Crowell Moring Managed Care Lawsuit Watch Archive
CONTACTS +

This summary of key lawsuits affecting managed care is provided by the Health Care Law Group of Crowell & Moring LLP. If you have questions or need assistance on managed care law matters, please contact Art Lerner or any member of the health law group.


Click on a month below to jump to a previous archive.

2016 -- | Mar. |

2015 -- | Mar. | Jun. | Nov. |

2014 -- | Feb. | Apr. | Jul. | Oct. |

2013 -- | Feb. | May | Jul. | Oct. |

2012 -- | Apr. | Jul. | Dec. |

2011 -- | Feb. | Mar. | May | Jul. | Oct. |

2010 -- | Feb. | Mar. | May | Aug. | Sept. | Dec. |

2009 -- | Jan. | Mar. | Jul. | Aug. | Sept. | Oct. | Nov. | Dec. |

2008 -- | Jan. | Feb. | May | Jun. | Jul. | Sept. | Nov. | Dec. |

2007 -- | Jan. | Feb. | Mar. | Apr. | May | Jun. |

2006 -- | Jan. | Feb. | Mar. | Apr. | May | Jun. | Jul./Aug. | Sept./Oct. | Nov. | Dec. |

2005 -- | Jan. | Feb. | Mar. | Apr. | May | Jun. | Jul. | Aug. | Sept. | Oct. | Nov. | Dec. |

2004 -- | Jan. | Feb. | Mar. | Apr. | May | Jun. | Jul. | Aug. | Sept. | Oct. | Nov. | Dec. |

2003 -- | Jul. | Aug. | Sept. | Oct. | Nov. |

To search the entire archive of cases, hit 'Control F' and type your desired search phrase.



March 2016 Managed Care Lawsuit Watch [full version]


  • Tenth Circuit holds that insurer could seek reimbursement from federal employee health benefit insurance plan member
    The U.S. Court of Appeals for the Tenth Circuit affirmed a district court’s granting of judgment on the pleadings judgment requiring a federal-employee health-insurance plan member to reimburse the plan insurer for benefits paid because the relevant state anti-subrogation statute was preempted by federal common law and FEHBA’s preemption provision.
    Helfrich v. Blue Cross & Blue Shield Ass'n

  • California Court of Appeal: utilization management physicians owe duty of care and can be sued for causing new or aggravated injuries that are not the subject of the UM review
    A California Court of Appeal found that a physician working for a workers’ compensation utilization review company may be liable to patients in certain circumstances. Although the Workers’ Compensation Act provides a mechanism for challenging utilization review decisions, claims that are based on new or aggravated injuries sustained due to a mishap in the claims process go beyond challenges to the utilization review decision. The Court also found that utilization review physicians owe patients a duty of care, even if the nature of the duty is likely less than that of a treating physician.
    King v. CompPartners, Inc.

  • California Court of Appeal finds that independent physician association is not liable for cost of out-of-network laboratory testing services ordered as a result of physician error
    California Court of Appeal Held that Independent Physician Association is not responsible for the Cost of Laboratory Tests on Specimens that were Misdirected to Non-Contracted Laboratories Due to Physician Error.
    Unilab Corp. v. Angeles-IPA

  • The U.S. District Court for the Northern District of California granted summary judgment holding that treating physician’s stabilization determination is binding on Kaiser
    The U.S. District Court for the Northern District of California granted the Secretary’s cross-motion for summary judgment, holding that the treating physician’s stabilization determination is binding on Kaiser with respect to its financial obligation to pay for emergency care up until the point of stabilization.
    Kaiser Found. Health Plan, Inc. v. Burwell

  • Northern District of California denied plaintiffs’ motion to remand the case to the New York Supreme Court in Anthem data breach litigation because plaintiffs’ claims were preempted by ERISA
    The U.S. District Court for the Northern District of California denied plaintiffs’ motion to remand, finding that the plaintiffs’ breach of contract and unjust enrichment claims were completely preempted by ERISA, the Court had subject matter jurisdiction over the action under 28 U.S.C. § 1331, and therefore removal was proper under 28 U.S.C. § 1441(a).
    Smilow and Katz v. Anthem Life & Disability Ins. Co.

  • U.S. District Court holds surgery centers are not health care providers covered under Pennsylvania’s AKS but certifies interlocutory appeal
    The U.S. District Court for the Eastern District of Pennsylvania holds that Surgery Center Defendants are not Health Care Providers under Pennsylvania’s AKS but Certified the Issue for Interlocutory Appeal to the United States Court of Appeals for the Third Circuit.
    Aetna Life Ins. Co. v. Huntingdon Valley Surgery Ctr.

  • Southern District of Florida remands contract and sequestration-based reimbursement dispute to state court for lack of subject matter jurisdiction, rejecting health insurers’ claims of removal based on federal officer and federal question grounds
    The U.S. District Court for the Southern District of Florida remanded a contract and sequestration-based reimbursement dispute back to state court, rejecting health insurers’ arguments that they were acting on behalf of the federal government in administering the FEHBA and Medicare program, and rejecting the insurers’ claims that the proper application and effect of sequestration on Medicare Advantage contracts were federal questions warranting removal.
    Baptist Hosp. of Miami, Inc. v. Humana Health Ins. Co. of Florida, Inc.

  • District Court in California determines that insured’s claims for invasion of privacy and unfair business practices not preempted by ERISA
    The U.S. District Court for the Eastern District of California remanded plaintiff insured’s action to California Superior Court. The court found that causes of action for privacy and unfair business practices in violation of California law were not preempted by ERISA.
    Rose v. Healthcomp, Inc.

[back to archive top]


November 2015 Managed Care Lawsuit Watch [full version]


[back to archive top]


June 2015 Managed Care Lawsuit Watch [full version]


[back to archive top]


March 2015 Managed Care Lawsuit Watch [full version]


[back to archive top]


October 2014 Managed Care Lawsuit Watch [full version]


[back to archive top]


July 2014 Managed Care Lawsuit Watch [full version]


[back to archive top]


April 2014 Managed Care Lawsuit Watch [full version]


[back to archive top]


February 2014 Managed Care Lawsuit Watch [full version]


[back to archive top]


October 2013 Managed Care Lawsuit Watch [full version]


[back to archive top]


July 2013 Managed Care Lawsuit Watch [full version]


[back to archive top]


May 2013 Managed Care Lawsuit Watch [full version]


  • Because a Michigan law banning most-favored-nation contract clauses renders the case unnecessary, the U.S. Department of Justice, State of Michigan, and Blue Cross Blue Shield of Michigan jointly ask Michigan federal court to dismiss an ongoing lawsuit.
    United States v. Blue Cross Blue Shield of Michigan

  • Supreme Court resolves Circuit split, holding that when an ERISA plan brings equitable action under § 502(a)(3) to enforce an equitable lien by agreement, equitable defenses cannot be asserted if they conflict with the terms of the plan.
    U.S. Airways, Inc. v. McCutchen

  • U.S. District Court denies motion to dismiss False Claims Act allegations.
    U.S., ex rel. Upton v. Family Health Network, Inc.

  • U.S. District Court denied Plaintiff's motion for summary judgment and granted summary judgment in favor of PacifiCare, finding that a California statute mandating an offer of coverage for prosthetic devices permits health plans to categorically exclude certain types of prosthetic devices.
    Garcia v. Pacificare of California, Inc.

  • The Circuit Court of Jackson County, MO permitted Humana to collect against plaintiff's personal injury settlement by subrogation and granted Humana's motion for summary judgment.
    Morris v. Humana Health Plan, Inc.

  • The First Circuit ruled against Pfizer in three separate cases involving claims that fraudulent marketing of Neurontin by Pfizer caused third-party payors financial harm.
    In re Neurontin Marketing and Sales Practices Litigation

  • U.S. District Court denied a health plan's motion for summary judgment that was based on an argument that an Independent Review Organization's claim denial review is an arbitration.
    Yox v. Providence Health Plan

  • U.S. Court of Appeals affirms a grant of summary judgment holding that an insurer could deny coverage for the medically necessary treatment provided at a nonparticipating facility.
    Brigolin v. Blue Cross Blue Shield of Michigan

  • U.S. District Court declined to grant class certification in a reimbursement suit against multiple health insurers.
    Puerto Rico College of Dental Surgeons v. Triple S Management

  • District court holds state law claims completely preempted under ERISA where coverage was denied based on medical necessity of a drug.
    S.M. v. Oxford Health Plans (NY), Inc.

  • Federal law pre-empts North Carolina's statutory presumption as applied to recovery of Medicaid expenses.
    WOS v. E.M.A.

[back to archive top]


February 2013 Managed Care Lawsuit Watch [full version]


[back to archive top]


December 2012 Managed Care Lawsuit Watch [full version]


[back to archive top]


July 2012 Managed Care Lawsuit Watch [full version]


[back to archive top]


April 2012 Managed Care Lawsuit Watch [full version]


[back to archive top]


October 2011 Managed Care Lawsuit Watch [full version]


[back to archive top]


July 2011 Managed Care Lawsuit Watch [full version]


[back to archive top]


May 2011 Managed Care Lawsuit Watch [full version]


[back to archive top]


March 2011 Managed Care Lawsuit Watch [full version]


[back to archive top]


February 2011 Managed Care Lawsuit Watch [full version]


[back to archive top]


December 2010 Managed Care Lawsuit Watch [full version]


[back to archive top]


September 2010 Managed Care Lawsuit Watch [full version]


[back to archive top]


August 2010 Managed Care Lawsuit Watch [full version]


[back to archive top]


May 2010 Managed Care Lawsuit Watch [full version]


[back to archive top]


March 2010 Managed Care Lawsuit Watch [full version]


[back to archive top]


February 2010 Managed Care Lawsuit Watch [full version]


[back to archive top]


December 2009 Managed Care Lawsuit Watch [full version]


[back to archive top]


November 2009 Managed Care Lawsuit Watch [full version]


[back to archive top]


October 2009 Managed Care Lawsuit Watch [full version]


[back to archive top]


September 2009 Managed Care Lawsuit Watch [full version]


[back to archive top]


August 2009 Managed Care Lawsuit Watch [full version]


[back to archive top]


July 2009 Managed Care Lawsuit Watch [full version]


[back to archive top]


March 2009 Managed Care Lawsuit Watch [full version]


[back to archive top]


January 2009 Managed Care Lawsuit Watch [full version]


[back to archive top]


December 2008 Managed Care Lawsuit Watch [full version]


[back to archive top]


November 2008 Managed Care Lawsuit Watch [full version]


[back to archive top]


September 2008 Managed Care Lawsuit Watch [full version]


[back to archive top]


July 2008 Managed Care Lawsuit Watch [full version]


[back to archive top]


June 2008 Managed Care Lawsuit Watch [full version]


[back to archive top]


May 2008 Managed Care Lawsuit Watch [full version]


[back to archive top]


February 2008 Managed Care Lawsuit Watch [full version]


[back to archive top]


January 2008 Managed Care Lawsuit Watch [full version]


[back to archive top]


June 2007 Managed Care Lawsuit Watch [full version]


[back to archive top]


May 2007 Managed Care Lawsuit Watch [full version]


[back to archive top]


April 2007 Managed Care Lawsuit Watch [full version]


[back to archive top]


March 2007 Managed Care Lawsuit Watch [full version]


[back to archive top]


February 2007 Managed Care Lawsuit Watch [full version]


[back to archive top]


January 2007 Managed Care Lawsuit Watch [full version]


[back to archive top]


December 2006 Managed Care Lawsuit Watch [full version]


[back to archive top]


November 2006 Managed Care Lawsuit Watch [full version]


[back to archive top]


September/October 2006 Managed Care Lawsuit Watch [full version]


[back to archive top]


July/August 2006 Managed Care Lawsuit Watch [full version]


[back to archive top]


June 2006 Managed Care Lawsuit Watch [full version]


[back to archive top]


May 2006 Managed Care Lawsuit Watch [full version]


[back to archive top]


April 2006 Managed Care Lawsuit Watch [full version]


[back to archive top]


March 2006 Managed Care Lawsuit Watch [full version]


[back to archive top]


February 2006 Managed Care Lawsuit Watch [full version]


  • Beard v. Benicorp Insurance Co.
    The District Court for the Western District of Tennessee determined that the Employee Retirement Income Security Act ("ERISA") preempts a Tennessee common law requirement that an insurer provide notice of the nonpayment of the insurance premium by the insured's employer. more...

  • CareFirst of Maryland, Inc. v. First Care, P.C.
    The Fourth Circuit affirmed a district court's grant of summary judgment for First Care, P.C., ("First Care") a physician group, which was the defendant in a trademark infringement action brought by CareFirst of Maryland ("CareFirst"). more...

  • In re Managed Care Litigation
    Judge Moreno of the U.S. District Court for the Southern District of Florida gave final approval to a proposed settlement involving WellPoint, Inc. ("WellPoint") that would resolve the claims against WellPoint in the national class actions filed by over 700,000 physicians against the nation's major managed care companies. more...

  • New York Insurance Department Fines CIGNA
    CIGNA Healthcare of New York, Inc. ("CIGNA") was fined $150,000 by the New York Superintendent of Insurance (the "Department") for allegedly neglecting to respond to consumer complaints in a timely fashion. more...

  • Knieriem v. Group Health Plan
    The court of appeals for the Eighth Circuit affirmed the dismissal of a plan participant's request for restitution for the plan's refusal to approve a stem cell transplant for the participant. more...

  • In Re: Managed Care Litigation
    On January 31, 2006, Judge Moreno of the U.S. District Court for the Southern District of Florida granted PacifiCare Health Systems, Inc.'s ("PacifiCare's") motion for summary judgment in In Re: Managed Care Litigation, MDL No. 1334, 00-1334-MD-Moreno. more...

[back to archive top]


January 2006 Managed Care Lawsuit Watch [full version]


  • Capital Blue Cross v. Commissioner
    The United States Court of Appeals for the Third Circuit found that the U.S. Tax Court erred in determining that a Blue Cross Blue Shield organization had a zero basis in cancelled subscriber contracts and thus could not claim the cancelled contracts as a loss on its tax return. more...

  • Central States Southeast and Southwest Areas Health and Welfare Fund v. Merck-Medco Managed Care, L.L.C.
    The Second Circuit Court of Appeals recently remanded a case to the U.S. District Court for the Southern District of New York in order for it to determine whether health plan beneficiaries can demonstrate sufficient injury-in-fact resultant from alleged activities of a pharmacy benefit manufacturer. more...

  • In re Hartwig v. Commissioner, Connecticut Department of Social Services
    The Connecticut Freedom of Information Commission (the "Commission") ruled that Anthem Blue Cross and Blue Shield of Connecticut, Community Health Network of Connecticut, Health Net of Connecticut and WellCare of Connecticut, each of which run Medicaid health maintenance organization ("HMOs"), are subject to the state's Freedom of Information Act ("CN-FOIA"). more...

  • Hagan v. Vision Service Plan
    The U.S. District Court for the Eastern District of Michigan granted preliminary injunctive relief to three doctors ("Plaintiffs") whom Vision Service Plan ("VSP") terminated for failing to comply with VSP's franchise affiliation requirements. more...

  • United States v. UnitedHealth Group, Inc. and PacifiCare Health Systems, Inc.
    One day after California's Department of Managed Health Care ("DMHC") and Department of Insurance ("DOI") approved the proposed merger between UnitedHealth Group, Inc. ("United") and PacifiCare Health System, Inc. ("PacifiCare"),the U.S. Department of Justice ("DOJ") entered into a consent agreement to resolve antitrust allegations relating to the proposed acquisition. more...

[back to archive top]


December 2005 Managed Care Lawsuit Watch [full version]


[back to archive top]


November 2005 Managed Care Lawsuit Watch [full version]


  • Academy of Medicine of Cincinnati v. Aetna Health Inc.
    Courts in Ohio and Kentucky have given preliminary approval to a settlement agreement between Cincinnati area physicians and Anthem Blue Cross and Blue Shield. The courts previously approved similar settlements with Humana and Aetna. more...

  • Georgia Insurance Commissioner proposes to fine United HealthCare of Georgia, Inc.
    On November 11, 2005, Georgia's Insurance Commissioner announced the scheduling of a show-cause hearing, during which United Healthcare of Georgia will have the opportunity to contest a $2.4 million fine for alleged prompt pay law violations. more...

  • In re: Managed Care Litigation
    Humana announced that it has reached an agreement to settle the national class action in which over 700,000 physicians had alleged that Humana and other major managed care companies conspired to systematically underpay the physicians. more...

  • Medical Associates Health Plan, Inc. v. CIGNA Corp.
    An Iowa federal district court determined that a health insurance company was not permitted to unilaterally terminate a group insurance contract with a health maintenance organization ("HMO") after the insurer sold a subsidiary whose employees had utilized the HMO's services. more...

  • Pagarigan v. Aetna U.S. Healthcare of California, Inc.
    The California Court of Appeals concluded that California Civil Code § 3428, concerning duties of health care service plans and managed care entities, imposes a duty of care on HMOs that contract out medical care responsibilities and coverage decisions to providers. more...

  • Viola v. California Department of Managed Care
    The California Court of Appeals ruled that the California Department of Managed Health Care (the "Department") did not violate the right of health plan participants to a civil jury trial when the Department approved health plan contracts that included mandatory binding arbitration provisions. more...

[back to archive top]


October 2005 Managed Care Lawsuit Watch [full version]


  • Ahmad v. Aetna U.S. Healthcare
    The United States District Court for the Eastern District of Pennsylvania remanded a lawsuit by a physician against Aetna U.S. Healthcare to state court because it found no basis for federal jurisdiction. more...

  • Collins v. Anthem Health Plans, Inc.
    The Connecticut Supreme Court determined that a state trial court erred in granting class certification in a complaint by physicians and physician groups against Anthem Health Plans, Inc. ("Anthem"). more...

  • Harris Methodist Fort Worth v. Sales Support Services Inc. Employee Health Care Plan
    The Fifth Circuit reversed a grant of summary judgment in favor of a self-insured employee welfare benefit plan by the District Court for the Northern District of Texas, finding that an expectant mother had sufficiently assigned her benefits claim on behalf of her twins to the admitting hospital. more...

  • In re Managed Care Litigation
    On September 26, Judge Moreno of the U.S. District Court for the Southern District of Florida gave final approval to proposed settlements involving Health Net Inc. and Prudential Financial Inc. that would resolve the claims against those companies in the national class actions filed by over 700,000 physicians against the nation's major managed care companies. more...

  • McDonald v. Household International Inc.
    The Seventh Circuit reversed a district court's dismissal of a complaint based on state law claims, holding that although the claims were preempted by ERISA, the facts alleged were sufficient to permit the case to go forward in a claim under ERISA. more...

  • Medical Staff of Doctors Medical Center in Modesto v. Kamil
    A California court held that an arbitration clause in a contract between a health insurer and a hospital employing a group of physicians did not compel the physicians to arbitrate defamation claims against the health insurer. more...

  • Minnesota v. Medica Health Plans
    The Minnesota District Court for Hennepin County dismissed a suit brought by the Minnesota Attorney General that alleged wrongdoing by the Board of Medica Health Plans ("Medica"), finding that there was no evidence that Board members acted improperly in carrying out their court-ordered responsibilities. more...

  • Nechis v. Oxford Health Plans, Inc.
    The United States Court of Appeals for the Second Circuit affirmed the dismissal of two health benefit plan participants' claims that Oxford Health Plans ("Oxford") engaged in deceptive practices in violation of ERISA. more...

  • Tow Distributing Inc. v. Blue Cross and Blue Shield of Minnesota
    A Minnesota court approved settlement of a class-action lawsuit brought by employer groups challenging the plans of Blue Cross and Blue Shield of Minnesota ("BCBSMN") to distribute the proceeds of its tobacco suit. more...

  • U.S. v. AdvancePCS
    On September 7, pharmacy benefit manager AdvancePCS reached agreement with the federal government to settle False Claims Act and Public Contract Anti-Kickback Act claims that had been brought against it on the basis of its financial relationships with pharmaceutical manufacturers and customers. more...

[back to archive top]


September 2005 Managed Care Lawsuit Watch [full version]


  • Brown v. Wiener
    The U.S. District Court for the Eastern District of Pennsylvania granted defendant Aetna's motion for judgment on the pleadings, finding that plaintiff's negligence claim was preempted under the Employee Retirement Income Security Act ("ERISA"). more...

  • Cooperstein v. Independence Blue Cross
    The U.S. District Court for the Eastern District of Pennsylvania ruled that ERISA preempted claims brought by prescription drug benefit plan insureds against their insurer and a pharmacy benefits manager ("PBM") that were alleged to have improperly refilled prescriptions through mail-order pharmacy services. more...

  • Daley v. Marriott International Inc.
    The Eighth Circuit Court of Appeals held that ERISA preempts Nebraska's mental health parity law as applied to self-funded ERISA plans. more...

  • International Union of Operating Engineers Local No. 68 Welfare Fund. v. Merck & Co.
    A New Jersey trial court granted a motion for certification of a third-party payor class in a suit against Merck for misrepresenting the safety of Vioxx. more...

  • In re Managed Care Litigation
    The District Court for the Southern District of Florida granted Defendants' motion for summary judgment on all "missing months" capitation claims in a long-running case before Judge Moreno. more...

  • Jackson, Tennessee Hosp. Co. v. West Tennessee Healthcare, Inc.
    The Sixth Circuit Court of Appeals affirmed a lower court decision holding that the allegedly anticompetitive actions of a hospital district were authorized by the plain language of a Tennessee statute. more...

  • North Jackson Pharmacy v. Caremark Rx Inc.
    The U.S. District Court for the Northern District of Illinois held that it would apply the rule of reason as opposed to the per se rule in analyzing whether the joint administration of prescription drug benefit plans by PBMs and drug plan sponsors violated Section 1 of the Sherman Act. more...

  • Smelik v. Mann
    A Texas jury awarded $7.4 million in actual damages to the family of an HMO participant who died from complications of acute renal failure. more...

  • U.S. ex rel. Garner v. Anthem Insurance Companies Inc.
    Anthem Insurance Companies ("Anthem") agreed to pay the United States $1.5 million to settle allegations that from 1992 through 2002. more...

  • U.S. ex rel. Morton
    The Tenth Circuit affirmed a district court dismissal of a qui tam action brought against an ERISA plan because the relators had failed to allege a "false or fraudulent" claim under the federal False Claims Act. more...

[back to archive top]


August 2005 Managed Care Lawsuit Watch [full version]


[back to archive top]


July 2005 Managed Care Lawsuit Watch [full version]


  • Christianson v. Poly-America Inc. Medical Benefit Plan
    The Eighth Circuit affirmed a district court decision granting summary judgment to Plaintiff on the ground that Defendant had abused its discretion in denying a claim for benefits under an employer-sponsored plan. more...

  • Cleghorn v. Blue Shield of California
    The Ninth Circuit affirmed a district court's dismissal of Plaintiff's complaint in a suit involving state-law claims for an alleged violation of an emergency services provision of the California Health and Safety Code. more...

  • Consumers Union v. New York
    The New York Court of Appeals held that Plaintiffs failed to state a viable cause of action when they challenged legislation that permitted the conversion of Empire Blue Cross and Blue Shield ("Empire"), the state insurer of last resort, from a non-profit to a for-profit corporation. more...

  • Friedman Professional Management Co. v. Blue Shield of California
    In an unpublished opinion, the California Court of Appeals ruled that a health insurer's request for declaratory relief for money held in a patient's trust account was in fact a claim for money damages for health benefits already conferred, and was thus not actionable under ERISA. more...

  • In Re Lorazepam & Clorazepate Antitrust Litigation
    On June 1, 2005, a federal jury found that generic drug manufacturer Mylan Laboratories Inc. had violated state antitrust laws, and awarded approximately $12 million in damages to four health insurers. more...

  • Torres v. Dean Health Plan, Inc.
    The Wisconsin Court of Appeals affirmed a decision by the lower court dismissing an action Plaintiff brought against her HMO for exercising subrogation rights under Wisconsin statutory law. more...

  • United States v. Capital Group Health Services of Florida, Inc.
    In a qui tam action that alleged a scheme between a hospital, an HMO and a psychiatrist for submission of false claims under the Medicare and Medicaid programs, a federal district court dismissed the action as against the hospital and the HMO, but denied a motion to dismiss the action as against the psychiatrist. more...

  • Zoblotsky v. Tenet Choices, Inc.
    A federal district court refused to dismiss a state-law negligence claim alleging that a health insurer's decision to only provide coverage for a generic form of a drug required an enrollee to change medications and suffer "significant clinical problems" and physical debilitation. more...

[back to archive top]


June 2005 Managed Care Lawsuit Watch [full version]


[back to archive top]


May 2005 Managed Care Lawsuit Watch [full version]


  • Boales v. Blue Shield of California
    The Court of Appeals of the State of California, Second Appellate District, affirmed the lower court's decision dismissing a complaint brought by Michael Boales and Alice Marion La Rue-Boales against Blue Shield of California, Health Net of California, Inc., and Health Net, Inc. and several health care providers. more...

  • Chatham Surgicare Ltd. v. Health Care Service Corp.
    The Illinois Appeals Court held that the circuit court erred in dismissing a medical service corporation's promissory estoppel claim against Health Care Services Corporation, but affirmed the lower court's dismissal of a fraud claim. more...

  • Illinois Health Maintenance Guaranty Association v. Shapo
    The Illinois Appeals Court upheld the decisions of a trial court and the Director of the Illinois Department of Insurance (the "Department") awarding $22 million to health care providers for services rendered to participants of the now insolvent MedCare HMO. more...

  • In the Matter of UAHC Health Plan of Tennessee, Inc.
    The Commissioner for the Department of Commerce and Insurance has determined that there are sufficient grounds for imposing administrative supervision on UAHC Health Plan of Tennessee. more...

  • In the Matter of: Inquiry into the Charitable Obligations of GHMSI/CareFirst in the District of Columbia
    Commissioner Mirel of the District of Columbia Department of Insurance, Securities and Banking ("DISB") issued a report addressing the alleged charitable obligations of Group Hospitalization and Medical Services, Inc. ("GHMSI"), the Blue Cross Blue Shield plan for the Washington, D.C. area. more...

  • J.E. Pierce Apothecary Inc. v. Harvard Pilgrim Health Care Inc.
    The U.S. District Court for the District of Massachusetts ruled that an HMO and a pharmacy operator violated the state's Any Willing Provider ("AWP") law and the state's unfair trade practices / consumer protection statute (MGL ch. 93A) by renegotiating an agreement that would keep the pharmacy operator's wholly-owned PBM as the HMO's dominant drug supplier. more...

  • Levine v. United Healthcare Corp.
    The United States Court of Appeals for the Third Circuit held that ERISA § 502(a) preempts plan participants' claims that health plans violated New Jersey law by attempting to enforce subrogation and reimbursement liens. more...

  • Parnell v. Adventist Health System/West
    The California Supreme Court held that a hospital seeking to assert a lien under the state's Hospital Lien Act ("HLA") can only do so if the patient owes an underlying debt to the hospital. more...

  • State Farm Mutual Auto. Ins. Co. v. Mallela
    The New York Court of Appeals held that under New York's no fault insurance laws, an insurance company may refuse to pay a fraudulently incorporated medical services corporation for a claim assigned to the corporation by an insured. more...

[back to archive top]


April 2005 Managed Care Lawsuit Watch [full version]


  • Abraham v. Intermountain Health Care Inc.
    A group of optometrists brought an action in the District Court of Utah against Intermountain Health Care ("IHC") alleging illegal tying arrangements, an illegal group boycott, and a conspiracy or attempt to monopolize the hospital and surgical facilities market. more...

  • CareFirst of Maryland, Inc. v. First Care, P.C.
    The District Court for the Eastern District of Virginia granted summary judgment for First Care, P.C., a physician group, which was the Defendant in a trademark infringement action brought by CareFirst of Maryland. more...

  • Geddes v. United Staffing Alliance Employee Medical Plan
    The United States District Court for the District of Utah held that an ERISA plan fiduciary unreasonably interpreted the plan's provision to pay the "usual and customary amount" for services from out-of-network providers to mean that the plan would only pay an out-of-network provider the same discounted amount it had contractually arranged to pay in-network providers. more...

  • Maine Coast Memorial Hospital v. Sargent
    The U.S. District Court for the District of Maine held that ERISA preempted state law claims brought by a health plan participant against her employer, Wal-Mart Stores Inc., for allegedly unpaid medical bills. more...

  • In re Preferred Health Services, Inc.
    The FTC announced a proposed consent order with Preferred Health Services, Inc., an organization consisting of over 100 physicians and a hospital in the Seneca, South Carolina area, to settle charges that Preferred Health had orchestrated agreements among its member physicians to fix the prices charged to health plans and other payors. more...

  • Tourdot v. Rockford Health Plans Inc.
    The U.S. District Court for the Western District of Wisconsin granted summary judgment for Defendant Rockford Health Plans, Inc., in a suit for benefits brought under ERISA. Plaintiff Tourdot brought suit after the plan denied him coverage for medical costs incurred following an accident between Tourdot's motorcycle and an automobile. more...

  • Trustees of the Southern Illinois Carpenters Welfare Fund v. RFMS Inc.
    The Seventh Circuit affirmed the district court's ruling that a beneficiary's ERISA-governed employer-sponsored health plan ("RFMS' health plan") explicitly limited payments to $1,000 and is not liable for the participant's $160,000 medical expenses. more...

  • U.S. ex rel. Jiminez v. Health Net, Inc.
    The Tenth Circuit dismissed Plaintiff's appeal of its qui tam action for lack of prosecution sua sponte. more...

[back to archive top]


March 2005 Managed Care Lawsuit Watch [full version]


  • Bruun v. Prudential Health Care Plan, Inc.
    On an appeal from a Rule 12(b)(6) dismissal by the District Court of New Jersey, the Third Circuit considered two issues: (1) whether the HMO Act, 42 U.S.C. § 300e, allows an HMO to subrogate recoveries from third parties, and (2) whether Defendant-Appellee Prudential Health Care Plan ("PruCare") was entitled to reimbursement of the reasonable cash value of benefits in lieu of actual costs paid. more...

  • In re Managed Care Litigation
    The District Court for the Southern District of Florida has ordered that, based on the factors set forth in Fed. R. Civ. P. 42, the trial be bifurcated into a liability phase followed, if necessary, by determination of individualized damages to be tried to the same jury. more...

  • Kotler v. PacifiCare of California
    The Second Appellate District of the Court of Appeals of California reversed a district court's ruling in favor of PacifiCare, saying that the HMO unreasonably delayed the referral of a member to a specialty physician, breaching its obligation to provide medical services on a timely basis. more...

  • Reuben-Schneiderman v. Merit Behavioral Care Corp.
    In an unpublished opinion, the Second Circuit affirmed a lower court's determination that ERISA preempted a state negligence claim brought by a participant in a preferred provider organization ("PPO") against a company providing utilization review services to the PPO. more...

[back to archive top]


February 2005 Managed Care Lawsuit Watch [full version]


  • Empire Healthchoice Assurance Inc. v. McVeigh
    The Second Circuit Court of Appeals, in a 2-1 decision, ruled that a Federal Employees Health Benefit Act ("FEHBA") -governed health plan administrator cannot sue a beneficiary's estate in federal court under a subrogation provision. more...

  • In re Evanston Northwestern Healthcare Corporation and ENH Medical Group, Inc.
    The Federal Trade Commission ("FTC" or "Commission") withdrew Count III of its complaint filed against Evanston Northwestern Healthcare Corporation ("ENH"), which alleged price-fixing of physicians services in managed care contracts. more...

  • RenCare, Ltd. V. Humana Health Plan of Texas, Inc.
    The Fifth Circuit found that because RenCare's claims against Humana were not inextricably intertwined with a claim for Medicare benefits and because there were no administrative appeals for RenCare to pursue, the district court erred in its partial denial of RenCare's motion to remand its claims to state court and its dismissal of RenCare's claims. more...

  • Rome Ambulatory Surgical Center, LLC v. Rome Memorial Hospital, Inc.
    The case arose when Rome Ambulatory Surgical Center ("RASC") brought an action against Rome Memorial Hospital ("Hospital") and its corporate parent, Greater Affiliates, Inc., alleging violations of Sections 1 and 2 of the Sherman Act and state law claims, including tortious interference with business relations and intentional interference with contractual relations. more...

  • UnitedHealth Group Inc. v. Klay
    In the latest chapter of the ongoing managed care litigation involving federal and state law claims brought by a class of thousands of doctors against major health maintenance organizations, the United States Supreme Court declined to review the September 1, 2004 decision by the 11th Circuit Court of Appeals to allow the physicians to pursue their federal RICO claims as a class. more...

[back to archive top]


January 2005 Managed Care Lawsuit Watch [full version]


[back to archive top]


December 2004 Managed Care Lawsuit Watch [full version]


[back to archive top]


November 2004 Managed Care Lawsuit Watch [full version]


[back to archive top]


October 2004 Managed Care Lawsuit Watch [full version]


  • Cicio v. Does
    Reviewing its February 2003 Cicio v. Vytra decision in light of the U.S. Supreme Court's recent decision in Aetna Health Inc. v. Davila, the Second Circuit Court of Appeals vacated its earlier decision and affirmed the district court's dismissal of a state law medical malpractice claim as preempted by ERISA. more...

  • Connecticut v. Health Net, Inc. (In re Managed Care Litigation)
    In what the Eleventh Circuit described as an issue of first impression, it held that Connecticut had no standing to pursue the ERISA claims of its citizens in its capacity as assignee, because Connecticut failed to show that it had or would suffer actual or imminent harm to a legally protected interest. more...

  • Land v. CIGNA Healthcare of Florida
    The Eleventh Circuit reviewed its July 2003 Land v. CignaHealthcare of Florida decision, which the U.S. Supreme Court had vacated and remanded for consideration in light of Aetna Health Inc. v. Davila, and determined that the Land plaintiff's state law malpractice claims were preempted by ERISA. more...

  • Smith v. United Health Care Services, Inc.
    A federal judge accepted a settlement between UnitedHealth Group and two named plaintiffs in a class action that alleged the company over-billed beneficiaries for their prescription drugs. more...

[back to archive top]


September 2004 Managed Care Lawsuit Watch [full version]


  • Aetna and American Dental Association Settlement (In re Managed Care Litigation)
    A federal judge in the U.S. District Court for the Southern District of Florida gave final approval to an agreement between Aetna and the American Dental Association ("ADA"), settling a class action lawsuit brought by 147,000 dentists against Aetna in 2001 for alleged underpayment of patients' out-of-network dental services. more...

  • Community General Hospital Inc. v. Zebrowski
    The United States District Court for the Northern District of New York held that the Employee Retirement Income Security Act ("ERISA") preempted claims against a third party administrator ("TPA") for breach of contract, bad faith processing of a claim, and infliction of emotional distress. Zebrowski, a beneficiary of a plan provided by Lockheed Martin for its employees, commenced an action pro se against the plan's TPA after himself being sued by Community General Hospital in a collection action. more...

  • Klay v. Humana, Inc. (In re Managed Care Litigation)
    In the latest chapter of the ongoing managed care litigation involving federal and state law claims brought by thousands of doctors against major health maintenance organizations, the U.S. Court of Appeals for the 11th Circuit affirmed the District Court of the Southern District of Florida's grant of class certification for the plaintiff's federal RICO claims. more...

  • State Farm Mutual Automobile Insurance Co. v. Blue Cross Blue Shield of Louisiana
    A Louisiana District Judge held that a hospital violated Louisiana's Health Care Consumer Billing and Disclosure Protection Act by filing a lien against an insured patient, seeking to recover payment from the patient in excess of the hospital's contracted reimbursement rate with the patient's health insurer. more...

  • Wachtel v. Guardian Life Ins. Co.
    A lawsuit brought by participants of a Health Net of New Jersey, Inc. point-of-service (POS) plan alleging a breach of fiduciary duty was certified as a class action by the federal judge hearing the case. Original defendant Guardian Life Ins. Co. was dropped from the case. more...

[back to archive top]


August 2004 Managed Care Lawsuit Watch [full version]


  • Carter v. Health Net of California Inc.
    The U.S. Court of Appeals for the Ninth Circuit held that a district court did not have subject matter jurisdiction over a health plan enrollee's petition to confirm an arbitrator's award of plan benefits or the health plan administrator's petition to challenge the award, as neither petition presented a federal question. more...

  • Peninsula Regional Medical Center v. Mid Atlantic Medical Services LLC
    The U.S. District Court for the District of Maryland held that a hospital's lawsuit, which alleged that health insurers had violated contractual agreements by failing to promptly pay for services rendered to the insurers' subscribers, was not preempted by ERISA and was improperly removed by the insurers to federal court. more...

  • Johns Hopkins Hospital v. Carefirst of Maryland, Inc.
    In a case that presented an identical question as Peninsula Regional Medical Center and that was decided on the same day, the U.S. District Court for the District of Maryland held that a contracting hospital's state law contract claims against a health insurer were not removable to federal court. more...

[back to archive top]


July 2004 Managed Care Lawsuit Watch [full version]


[back to archive top]


June 2004 Managed Care Lawsuit Watch [full version]


  • American Chiropractic Assoc., Inc. v. Trigon Healthcare, Inc.
    Affirming the 2003 decision made by the U.S. District Court for the Western District of Virginia, the Fourth Circuit held that Trigon Healthcare, its affiliated companies, medical doctors and medical associations had not participated in an "anticompetitive conspiracy" and were not in violation of state and federal antitrust laws and the Racketeer Influenced and Corrupt Organizations Act ("RICO"). more...

  • Chambers v. Coventry Health Care of Louisiana, Inc.
    The U.S. District Court for the Eastern District of Louisiana issued an injunction, ordering Coventry, an HMO, to cover a PET fusion scan for Chambers, a 62-year old colon cancer patient, after his physician requested authorization for such procedure. more...

  • QualChoice Inc. v. Rowland
    The U.S. Court of Appeals for the Sixth Circuit dismissed for lack of subject matter jurisdiction an action by a health plan administrator against a beneficiary for reimbursement of medical payments. more...

  • Rizzo v. Bankers Life & Casualty Company
    State law unjust enrichment claims brought by a beneficiary of a collectively bargained health plan against his insurer based on payments the insurer received from the third-party tortfeasor are pre-empted by ERISA. more...

  • Vista Health Plan Inc. v. Texas Health and Human Services Commission
    Vista Health Plan brought suit against the Texas Department of Health in an attempt to hold the agency responsible for the allegedly inadequate reimbursement rates that Vista received pursuant to its contract with HMO Blue. more...

[back to archive top]


May 2004 Managed Care Lawsuit Watch [full version]


  • Artandi v. Buzack
    In a suit by a physician against a plan sponsor, four plan participants, and a third party administrator ("TPA") seeking approximately $100,000 in unpaid medical claims, the U.S. District Court for the Southern District of New York dismissed the claim against the TPA. more...

  • Klay v. Humana Inc. (In re Managed Care Litigation)
    The only appeals challenging CIGNA HealthCare's $550 million settlement of a national class action brought by 700,000 physicians have been dismissed, clearing the way for the terms of the settlement agreement to be implemented. more...

  • Watters v. The Wellness Plan; Cox v. Michigan Health Maintenance Organization Plans, Inc.
    The State of Michigan Insurance Commissioner, Linda Watters, filed two petitions seeking state approval of asset sales of two HMOs—The Wellness Plan and Omnicare. more...

  • York v. Ramsay Youth Services of Dothan
    The U.S. District Court for the Middle District of Alabama ruled that a state court lawsuit alleging fraud, negligence and intentional or reckless infliction of emotional distress brought by plaintiffs who had health insurance through their employment by the defendant was preempted by ERISA. more...

[back to archive top]


April 2004 Managed Care Lawsuit Watch [full version]


  • Aetna Life Insurance Co. v. DFW Sleep Diagnostics Center
    In a lawsuit filed by Aetna and a countersuit filed by DFW Sleep Diagnostics Center ("DFW") over a billing dispute, the court ruled that Aetna was obligated to turn over documents detailing performance guarantees it made to sponsors of ERISA benefit plans. more...

  • Carey v. Connecticut General Life Insurance Co.
    A judge in the District of Minnesota ruled that a denial of coverage for treatment for a plan participant's autistic son occurred when a health plan administrator called the participant, not when the HMO sent written notice of the same several months later. more...

  • Crawley v. Oxford Health Plans
    Plaintiff alleged that his health plan wrongfully terminated coverage for failure to pay a premium, and filed suit in state court. more...

  • Heaser v. Blue Cross and Blue Shield of Minnesota
    The U.S. District Court for the District of Minnesota held that the ERISA preempts state claims relating to a plan administrator's denial of benefits. more...

  • Patient Advocates LLC v. Prysunka
    The U.S. District Court for the District of Maine concluded that health claims data that are not held in trust and have not been proven to have economic value are not "plan assets." more...

  • Providence Health Plan v. McDowell
    The Ninth Circuit heard appeals of two actions in which Providence sought to recover benefits it paid to its insureds; action I for breach of contract, filed in state court, and action II for equitable relief under ERISA, filed in federal court. more...

[back to archive top]


March 2004 Managed Care Lawsuit Watch [full version]


  • Kroning v. Resurrection Health Care
    The Northern District of Illinois granted summary judgment in favor of Resurrection Health Care, a plan sponsor, on the grounds that the plaintiff had not exhausted administrative remedies prior to filing suit in which she alleged that Resurrection's claims administrator for mental health claims, Accord Behavioral Health, denied pre-certification for her son's treatment. more...

  • N.C. Medical Society v. BlueCross and BlueShield of North Carolina
    The North Carolina Medical Society ("NCMS") filed a lawsuit against BlueCross and BlueShield of North Carolina in state court in Raleigh, alleging that the defendant HMO intentionally engages in unfair and deceptive trade practices, and seeking injunctive relief to force the HMO to change its business practices. more...

[back to archive top]


February 2004 Managed Care Lawsuit Watch [full version]


  • Adler v. Unicare Life & Health Insurance Co.
    The U.S. District Court for the Southern District of New York concluded that state contract law claims against a health insurance company were preempted because the plans at issue were employee benefit plans governed by the Employee Retirement Income and Security Act (ERISA). more...

  • Arana v. Ochsner Health Plan
    The United States Supreme Court denied certiorari, leaving in place the Fifth Circuit's July 2003 ruling that ERISA preempts a plan beneficiary's claims that attempts by the plan administrator to recover amounts received by the beneficiary as settlement for personal injuries were impermissible under Louisiana law. more...

  • Baylor Univ. Medical Center v. Arkansas Blue Cross Blue Shield
    The District Court for the Northern District of Texas held that ERISA does not preempt a medical center's claim that an HMO violated state prompt pay laws when it failed to pay the medical center for a subscriber's medical bills. more...

  • Saint Agnes Medical Center v. Pacificare of California, et al
    The California Supreme Court ruled that PacifiCare could invoke the arbitration clause of a health services agreement, even though it had argued in a connected lawsuit that the health service agreement in question was invalid and should not be enforced. more...

[back to archive top]


January 2004 Managed Care Lawsuit Watch [full version]


  • Academy of Medicine v. Aetna
    On December 29, 2003, judges from Ohio and Kentucky presided jointly over a hearing on a settlement between Humana Inc. and Cincinnati area physicians. more...

  • In re CIGNA Healthcare of Maine, Inc., and CIGNA Behavioral Health, Inc.
    CIGNA Healthcare of Maine, Inc., and its subsidiary, CIGNA Behavioral Health, Inc., will pay over $2 million in fines and restitution under a Consent Agreement with the Maine Bureau of Insurance and Department of the Attorney General. more...

  • In re Managed Care Litigation
    Judge Moreno denied most parts of a motion brought by managed care companies seeking the dismissal of RICO and other claims against them by more than 700,000 doctors. more...

  • In the Matter of LymeCare, Inc., and Neuner v. Horizon Blue Cross Blue Shield
    The Bankruptcy Court for the District of New Jersey ruled that a provider specializing in the treatment of Lyme's Disease that was assigned benefits by Horizon Blue Cross and Blue Shield ("Horizon") subscribers had standing under ERISA to bring a claim for reimbursement against the health plan for services that it provided to subscribers while it was a participating provider. more...

  • Singh v. Prudential Health Care Plan, Inc.
    The Supreme Court left standing the Fourth Circuit's July 2003 ruling that a state law action seeking restitution for money that a plaintiff paid to comply with defendant HMO's subrogation clause was completely preempted by ERISA because it involved a claim that sought return of benefits under the plaintiff's plan. more...

[back to archive top]


November 2003 Managed Care Lawsuit Watch [full version]


[back to archive top]


October 2003 Managed Care Lawsuit Watch [full version]


[back to archive top]


September 2003 Managed Care Lawsuit Watch [full version]


  • Aetna and American Dental Association Settlement
    Aetna and the American Dental Association announced that they had settled a class action lawsuit brought by 147,000 dentists against Aetna in 2001 for alleged underpayment of patients' out-of-network dental services. more...

  • Blue Cross and Blue Shield of Kansas v. Praeger
    The Kansas Supreme Court upheld the Kansas Insurance Commissioner's decision to block the merger of Blue Cross and Blue Shield of Kansas with Indianapolis-based Anthem, Inc. more...

  • Lefler v. United Healthcare of Utah, Inc.
    The 10th Circuit Court of Appeals upheld a district court's ruling in favor of United HealthCare of Utah in a class action lawsuit brought by some of its insureds. more...

  • U.S. v. Baldwin, et al.
    The U.S. District Court for the District of Columbia denied a motion to dismiss a health care fraud claim, declining to agree with defendants' argument that 18 U.S.C. § 1347 did not apply to fraud against a nonprofit HMO. more...

  • Wheeler, et al. v. Aetna Life Insurance Co.
    The District Court for the Northern District of Illinois denied defendant-Aetna's motion for summary judgment, finding the company's decision to deny benefits for physical, occupational, speech, and other therapies arbitrary and capricious. more...


[back to archive top]


August 2003 Managed Care Lawsuit Watch [full version]


  • Abbott v. Blue Cross and Blue Shield of Texas, et al.
    The Texas Court of Appeals ruled against the state's Attorney General finding that Blue Cross Blue Shield of Texas was not a charitable organization prior to its merger with Health Care Service Corporation in 1998. more...

  • Arana v. Ochsner Health Plan
    The Fifth Circuit, in a rehearing en banc, held that only complete preemption of a claim under ERISA § 502(a) is required for removal, and that conflict preemption under ERISA §514 is not also required. more...

  • Land v. Cigna
    The Eleventh Circuit held that Land's state law malpractice claim against its HMO was not preempted by ERISA. Land suffered injuries from an animal bite and was treated by an ER doctor and his primary care physician before seeking additional care from a Cigna-approval nurse. more...

  • Singh v. Prudential Health Care Plan, Inc.
    The Fourth Circuit held that the plaintiff's state law action seeking restitution for money she paid to comply with defendant HMO's subrogation clause was completely preempted by ERISA because it involved a claim that sought return of benefits under the plaintiff's plan. more...

  • Vytra Healthcare v. Cicio
    Vytra Healthcare filed a petition for review with the Supreme Court seeking the Court to reject a February decision of the U.S. Court of Appeals for the Second Circuit that allowed Cicio to bring medical malpractice claims on behalf of herself and her deceased husband. more...


[back to archive top]


July 2003 Managed Care Lawsuit Watch [full version]


  • Care Choices HMO v. Engstrom
    The Sixth Circuit Court of Appeals ruled that there is no federal cause of action for Medicare HMOs seeking reimbursement for benefits paid to an insured who also receives benefits from another source of insurance. more...

  • Horvath v. Keystone Health Plan East, Inc.
    The Third Circuit upheld a district court's decision that Keystone Health Plan East, Inc., a Pennsylvania HMO, had no fiduciary obligation under ERISA to disclose its physician compensation scheme to a subscriber. more...

  • International Healthcare Management v. Hawaii Coalition for Health
    The Ninth Circuit upheld a district court decision that activity by physician and consumer advocacy groups to influence the terms of an HMO's participating provider agreement ("PPA") did not violate federal antitrust laws. more...

  • Nordella v. Blue Cross of California
    Plaintiff Nordella, a California physician, filed a suit against Blue Cross of California, alleging that Blue Cross terminated him as a participating provider in retaliation for his refusal to accept the company's medical coverage policies. more...

  • United States ex rel. Willard v. Humana Health Plan of Texas, Inc.
    The Fifth Circuit upheld a district court's dismissal of a qui tam action against Humana Health Plan of Texas. The action had alleged that Humana had violated the federal False Claims Act by discouraging less healthy patients from joining Humana's Medicare+Choice plan. more...


[back to archive top]

Crowell & Moring LLP - All Rights Reserved
This material was prepared by Crowell & Moring attorneys. It is made available on the Crowell & Moring website for information purposes only, and should not be relied upon to resolve specific legal questions.