct purchaser exception denied (D.N.J.), 827
– Cancer-only insurance policies

– – “Actual charges,” retroactive application of S.C. law (4th Cir.), 239
– – Class certification and injunction (M.D. Tenn.), 30
– – Okla. “actual charges” law applies prospectively (W.D. Okla.), 904

– Colon cancer treatment, causation expert opinion must be “medically superior” to support jury verdict (Tex.), 1716
– Colo., new laws on mammography and prescription drug coverage, 748
– CON

– – Denials not unconstitutional (N.C. Ct. App.), 707
– – Nearby cancer treatment facilities (S.C.), 377
– – Out-of-state diagnostic equipment usage by cancer center (N.C. Ct. App.), 561

– Dietitian and social worker free to Medicare cancer patients at free-standing radiation oncology centers, advisory opinion, 867
– “Experimental treatment” exclusion of coverage for child's bone cancer treatment, claim allowed (S.D. Ohio), 140
– Medicare reimbursements to cancer hospital reasonable (D.D.C.), 608
– Oral chemotherapy medications

– – Colo., new coverage law, 571
– – Conn., new coverage law, 773
– – Minn., cost parity law, 719

– Radiation oncology services qui tam case, clinic and physician agree to pay (M.D. Fla.), 451
– Staff privileges, state-run hospital denial of radiation oncologist's reappointment application reasonable (Cal. Ct. App.), 311
– Stem cell transplant denial, discovery on “structural conflict of interest” (D. Neb.), 456

CARDIOLOGY

– Cardiac diagnostic services, false claims settlement (C.D. Cal.), 976
– Cardiology services market, restraint of trade suit against hospital (8th Cir.), 17; (U.S., rev den), 897
– CON, limitation on number of hospitals that can perform elective angioplasty procedures upheld (E.D. Wash.), 799
– Defective internal cardioverter defibrillator, expert testimony, physician standards of care (S.C. Ct. App.), 1290
– Evaluation and management of cardiology patients overbilling alleged, Genesys Health Sys. agrees to pay, 24
– Federal peer review privilege not recognized, discovery by whistleblower allowed (M.D. Pa.), 879
– Informed consent, subclavian bypass risk, expert proof not required (S.C.), 1288
– Kickback allegations

– – “Operational conversations” between non-attorneys not privileged, discovery allowed in qui tam suit (S.D. Ohio), 22; settlement, 208
– – Postmarket studies, Boston Scientific Corp. settles, 24
– – St. Jude Medical

– – – FCA settlement (N.D. Ohio), 809
– – – Government motion to intervene in qui tam suit (D. Mass.), 1133

– Md., hospital agrees to pay to resolve allegations of payments to cardiology group (D. Md.), 1594
– Medicare 2010 physician fee schedule, cardiologists file suit over reductions (S.D. Fla.), 38; dismissed for lack of jurisdiction, 655
– Preliminary injunction blocking restriction on doctors' staff privileges, notice of appeal (S.D. Tex.), 417; declaratory judgment suit seeking injunction dismissed, 1018
– Self-disclosure protocols, cardiologists urge rapid release, 644
– Sexual assault by cardiologist, no vicarious liability for hospital (W.D. Mich.), 843
– Shoulder injury, fired cardiac sonography technician may pursue disability claims (E.D. Cal.), 378
– Stents

– – Placement, fact question about date of discovery (6th Cir.), 218
– – Unnecessary implantations, Senate panel looks at cost and doctor's relationship to Abbott, 1700

CATHOLIC HOSPITALS

– Abortion issues

See generally ABORTION

– Caritas Christi Health Care sale

– – Acquisition by private equity firm, 462
– – Approved by Mass. Atty. Gen., 1439
– – Court approval (Mass.), 1530

– Catholic Healthcare West, citizenship status discrimination settlement, 1456
– Catholic Med. Center Healthcare Sys. acquisition by Dartmouth-Hitchcock Health, N.H. attorney general disapproves, 782
– Contraception issues

See generally CONTRACEPTION

– St. Mary's Hospital, Passaic, N.J., bankruptcy reorganization plan (Bankr. D.N.J.), 268

CAUSATION

– Allergic reaction to stents claim dismissed for lack of scientific proof (Wash. Ct. App.), 316
– Colon cancer treatment, causation expert opinion must be “medically superior” to support jury verdict (Tex.), 1716
– Dentsply anticompetitive business practices summary judgment, plaintiffs' proof required (M.D. Pa.), 526; correction, 560
– Expert reports to establish standard of care required in Texas

See TEXAS

– Expert testimony

See EXPERT WITNESSES

– Res ipsa loquitur, surgical sponge left in patient, expert proof not required for negligence suit (Tenn. Ct. App.), 1220
– Speculation about injury from shoulder surgery by expert, summary judgment for defendants (N.C. Ct. App.), 392

CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS)

– Berwick nominated as administrator, 579; recess appointment bypasses Senate confirmation process, 986; GOP senators express concern, 1352
– Contractor oversight, Grassley (R-Iowa) questions accountability, 1427
– Tavenner acting administrator, 656

CERTIFICATE OF NEED (CON)

– Ala., required for medical office building (Ala. Civ. App.), 929
– Miss. law does not permit extensions after expiration (Miss.), 269
– N.J., hospital closure process (N.J. Super. Ct. App. Div.), 560
– North Carolina

– – Denials not unconstitutional (N.C. Ct. App.), 707
– – Out-of-state diagnostic equipment usage by cancer center (N.C. Ct. App.), 561

– S.C., nearby cancer treatment facilities (S.C.), 377
– Tenn., draft standards for home health services, 1455
– Washington

– – Ambulatory surgery center, reasonable finding of need (Wash.), 1349
– – Limitation on number of hospitals that can perform elective angioplasty procedures upheld (E.D. Wash.), 799

CERTIFICATION

See ACCREDITATION AND CERTIFICATION

CHARITY CARE

– AHA guidelines not met, advocacy groups, 695
– Community needs assessment, health reform law, 673
– Corporate governance

See CORPORATE GOVERNANCE

– DSHs, N.J. program patient days exclusion upheld (3d Cir.), 1524
– Form 990, community benefit changes urged by AHA, 356; hospitals urge IRS to approve consolidated reporting, 1073
– Health reform law requirements

– – Excise tax for failure to satisfy community needs assessment requirement, 445
– – Financial assistance policies, IRS and “limitation on charges,” 1415
– – Guidance will address questions, IRS official says, 1720
– – Provena and new federal law, BNA Insights, 467
– – Reviews every 3 years not audits, IRS official, 1365
– – Still essential, report, 1222
– – Treasury Dep't and IRS aware of need for guidance, official says, 1671

– Ill., Provena Covena Medical Center not entitled to property tax exemption (Ill.), 409
– Nonprofit corporate law developments in 2009, BNA Analysis & Perspective, 111
– Ohio property tax, no exemption for dialysis facility, insufficient charitable institution proof (Ohio), 1479
– Online posting of policies encouraged by N.C. advocacy group, 253
– Reporting requirements

– – Distinguishing nonprofit from for-profit hospitals, 621
– – Fin. Accounting Standards Bd., proposals to clarify accounting issues, 578; final update, 1221

CHILDBIRTH

See PREGNANCY AND CHILDBIRTH

CHILDREN'S HEALTH CARE

– After hours visits billing, Conn. pediatric practice settles FCA claims, 770
– Antitrust, hospital exclusivity, neonatologists with privileges barred (E.D. Cal.), 594
– Appropriate settings, challenge to class of Mass. developmentally disabled persons settlement (1st Cir.), 148
– Autism

See AUTISM

– California

– – Inpatient psychiatric care for jailed youths, restoration of benefits after release (Cal. Super. Ct.), 685
– – Insulin injections by unlicensed school staff (Cal. Ct. App.), 839; review granted (Cal.), 1387
– – Vaccines, veto of bill requiring insurers to reimburse entire cost, 1386

– Child-only policies, elimination, House hearing, 1427
– Children's hospitals, 340B program discounts

See LEGISLATION, FEDERAL, HR 5712

– Discrimination claim, doctors' interference with pediatrician's contracts with potential clients (E.D. Cal.), 973
– “Experimental treatment” exclusion of coverage for child's bone cancer treatment, claim allowed (S.D. Ohio), 140
– Expert witnesses, locality rule inapplicable, pediatric nurse practitioner testimony on uniform practice (La. Ct. App.), 1565
– HIV blood testing of nonparties, data based on review of tests barred (Cal. Ct. App.), 1463
– Medicaid

– – Dental management company services to low income children (D. Md.), 135
– – Early and periodic screening, diagnostic, and treatment services for children settlement, D.C. waited too long to seek relief alleging change of law (D.D.C.), 1140
– – Inpatient psychiatric care for jailed youths, restoration of benefits after release (Cal. Super. Ct.), 685
– – N.H., class action children's dental care settlement, contempt claim fails (D.N.H.), 776
– – Tenn., early periodic screening, diagnosis, and treatment, injunction modified (6th Cir.), 1708

– Medical monitoring claim fails, unapproved device used on infant (3d Cir.), 1249
– Minn., newborn blood samples for DNA screening, genetic privacy claims (Minn. Ct. App.), 1243
– N.C., hearing aid coverage for young people, new law, 812
– Parent company dismissed from FCA case, no proof of involvement in subsidiaries' juvenile psychiatrist facility alleged Medicaid reimbursement scheme (W.D. Va.), 1096
– Parental rights violation, refusal to let mother visit child, hospital must defend civil rights case (N.D. Ga.), 1662
– Patient files from office of Tenn. pediatrician indicted on health care fraud charges, warrants sufficient (6th Cir.), 840
– Pre-existing conditions

– – New rules bar coverage denial, 871
– – Okla. law no bar to denial, removal of congenital cyst from infant (10th Cir.), 1386
– – Private insurers full compliance, 452

– Residential care for dependent's eating disorder, denial not abuse of discretion (N.D. Cal.), 383
– Sexual abuse of child by minor sibling suspected, new trial for physician on damages apportionment (N.D.N.Y.), 660
– Speech therapy coverage, plan administrator's failure to do enough to help participant, penalty (W.D. Wis.), 1354
– Stillborn infant, dismissal of claims improper (Ind. Ct. App.), 1111
– Testicular torsion care, gross negligence, summary judgment, appropriateness (Tex. App.), 1182
– Tonsillectomy patients, one free night in hospital, advisory opinion, 1384
– Unsupervised nurse practitioners allegedly performed procedures, qui tam suit dismissed (9th Cir.), 1776
– Vaccine storage, arbitration required for pediatrician whistleblower's contract breach suit (Or. Ct. App.), 411
– Wrongful birth

See WRONGFUL BIRTH

– Young adults coverage continuation, interim final rule, 681

CHILDREN'S HEALTH INSURANCE PROGRAM (CHIP)

– Anti-fraud bill

See LEGISLATION, FEDERAL, S 2964

– Ariz. first state to eliminate due to fiscal constraints, 413
– Funding end in health reform bills

See LEGISLATION, FEDERAL, HR 3590, HR 3962

– FY2011 budget, $10.5B requested, 180
– Medicaid fiscal health report overdue, Grassley (R-Iowa), 1352
– Payment error rate measurement program, final rule, 1140

CHIP

See CHILDREN'S HEALTH INSURANCE PROGRAM (CHIP)

CHIROPRACTIC SERVICES

– Administrative subpoena to search office, state board official not liable (10th Cir.), 721
– Cal., “excessive treatment” discipline by licensing board (U.S., rev den), 1659
– ERISA

– – Claims against BCBS allowed, RICO claims fail (N.D. Ill.), 747; claims against WellPoint dismissed, 1432
– – R.I. BCBS suit against chiropractors preempted (D.R.I.), 1560

– N.J., scope of practice, 152
– Records of nonpatient subpoenaed by licensing board must be produced (Ariz. Ct. App.), 103
– Tex., workers' compensation insurer must pay for procedure (Tex. App.), 108
– Unlicensed

– – Automobile insurer may recoup payments (W.D. Ky.), 190
– – Penalty for N.J. pain management center and owner (N.J. Super. Ct.), 769

CHRONIC AND TERMINAL ILLNESS

– End-of-life care

See END-OF-LIFE CARE

– Medical homes

– – Md., new law, 566
– – Patient-centered, new relationships between doctors and hospitals, BNA Insights, 1612
– – Primary Care Home Initiative standards, expansion of Joint Commission ambulatory health care organizations accreditation, 1294

CIAs

See CORPORATE INTEGRITY AGREEMENTS (CIAs)

CIVIL MONETARY PENALTIES (CMPs)

– ACOs

– – DOJ official promises guidelines will held avoid violations, 1691
– – Guidance needed, stakeholders tell federal officials, 1424; recordings and transcript available, 1500

– LTC, failure to prevent wandering, review denied (5th Cir.), 1326
– Nursing homes, lower penalties for self-reported violations, proposed rule, 984
– SNFs

– – Change in condition, failure to inform physician and family, upheld (6th Cir.), 940
– – Medications, failure to dispense and monitor patient's condition, upheld (4th Cir.), 183
– – Penalty paid by buyer, review petition dismissed (2d Cir.), 908
– – Risk of accident, failure to minimize (7th Cir.), 685

CIVIL PROCEDURE

– Pleading

See PLEADING

CLAIMS PROCESSING

– Appeals of insurance coverage or claims denials, interim final rule, 1061; safe harbor, guidance, 1318; proposal to extend information collections, 1750
– BCBS Ass'n not liable for claims reimbursement practices of Tex. affiliate (S.D. Tex.), 1464; summary judgment denied both parties, 1489
– Chiropractors' ERISA claims against BCBS allowed, RICO claims fail (N.D. Ill.), 747; ERISA claims against WellPoint dismissed, 1432
– Colo., new law bars insurer incentives to employees for denying claims, 748
– “Customary and reasonable” charges, administrator's speculation abuse of discretion (5th Cir.), 1212
– Denial of benefits, conflict of interest discovery after Glenn, BNA Insights, 1149
– Dentists failed to adequately allege conspiracy in RICO suit (11th Cir.), 719
– Dual role administrators, standard of review and discovery issues, 125
– Experimental treatment exception, procedural irregularities (W.D. Wash.), 568
– Hospitals' claims against HMO providing TRICARE services, class certification rejected (11th Cir.), 510
– Idaho, new independent external review of claims denied on medical necessity grounds, 31
– Ill., independent review of denied insurance claims law, 72
– Ind., Medicaid transportation reimbursement, suit by recipients (Ind.), 1283
– MACs

See MEDICARE ADMINISTRATIVE CONTRACTORS (MACs)

– Medicaid and Medicare claims databases, update to help fraud detection, 337
– Medicare claims records, nonprofit consumer magazine may not obtain documents (U.S., rev den), 574
– N.J. Portal Initiative, 5 health plans offer single online point of access to reduce physician office costs, 243
– Out-of-network, delays, hospital's fiduciary breach claims against plan administrator not covered by patient assignments (S.D. Tex.), 1652
– Preauthorization service for free, advisory opinion

– – Hospital, 1272
– – Radiology group, 1383

– Prompt payment

– – Cal., fines for violations of state laws, 1656
– – Ga., bill requiring third-party administrators of self-insured plans to comply vetoed, 836
– – Mo., new law gives insurers 45 days to pay or deny claims, 650
– – New York enforcement

– – – Fines for 20 insurers and HMOs, 1245
– – – Managed Health Inc. agrees to pay fine, 649

– – Ohio providers' RICO claims preempted (6th Cir.), 532; (U.S., rev sought), 983; cases pending at beginning of new term, 1307; (rev den), 1385
– – Third-party administrator must pay hospital's full billed charges due to delays (N.D. Tex.), 1704

– Provider class action settlement with Aetna does not bar contract breach suit by bankrupt physician group (11th Cir.), 718
– Recovery audit contractors

See RECOVERY AUDIT CONTRACTORS (RACs)

– Stop-loss claims, Anthem agrees to pay Cal. hospitals, 1656
– Tenn., appeals process for denial of health insurance claims, new law, 773; correction, 812
– Utah discretionary clause limitation preempted by ERISA (10th Cir.), 69

CLASS ACTIONS

– Administrative services agreement no basis for providers' claims against sponsors of employee health plans (N.D.W. Va.), 1705
– Aetna Inc.

– – Dismissal of suit alleging misrepresentations to conceal underpricing to gain market share (3d Cir.), 1186
– – Provider class settlement does not bar contract breach suit by bankrupt physician group (11th Cir.), 718

– Appropriate settings, challenge to class of Mass. developmentally disabled persons settlement (1st Cir.), 148
– Autism applied behavior analysis therapy coverage

– – BCBS of Tenn., certification denied (E.D. Tenn.), 277
– – Empire Blue Cross, denial of coverage (E.D. Mich.), 1748
– – Suit reinstated (Cal. Ct. App.), 177

– Blood reagents producers, antitrust claims (E.D. Pa.), 1234
– Cancer-only insurance policies, class certification and injunction (M.D. Tenn.), 30
– Cipro patent litigation settlement, direct purchasers, rehearing denied (2d Cir.), 1267
– Class representative delay prejudicial (W.D. Tenn.), 63
– Copayment and coinsurance overcharges by Coventry Health Care HMO, certification, 2 cases (W.D. Mo.), 1321; copay cap applies to prescription drugs, 1704
– Developmentally disabled, Tex. appropriate treatment class action filed (W.D. Tex.), 1785
– Duract pain relief drug, third-party payers class certification (Ala.), 144
– ERISA, failure to exhaust administrative remedies bars certification (8th Cir.), 533
– Federal Rule 23 rule overrides state law blocking “penalties” cases (U.S, judg rvs), 499
– Fla., AvMed customers, theft of laptops with unencrypted information (Fla. Cir. Ct.), 1649
– HealthSouth shareholder suits, settlement approved (N.D. Ala.), 1073
– HMO violated state rule by charging copayment and coinsurance for single service, member standing (W.D. Mo.), 1490
– Hospitals' claims against HMO providing TRICARE services, certification rejected (11th Cir.), 510
– Hurricane Katrina, poor hospital preparation and handling alleged, certification denied, 2 cases (E.D. La.), 842
– Ill., right-to-work group seeks to invalidate state law allowing unions for home health aides (N.D. Ill.), 651; constitutional challenge to union organizing campaigns dismissed, 1658
– Mass., AstraZeneca average wholesale prices, aggregate damages award (U.S., rev sought), 1307; dismissed, 1379
– Medical records copying, proposed class suit dismissed, amended complaint allowed (E.D. La.), 909
– MSP collection practices, discovery outside administrative record (D. Ariz.), 574
– N.H., Medicaid children's dental care settlement, contempt claim fails (D.N.H.), 776
– N.J., discretionary clauses in insurance (D.N.J.), 1747
– Nursing homes, overtime pay suit against chain (C.D. Ill.), 1245
– Out-of-network services, “allowable amount” challenge (N.D. Ill.), 141
– Patient antitrust suit against Evanston Northwestern hospitals, certification denied (N.D. Ill.), 559
– Physician bonuses not paid, certification reversed (Fla. Dist. Ct. App.), 617
– Physician rankings, Cal. doctors sue Blues plan over online program (Cal. Super. Ct.), 1295
– Physicians' BCBS claims settlement bars suit (11th Cir.), 139
– RICO dismissal no bar to ERISA claims against insurer by other providers (11th Cir.), 979
– Schering-Plough/Merck merger, settlement of shareholder suit approved (D.N.J.), 511
– Securities fraud

See generally SECURITIES

– Temporary staffing agency overtime suit, certification denied (E.D. Pa.), 244
– Uninsured persons, excessive rates, reliance on admission agreement, 2 cases (Cal. Ct. App.), 618
– UnitedHealth Group Inc., physicians' out-of-network claims settlement, AMA assistance, 604; doctors urged to file early, 1279
– Wages

– – Ariz. hospital nurses' registry, settlement (D. Ariz.), 1377
– – Boston-area hospital agree to pay to settle suit (D. Mass.), 838
– – Medi-Cal in-home care providers, pay cuts, class certified (N.D. Cal.), 876
– – Nurses' wage-fixing conspiracy charges, amendment of class certification denied (N.D.N.Y.), 267; nurses may pursue claims, 2 rulings, 1053; preliminary approval of settlement, 1454

– Wellbutrin XL

– – Dismissed direct purchaser class representative, compliance with discovery order (E.D. Pa.), 1054
– – End-payers, class certification denied health plans and others (E.D. Pa.), 1418

– WellCare, accounting schemes securities settlement (M.D. Fla.), 1186
– Zoladex and/or Pulmicort Respules, AstraZeneca settles pricing allegations, 868

CLEANING

– Disinfection

See DISINFECTION

CLINICAL LABORATORIES

– Interest on Medicare payment owed by HHS (5th Cir.), 1065
– Laboratory Corp. of America acquisition of Westcliff Med. Lab. challenged (FTC), 1690
– Urine drug tests not covered by Medicaid, Life Lab. agrees to pay Mass., 237

CLINICAL TRIALS

– Drug trials, proper structure may make income exempt for AMC's, attorney says, 1687
– Postmarket studies to pay kickbacks, Boston Scientific Corp. settles, 24

CMPs

See CIVIL MONETARY PENALTIES (CMPs)

CMS

See CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS)

COBRA (HEALTH CARE COVERAGE CONTINUATION)

– Exhaustion of administrative remedies required before suit against former employer for subsidy (D.D.C.), 647
– Extension left out of tax extenders package, 770

CODING

– False diagnosis codes, Fla. MA company and owners agree to pay to settle FCA claims (S.D. Fla.), 1640
– ICD-10, competitive advantage for hospitals, 705
– N.Y. Medicaid eligibility errors, state to reimburse NYC (N.Y. Ct. Cl.), 283
– One-day inpatient admissions, Philadelphia hospital system agrees to pay, 1098

COLLECTIVE BARGAINING

– Ed. Note: This heading covers pre-ratification conduct and issues. For ratification and post-ratification conduct and issues, see COLLECTIVE BARGAINING AGREEMENTS.
– Conn. nursing home strikes, terminations for union activities alleged, complaint (NLRB), 1247
– Good Samaritan Hospital, Los Angeles, new SEIU decertification hearing (NLRB), 246
– Health reform rules, challenges for multiemployer plans, 1137
– Inflatable rat and banners, request for injunction dismissed (N.D. Ohio), 384
– Kaiser Permanente facilities refuse to grant wage increase after workers switch to representation by Natl. Union of Healthcare Workers, complaint (NLRB), 1246; injunction sought (C.D. Cal.), 1434; unfair labor practices by Kaiser (NLRB ALJ), 1783
– Kentucky River Med. Center, unlawful suspension due to union activity (NLRB), 1491
– Libel, union postcard claim hospital linens dirty, proof of malice required (Cal. Ct. App.), 1064
– Nurses

See NURSES AND NURSING

– Outlook 2010, 5
– St. Barnabas Hosp., election among interns and residents (NLRB), 837
– Tex. Dental Ass'n, illegal discharge, settlement (NLRB), 1028

COLLECTIVE BARGAINING AGREEMENTS

– Ambulance service illegally fired worker over Facebook comments about supervisor (NLRB Region 34), 1561
– Cal. Pacific Med. Center unilateral changes in health plan, hearings set in SEIU or Cal. Nurses Ass'n cases (NLRB), 245
– Cal. Public Employment Relations Board has exclusive authority over county hospital's complaint against union (Cal. Ct. App.), 32
– Forum Health sale of assets to Youngstown Ohio Hosp. Co., SEIU and AFSCME negotiations (Bankr. N.D. Ohio), 1163
– Kingsbridge Heights Care Center/SEIU, nursing home operator unlawfully failed to make pension and benefit contributions (2d Cir.), 31
– Nurses

See NURSES AND NURSING

– Off-duty picketing, “law of the case,” firings unlawful (NLRB), 1784
– Tobacco-free campus, smoking policy outside of scope of contract (W.D. Pa.), 683

COLLEGES AND UNIVERSITIES

– Demoted former university school of medicine administrator's claims fail (4th Cir.), 131
– Liberty Univ., standing to challenge PPACA mandatory coverage (W.D. Va.), 1641
– Teaching hospitals

See TEACHING HOSPITALS

COLORADO

– Abortion, voters defeat antiabortion initiative, 1570
– Chemotherapy, orally administered, new coverage law, 571
– Deaf patients, clinic failure to provide preferred sign language interpreter (D. Colo.), 1531
– Disclosures, new laws require information from doctors, certain drugmakers, and health care facilities, 844
– Health care reform

– – Ballot measure to block imposition of health insurance mandate, 1242; initiative defeated by voters, 1570
– – Constitutionality challenge

See PATIENT PROTECTION AND AFFORDABLE CARE ACT (PPACA)

– Health insurance

– – Anthem BCBS will pay $20M in premium credits after consumer complaints, 1323
– – Mammography, insurance practices, and cancer drugs, new laws, 748
– – Market conduct, Aetna fined, 503
– – Premiums, new law bars using gender to determine rate, 504
– – Uniform application for individual market required by new law, 720

– Medicaid

– – In-home attendant care cuts (Colo. Dist. Ct.), 77
– – OTC drugs, new law, 748

– Medical marijuana, oversight, new requirements for providers and dispensaries, 844
– Nurse anesthetists, physician supervision, state may seek federal waiver of Medicare requirement, 1329; waiver sought, 1394
– Peer review

– – Hospital credentialing documents not privileged (D. Colo.), 1035
– – Physician's independent investigation, information not privileged (D. Colo.), 1498

– Physician sanction based on substandard care for surgical patients (U.S., rev sought), 74; (rev den), 280
– Underpayment for medical services, ERISA does not preempt provider's breach of contract claim (D. Colo.), 1139
– Univ. of Colo. Hospital, civil rights of patient, negligence claims against state-operated hospital fail (D. Colo.), 1289
– Verbal orders authentication requirements, new law, 726

COMMERCE CLAUSE

– Cal. law barring opticians to provide services in same location as optometrists and ophthalmologists (E.D. Cal.), 694
– CON, limitation on number of hospitals that can perform elective angioplasty procedures upheld (E.D. Wash.), 799
– Constitutionality analysis, Congressional Research Serv. report, 677
– Data mining, prescription drug data sales restrictions, Me. law upheld (1st Cir.), 1135
– Health care reform constitutionality challenge

See PATIENT PROTECTION AND AFFORDABLE CARE ACT (PPACA)

– La., in-state HMOs preferred for state employees, constitutionality (5th Cir.), 568

COMMUNITY CENTERS

– FY2011 budget request includes increase, 180

COMPLIANCE PROGRAMS

– Challenges, Atty. Gen. Holder and recent developments, BNA Insights, 154
– CIAs, disclosure of reports prepared by hospital to demonstrate compliance with Medicare and Medicaid (Tenn. Ct. App.), 1516
– Compliance officer access to board

– – Direct reporting to board more likely in health care industry, report, 742
– – Proposed sentencing guidelines, 203; amendments sent to Congress, 642
– – Reporting relationships focus of changes, BNA Insights, 728

– Joint defense agreements, increase in number, 1741
– Qui tam lawyers advise providers not to ignore whistleblowers, 273

COMPUTERS AND COMPUTER EQUIPMENT

– Data breach, Mass. hospital's data destruction contractor cannot account for files, 1060
– Electronic health records

See ELECTRONIC HEALTH RECORDS

– Removal of data after contract canceled, computer fraud claims against pathologists (D.N.H.), 1102

CON

See CERTIFICATE OF NEED (CON)

CONFERENCES AND MEETINGS

– ABA

– – Annual Healthcare Summit, 1694; 1697; 1702; 1720; 1741
– – Constitutionality of health reform, teleconference and web seminar, 1022
– – Eighth Annual Institute on Civil False Claims Act and Qui Tam Enforcement, 804; 805; 807
– – Emerging Issues in Healthcare Law, 265; 273; 489
– – Updating Your Medical Staff Governance and bylaws for MS 01.01.01, Health Law Section and Center for Continuing Education, 1051

– ACOs workshop, FTC and CMS, 1278
– AHLA

– – Fraud and Compliance Forum with Health Care Compliance Assn., 1382
– – Inst. on Medicare and Medicaid Payment Issues, 493

– American Enterprise Institute, 1486
– BNA health care webinars, 664; 696; 785; 846; 918
– 11th Annual Pharmaceutical Regulatory and Compliance Congress and Best Practices Forum, 1484
– Federal Bar Ass'n Tax Law Conference, 339
– Fraud and Compliance Forum, AHLA/Health Care Compliance Assn., 1382
– Health Care Compliance Association, Physician Practice Compliance Conf., 1457
– Health Care Fraud Prevention Summit, 1240
– Health Insurance Oversight in the Post-Reform World, Center for American Progress, 898
– Natl. Accountable Care Organization Congress, 1485
– Natl. HIPAA Summit, 210
– Reported Concerns, Retaliations, and Reprisals: How to Encourage One and Stop the Other, 1567

CONFIDENTIALITY

See PRIVACY AND CONFIDENTIALITY

CONFLICTS OF INTEREST

– ERISA benefit claims, discovery after Glenn, BNA Insights, 1149
– Financial ties between doctors and industry, senators urge HHS to provide disclosure guidance, 1596
– Health IT, Grassley (R-Iowa) surveys hospitals about contracts and incentives, 138
– Medical staff standard, Joint Commission

– – Draft, 167; revision to bylaws standard approved, 416; new revision allows flexibility, 637
– – Hospitals should begin compliance now, panelists, 1051
– – Reported concerns, “early warning system” for hospitals, experts say, 1567

– Stent implantations, unnecessary, Senate panel looks at cost and doctor's relationship to Abbott, 1700
– Structural conflicts

– – Dual role administrators, standard of review and discovery issues, 125
– – Limited discovery allowed (D. Neb.), 679
– – Stem cell transplant denial by insurer, discovery (D. Neb.), 456

CONGRESS, U.S.

– Ed. Note: This heading is used for administrative actions only. For coverage of legislation by bill number, see LEGISLATION, FEDERAL. For information on measures not yet assigned bill numbers, see relevant subject headings.
– Senate Fin. Comm., health and welfare counsel, 1023

CONNECTICUT

– Chemotherapy, orally administered, new coverage law, 773
– Dentists' state law claims alleging underpayments by insurer preempted by ERISA (11th Cir.), 28
– Excluded employee, SNF agrees to pay for improper billing, 713
– HIPAA

– – Health Net data breach charges filed by state attorney general (D. Conn.), 98; settlement, 936
– – United Healthcare acquires Health Net assets, medical group raises privacy issues, 139

– Medicaid

– – McKesson agrees to pay to settle inflated prices suit (D. Mass.), 1485
– – Participating nursing homes sue over low reimbursement levels (D. Conn.), 181; injunction denied, 839

– Medical errors, new law expands disclosure and whistleblower protections, 953
– Most favored nation clauses probe, Anthem BCBS will not require Conn. hospitals to give it same discounts as state plan, 169; Conn. Atty. Gen. calls on HHS to look into “anticompetitive” practices, 333
– Summary suspension of physician's privileges, favorable termination doctrine not applicable but compliance with bylaws not shown (Conn.), 723

CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT (COBRA)

See COBRA (HEALTH CARE COVERAGE CONTINUATION)

CONSTITUTION, U.S.

– Abortion issues

See generally ABORTION

– Case or controversy, MSP, qui tam action against cigarette manufacturer, advocacy groups and Medicare beneficiary lack standing (2d Cir.), 1436
– Commerce clause

See COMMERCE CLAUSE

– Contracts clause, in-state HMOs preferred for La. state employees (5th Cir.), 568
– Due process

See DUE PROCESS

– Eighth Amendment

See EIGHTH AMENDMENT

– Eleventh Amendment

See ELEVENTH AMENDMENT

– Equal protection

See EQUAL PROTECTION

– First Amendment

See FIRST AMENDMENT

– Fourteenth Amendment

See FOURTEENTH AMENDMENT

– Health care reform

– – Analysis, Congressional Research Serv. report, 677
– – Challenge

See PATIENT PROTECTION AND AFFORDABLE CARE ACT (PPACA)

– – Mandatory health insurance purchase, constitutionality, Congressional Research Serv. report, 1500

– Noneconomic damages cap challenge based on federal rights (E.D. Tex.), 589
– Pregnant woman's refusal of medical treatment, state must show compelling state interest for intervention (Fla. Dist. Ct. App.), 1184
– Search and seizure

See FOURTH AMENDMENT

– Seventh Amendment

See SEVENTH AMENDMENT

– Supremacy Clause, refusal of medical school director to provide peer review information to another hospital (U.S., rev den), 79

CONSUMER PROTECTION

– Antitrust issues

See ANTITRUST

– Cal., managed care, timely access to nonemergency care rules, 145
– Common law unfair competition claim not preempted by state consumer law (W.D. Wash.), 19
– Generic drugs, pay-for-delay

– – Ban proposed

See LEGISLATION, FEDERAL, HR 3962, HR 4899

– – Cipro patent litigation, direct purchasers (2d Cir.), 1267
– – FTC analysis, 93
– – Reverse payments, CVS, Rite Aid, and other purchasers call practice anticompetitive (U.S., rev sought), 1737
– – Wellbutrin XL

– – – Dismissed direct purchaser class representative, compliance with discovery order (E.D. Pa.), 1054
– – – End-payers, class certification denied health plans and others (E.D. Pa.), 1418

– Ky., cost increase due to proposed licensing rules, FTC letter, 233
– Medical residents, hours of work, petition to Occupational Safety and Health Admin., 1271; AHA opposes petition to limit hours of residents, 1666
– Medicare claims records, nonprofit consumer magazine may not obtain documents (U.S., rev den), 574
– Part D prescription drug benefits, preemption of beneficiaries' suit against insurer (9th Cir.), 1285
– Personal, medical, and financial information on stolen computer discs, failure to show injuries, dismissal (Or. Ct. App.), 1428
– Physician rankings, Cal. doctors sue Blues plan over online program (Cal. Super. Ct.), 1295
– Price transparency

See LEGISLATION, FEDERAL, HR 2249, HR 4700, HR 4803

– Privacy framework proposed by FTC, 1703
– Uninsured persons

See UNINSURED PERSONS

CONTINGENT WORKERS

See TEMPORARY EMPLOYEES

CONTRACEPTION

– Idaho “conscience” law signed by governor, health care providers can deny certain services, 462
– IUDs not approved by FDA, Tex. Atty. Gen. seeks injunction (Tex. Dist. Ct.), 1497
– Pa., Medicaid family planning services overpayment, denial of hearing request (W.D. Pa.), 775
– Wrongful birth

See WRONGFUL BIRTH

– Yasmin birth control pill, suit against maker should not be severed from malpractice claims against health care providers of deceased woman (N.D. Okla.), 1715

CONTRACTS AND CONTRACTORS

– AMA managed care contract database to help physicians negotiate, 421
– Arbitration clauses

See generally ARBITRATION

– Corporate practice of medicine

See CORPORATE PRACTICE OF MEDICINE

– ERISA issues

See ERISA

– Expert's draft report used for settlement, physician's breach claim against law firm and professional group allowed (E.D. Pa.), 1605
– Federal Contract Compliance Programs Office jurisdiction

– – Expanding to cover hospital and health care systems, 1093
– – TRICARE, subcontractor hospital (DOL OALJ), 1496

– Federal government compliance requirements, BNA Insights, 513
– Independent contractors

– – ADA, doctor under contract to P.R. corrections agency not employee (1st Cir.), 1692
– – Anesthesiologist terminated due to sickle cell anemia, Rehabilitation Act claim allowed (U.S., rev den), 864
– – Apparent agency theory fails (Fla. Dist. Ct. App.), 1036
– – Emergency room care, ostensible agency (Nev.), 987
– – Neurosurgeon's loss of staff privileges, no federal racial bias right of action against private nonemployer hospital (11th Cir.), 283
– – Physician alleges privileges revoked for reporting safety violations (N.Y. Sup. Ct. App. Div.), 235
– – Temporary staffing agency failure to pay overtime (E.D. Pa.), 244

– Joint defense agreements, increase in number due to growth in compliance programs, 1741
– Joint ventures that allow urologists to provide laser treatments to Medicare patients, claims dismissed (D.D.C.), 1777
– Ky., confidentiality claims allowed against physician terminated without cause (W.D. Ky.), 317
– MACs

See MEDICARE ADMINISTRATIVE CONTRACTORS (MACs)

– Most favored nation clauses probe, Anthem BCBS will not require Conn. hospitals to give it same discounts as state plan, 169; Conn. Atty. Gen. calls on HHS to look into “anticompetitive” practices, 333
– Noncompete clauses

See NONCOMPETE CLAUSES

– NPDB reporting, physician's employment contract bars suit against hospital (Neb. Ct. App.), 1466
– Peer review remedies, failure to exhaust remedies created by bylaws (Mass. App. Ct.), 1067
– Physician bonuses not paid, class certification reversed (Fla. Dist. Ct. App.), 617
– Physician recruiting agreements

See PHYSICIANS

– Physician's statement she would not help another doctor's patients while on call may not justify termination (D. Md.), 318; motion to reconsider denied, 828
– RACs

See RECOVERY AUDIT CONTRACTORS (RACs)

– Sole source contracts with GPOs, sharps disposal container maker settles (D. Mass.), 127
– Staff privileges issues

See STAFF PRIVILEGES

– Staffing services general contractor liable for negligence of nurse employed by subcontractor (D.N.H.), 220
– Subcontractors as business associates of health care entities

– – Proposed HIPAA rule changes, 978; hospital groups recommend easing burden, 1317; final rule expected by early 2011, 1429
– – Warning about preparing to meet obligations from attorney, 1136

– Tex., Medicaid managed care, no special authorization needed for payment to provider ordered by administrative law judge (Tex. App.), 908
– Tortious interference with contract, therapy provider may sue nursing home management firm (N.D. Ill.), 1255
– Vicarious liability of hospitals

See HOSPITALS

CONVERSIONS

See FOR-PROFIT CONVERSIONS

COPAYMENTS AND DEDUCTIBLES

– Ariz. Medicaid alternative program, co-pay increase, temporary stay (D. Ariz.), 1389
– Formularies, Plavix as Tier 3 drug, insurer did not violate terms of plans (3d Cir.), 832
– Grandfathered plans

– – Big copayment increases will be forbidden by health reform rules, 834
– – Frequently asked questions, Labor Dep't, 1518

– HMO charging copayment and coinsurance for single service, member standing to pursue damages and disgorgement (W.D. Mo.), 1490
– Overcharges by Coventry Health Care HMO, class certification, 2 cases (W.D. Mo.), 1321; copay cap applies to prescription drugs, 1704
– Patient assistance programs

– – Donor-funded program to assist underinsured with drug copays, advisory opinion, 768
– – Nonprofit organization grants shield beneficiaries from donors, advisory opinion, 809

CORPORATE GOVERNANCE

– ACOs, implications of draft NCQA criteria, BNA Insights, 1573; comments from providers and patient advocates, 1647
– Board responsiveness, examination of recent controversies, BNA Insights, 1533
– Challenges, Atty. Gen. Holder and recent developments, BNA Insights, 154
– Compliance officer access to board

– Doctor's RICO suit against hospital chief executive officer fails to allege elements of violation (W.D. Pa.), 1693
– Employment taxes of hospital unpaid, co-owners and official of affiliate company jointly and severally liable (5th Cir.), 1719
– Exclusion

– – Former pharmaceutical company board member excluded from participation in federal programs, 1638
– – Preview of “things to come,” IG official says, 1694

– Executive compensation

See EXECUTIVE COMPENSATION

– Form 990, IRS tool, 620
– Health care reform, hospital board responsibilities, BNA Analysis & Perspective, 81
– Key nonprofit corporate law developments in 2009, BNA Analysis & Perspective, 111
– Medical staff standard, Joint Commission

– Outlook 2010, top health law issues, 5

CORPORATE INTEGRITY AGREEMENTS (CIAs)

– Disclosure of reports prepared by hospital to demonstrate compliance (Tenn. Ct. App.), 1516

CORPORATE PRACTICE OF MEDICINE

– Cal., bill to extend pilot project to attract doctors to underserved communities raises issue, 993
– Tex., illegal orthodontic practice management agreement, unenforceable (5th Cir.), 1529
– Wash., employment of physical therapists by physicians' limited liability company no violation (Wash.), 422

CORRECTIONAL FACILITIES

See PRISONS AND PRISONERS

COST OF HEALTH CARE

– ACOs, effect on spending unclear, report, 1611
– Antitrust, hospital information exchange, Justice Dept. approval, 593
– Decline in Medicare beneficiaries out-of-pocket costs for hospital outpatient services, 945
– Deficit reduction panel proposed recommendations to cut spending, 1594; proposal lacks necessary votes for adoption, 1701
– GPOs

– – Concerns linger, reports, 1347
– – Debate among key industry associations, 1417
– – Govt. Accountability Office finds little support for savings claims, 320

– Medicare spending cuts in health reform law, report, 598
– N.J. Portal Initiative, 5 health plans offer single online point of access to reduce physician office costs, 243
– Price transparency

See LEGISLATION, FEDERAL, HR 2249, HR 4700, HR 4803

– Retail-based clinics

See LIMITED SERVICE CLINICS (LSCs)

– Some hospitals have market power to get noncompetitive prices from insurers, study, 1665
– Stent implantations, unnecessary, Senate panel looks at cost and doctor's relationship to Abbott, 1700
– Uninsured persons

See UNINSURED PERSONS

– Unnecessary tests ordered, protection against malpractice suits, survey, 952
– Wis., health care providers must disclose cost of common procedures, 394

COST REPORTS

– Bankruptcy, dismissal of trustee's suit against fiscal intermediary for not issuing timely Notice of Program Reimbursement (10th Cir.), 1141
– Cancer hospital reimbursements reasonable (D.D.C.), 608
– DSHs, dual eligibles who exhausted Medicare Part A, CMS improperly excluded from calculation (W.D. Mich.), 537
– False claims

See FALSE CLAIMS

– Offshore insurer, Medicare reimbursement for hospital group's malpractice and reimbursement premiums (D.C. Cir.), 1176
– Psychiatric care facilities

– – CMS calculation method error (5th Cir.), 1217
– – HHS reimbursement calculations, target amount caps (D.N.J.), 417

– Resident training costs reimbursement, failure to claim affiliated group status for full-time equivalents (N.D. Cal.), 1142
– St. Luke's Hospital/Allentown Osteopathic Med. Center merger, disallowance of claim, inadequate consideration (D.C. Cir.), 985
– Univ. of Pittsburgh Medical Center/Braddock Medical Center merger, depreciation denial (3d Cir.), 149

COVENANTS NOT TO COMPETE

See NONCOMPETE CLAUSES

COVERAGE AND REIMBURSEMENT POLICIES

– Abortion

– – Okla., veto of prohibition on health insurers covering elective abortions, 844
– – Tenn. health exchange plans must exclude coverage, 695

– Appeals of insurance coverage or claims denials, interim final rule, 1061; safe harbor, guidance, 1318; proposal to extend information collections, 1750
– Autism

See AUTISM

– Child-only policies, elimination, House hearing, 1427
– COBRA

See COBRA (HEALTH CARE COVERAGE CONTINUATION)

– Colo., orally administered chemotherapy, new law, 571
– Conn., orally administered chemotherapy, new law, 773
– Denial of claims, physician-target of fraud investigation failed to exhaust administrative remedies (D.N.J.), 1033
– Diabetic beneficiary, insurer liability for failure to pay for medically necessary items (N.D. Cal.), 1322
– Dual eligibles

See DUAL ELIGIBLES

– ERISA issues

See ERISA

– Experimental treatment exception, procedural irregularities (W.D. Wash.), 568
– “Facility fee” for use of surgical suite associated with physician's office, excluded by health plans (D.N.J.), 1213
– Federally mandated health insurance, Idaho governor signs opt out bill, 412
– High-risk pools

– – Cal., pre-existing conditions, new law, 939
– – HHS asks state to declare interest in implementation, 497

– Idaho, county liable for usual and customary rates for commitment proceeding costs (Idaho), 1756
– Me., new laws bars annual and lifetime caps on benefits, 536
– Medicaid drug coverage

See MEDICAID DRUG COVERAGE

– Medical necessity of inpatient substance abuse and mental health treatment, BCBS of Mass. refusal to pay upheld (D. Mass.), 278
– Medicare drug coverage

See MEDICARE DRUG COVERAGE

– Mental health parity

See MENTAL HEALTH

– Minn., oral chemotherapy medications, 719
– N.Y., plans prohibited from eliminating entire classes of policies, 1175
– N.C., hearing aid coverage for young people, new law, 812
– Out-of-network providers

– – Ambulatory surgical centers, Horizon BCBS agrees to pay to resolve underpayment claims, 3 cases (D.N.J.), 1490
– – La. clinic's reimbursement suit against out-of-state Kaiser HMOs dismissed for lack of personal jurisdiction (5th Cir.), 1183
– – UnitedHealth Group Inc., physicians' claims settlement, AMA assistance, 604; doctors urged to file early, 1279

– Pre-existing conditions

– – Children

– – – New rules bar coverage denial, 871
– – – Okla. law no bar to denial, removal of congenital cyst from infant (10th Cir.), 1386

– – Diverticulitis specifically excluded by rider (Tenn. Ct. App.), 1214
– – Misrepresentation not fraudulent (D.S.C.), 1027

– Preauthorization requirements not complied with, no abuse in limiting nose surgery reimbursement (D. Haw.), 648
– Preventive care coverage without cost-sharing by beneficiaries, interim final rule, 1026
– Rescission issues

See RESCISSION

– Surrogate mothers, insurer exclusion of maternity coverage violates state law (Wis.), 1027
– Telemedicine, new Va. law requires HMOs and health insurers to cover, 503
– Tex. bars discretionary clauses in all insurance policies, 1706
– Utah mental health coverage law, insurers may exclude residential treatment, 1560
– Young adults coverage continuation, interim final rule, 681

CREDENTIALING

See STAFF PRIVILEGES
– Negligent credentialing

See TORTS

– Peer review issues

See PEER REVIEW AND PEER REVIEW ORGANIZATIONS (PROs)

CRIMINAL PROSECUTION

– Alford plea, physician entitled to hearing prior to license revocation (Md.), 722
– Background checks, CMS proposes enhanced procedures for high-risk providers, 1329
– Deferred prosecution agreements and nonprosecution agreements

– – Accountability, report, 66
– – Exactech agrees to corporate compliance and monitoring (D.N.J.), 1743
– – Third-party monitoring, DOJ guidance for prosecutors, 803

– Elan, off-label promotion of Zonegran, settlement, 1779
– False diagnosis codes, Fla. MA company and owners agree to pay to settle FCA claims (S.D. Fla.), 1640
– Felony charge against nurse for report to state medical board, acquittal (Tex. Dist. Ct.), 251
– GlaxoSmithKline

– – Adulterated drugs charges, settlement (D. Mass.), 1485
– – Former in-house counsel, false statement and obstruction of justice charges (D. Md.), 1769

– HIPAA, former hospital worker violated privacy of celebrity patients (C.D. Cal.), 68
– Honest-services fraud limited to bribery and kickbacks, 3 cases (U.S.), 899
– Identity theft

See IDENTITY THEFT

– Individuals will be pursued as aggressively as companies, DOJ official, 1484
– Nationwide crackdown, 90 persons charged, 1020
– N.H., search warrants for privileged medical records (N.H.), 686
– N.Y., felony to assault nurses, new law, 1175
– Novartis off-label marketing of Trileptal, settlement, 1385
– Nursing homes

– – Involuntary manslaughter, no criminal liability for death based on negligence of multiple employees (Mass.), 739
– – Quality of care, St. Louis-area owner agrees to pay over $1M in fines (E.D. Mo.), 75

– Obstruction of justice, Forest Pharmaceuticals agrees to pay to resolve criminal and civil liability (D. Mass.), 1313
– Patient files from office of Tenn. pediatrician indicted on health care fraud charges, warrants sufficient (6th Cir.), 840
– Pretrial intervention program, N.J. Medical Board, summary sanction reversed (N.J. Super. Ct. App. Div.), 340
– Sentencing guidelines

See SENTENCING GUIDELINES

– “Skid Row” recruiting for unnecessary treatment

– – Former CEO sentenced to prison and restitution (C.D. Cal.), 1275
– – Hospital executive pleads guilty (C.D. Cal.), 236
– – Prison sentence for former co-owner of hospital (C.D. Cal.), 273

– Tex. law barring lawyers from soliciting persons who have been arrested unconstitutional (W.D. Tex.), 463

CRITICAL ACCESS HOSPITALS (CAHs)

– Wis., new tax on small hospitals to increase Medicaid reimbursement, 573