Health law, insurance coverage, appeals with a sprinkling of gorgonzola

Sixth Circuit expresses concern over health care reform law

A federal appeals court in Cincinnati expressed concern Wednesday over the sweeping health care reform law championed by President Barack Obama, especially the requirement that Americans purchase health insurance in coming years or face financial penalties. 

The case could turn on either a broad reading of congressional power to regulate the health insurance market, or more mundane procedural issues. It is one of 30-some legal challenges nationwide to the health care reform effort, an issue that is certain to ultimately reach the Supreme Court, perhaps by year's end.  More 

1st Circuit: Anti-kickback violations can underpin False Claims Act cases

The National Law Journal

June 2, 2011

The June 1 ruling in U.S. ex rel. Hutcheson v. Blackstone Medical Inc. reversed a March 2010 dismissal of the complaint for failing to identify a materially false or fraudulent claim under the FCA. The 1st Circuit has determined that anti-kickback statute violations can form the basis of a False Claims Act case.   More

 Jovine v. Abbott Laboratories, Inc. ,(S.D.Fla.)

Torts - Assuming shotgun complaint was not dismissed, negligence claim against infant formula manufacturer was adequately alleged.

Assuming consumers' "shotgun" complaint was not dismissed for incorporating by reference all allegations for each subsequent claim, the consumers adequately alleged a plausible class action claim for negligence, under Florida law, against the manufacturer of infant formula products recalled due to contamination with insect parts and larvae. The consumers alleged that the manufacturer owed a duty to consumers to use reasonable care to ensure that the products were not adulterated, contaminated, injurious to health, or otherwise unfit for consumption, that the duty was breached by failing to exercise reasonable care in formulating, manufacturing, marketing, advertising, distributing, and selling the products, and that damages were suffered as direct and proximate result of the breach when consumer's infant digested a defective product and became ill as result.

Approved by the Governor May 26, 2011.

2011 Fla. Sess. Law Serv. Ch. 2011-61 (S.B. 2144) (WEST)

MEDICAID--STANDARDS

Approved by the Governor May 26, 2011.

An act relating to Medicaid; amending s. 400.23, F.S.; revising the minimum staffing requirements for nursing homes; amending s. 408.815, F.S.; requiring that the Agency for Health Care Administration deny an application for a license or license renewal of an applicant, a controlling interest of the applicant, or any entity in which a controlling interest of the applicant was an owner or officer during the occurrence of certain actions; authorizing the agency to consider certain mitigating circumstances; authorizing the agency to extend a license expiration date under certain circumstances; amending s. 409.904, F.S.; repealing the sunset of provisions authorizing the federal waiver for certain persons age 65 and older or who have a disability; repealing the sunset of provisions authorizing a specified medically needy program; eliminating the limit to services placed on the medically needy program for pregnant women and children younger than age 21; amending s. 409.905, F.S.;

FL LEGIS 2011-61

Property: 11TH CIRCUIT: INSURER'S POLICY SAYS POSSESSION IS 9/10 OF THE LAW, Aydin & Co. v. Jewelers Mut. Ins. Co., 21 No. 33 Westlaw Journal Insurance Coverage 1, Westlaw Journal Insurance Coverage May 27, 2011

An insurer owed no coverage when a jeweler lost over $300,000 in high-priced merchandise while traveling by plane because the jewelry was not in his custody as required by the policy, the 11th U.S. Circuit Court of Appeals has ruled. The unanimous panel affirmed that Jewelers Mutual Insurance Co.'s policy with Aydin & Co. explicitly limited the insurer's liability when jewelry left the retailer's Atlanta store.Therefore, Jewelers Mutual did not breach its contract when it denied coverage.

Medical Information: HEALTH NET'S, IBM'S NEGLIGENCE COMPROMISED MEDICAL DATA, SUIT SAYS, Bournas v. Health Net, 21 No. 33 Westlaw Journal Insurance Coverage 2, Westlaw Journal Insurance Coverage May 27, 2011

Health Net Inc. and IBM face a class-action lawsuit seeking $5 million in damages over the loss of computer storage devices that held the medical histories, financial data and Social Security numbers of 2 million people. Alana Bournas' class-action complaint in the U.S. District Court for the Eastern District of California alleges that the insurer and IBM breached their duty of confidentiality and negligently allowed the release of highly personal and confidential information of millions.

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