Justia Class Action Opinion Summaries

Main & Associates, Inc., d/b/a Southern Springs Healthcare Facility, filed an action in the Bullock Circuit Court, on behalf of itself and a putative class of Alabama nursing homes, against Blue Cross and Blue Shield of Alabama (BCBS), asserting claims of breach of contract, intentional interference with business relations, negligence and/or wantonness, and unjust enrichment and seeking injunctive relief. BCBS removed the case to the the federal court, arguing among other things, that Southern Springs' claims arose under the Medicare Act and that the Medicare Act, as amended by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (the MMA) completely preempted Southern Springs' state-law claims. Southern Springs moved the federal court to remand the case to the circuit court, arguing that the federal court did not have jurisdiction over its claims. The federal court granted the motion and remanded the case to the Bullock Circuit Court. After remand, BCBS moved the circuit court for a judgment on the pleadings, arguing that Southern Springs had not exhausted its administrative remedies and that the circuit court did not have subject-matter jurisdiction over the case. The circuit court denied BCBS's motion, and BCBS petitioned the Supreme Court for a writ of mandamus to direct the circuit court to dismiss Southern Springs' claims. Upon review, the Court concluded that Southern Springs' claims were inextricably intertwined with claims for coverage and benefits under the Medicare Act and that they were subject to the Act's mandatory administrative procedures and limited judicial review. Southern Springs did not exhaust its administrative remedies, and the circuit court did not have jurisdiction over its claims. Therefore, the Court granted BCBS's petition and issue a writ of mandamus directing the circuit court to dismiss the claims against BCBS. View "Main & Associates, Inc. v. Blue Cross & Blue Shield of Alabama" on Justia Law

In 2003, the New Hampshire Department of Health and Human Services and a certified class of Medicaid-eligible children reached a settlement agreement and proposed a consent decree that outlined the Department's obligations to provide dental services to Medicaid-enrolled children in accordance with federal law. The district court approved the Decree in 2004. Between 2007 and 2010, the district court denied four motions alleging that the Department was not in compliance. The First Circuit affirmed, upholding the district court's requirement that the Class to file a motion for contempt to enforce the Decree; denial of a 2010 motion for contempt; denial of a request for an evidentiary hearing in 2010; and holding the Class to a clear and convincing burden of proof on its 2010 motion to modify or extend the Decree. View "Hawkins v. Dep't of Health & Human Servs. for the State of NH" on Justia Law

The Federal Trade Commission found that a merger between a health system and a hospital violated the Clayton Act, 15 U.S.C. 18. Plaintiffs sought treble damages and certification of a class of patients and third-party payors who allegedly paid higher prices for care. Under FRCP 23(b)(3), a class may be certified only if questions of law and fact common to members predominate over questions affecting only individuals in the class. Plaintiffs proposed to rely on economic and statistical methods used by the FTC and defendant's economic experts to analyze antitrust impact. The "difference-in-differences" method estimates price increases resulting from exercise of market power rather than from other factors. The district court denied certification, concluding that the expert had not shown that his methodology could address impact on a class-wide basis. The Seventh Circuit granted interlocutory appeal, vacated, and remanded. Although plaintiffs' expert initially believed that the health system did increase prices uniformly across all services, he acknowledged that it might not have done so, and explained how his methodology could show impact to the class despite such complications. The degree of uniformity the court demanded is not required; "it is important not to let a quest for perfect evidence become the enemy of good evidence." View "Messner v. Northshore Univ. Healthsystem" on Justia Law

Blue Cross and Blue Shield of Montana (BCBS) and New West Health Services (collectively TPAs) administered a self-funded employee healthcare benefit plan for the State's employees. Jeannette Diaz and Leah Hoffmann-Bernhardt (Plaintiffs), who were both injured in accidents, filed suit against the state, BCBS, and New West for allegedly violating their made-whole rights by failing to conduct a made-whole analysis before exercising subrogation rights. Plaintiffs moved for class certification seeking to include in the lawsuit individuals who had their benefits reduced under the State plan, as well as individuals who had their benefits reduced under policies independently issued and administered by the TPAs. The district court denied class certification and determined that Montana's made-whole laws did not apply to TPAs. The Supreme Court (1) affirmed the district court's finding that BCBS and New West, in their capacities as TPAs in the present case, were not subject to the made-whole laws under either the subrogation statutes or under a third-party beneficiary theory; and (2) reversed the district court denial of class certification, as Diaz and Hoffmann-Bernhardt demonstrated that the requirements of Mont. R. Civ. P. 23 were met. View "Diaz v. Blue Cross & Blue Shield" on Justia Law

The Taranto Group contracted with two outside vendors to send out advertising via facsimile transmissions on its behalf. It was later calculated that at least 5,000 transmissions were made in violation of the Telephone Consumer Protection Act (TCPA). A doctor brought an action individually and as a class representative against the Taranto Group, seeking damages and injunction relief under the TCPA and tort damages for conversion. A professional corporation then sought to intervene as an additional class representative. The district court issued an order certifying the proposed class and, in an amended order, certified the order for interlocutory appeal. The Supreme Court affirmed the district court's determination that class certification was appropriate in this case, holding, among other things, that the district court (1) correctly found the plaintiffs met their burden of demonstrating that they met the statutory requirements for class certification, (2) properly determined that a class action in this case was superior to individual small claims actions, and (3) properly concluded that a class action would avoid inconsistent adjudications.

Plaintiffs, representing a putative class of purchasers of contact lens solutions, appealed the district court's order granting summary judgment for defendant. Plaintiffs brought suit alleging that defendant violated California's Unfair Competition Law (UCL), Cal. Bus. & Prof. Code 17200 et seq., and False Advertising Law (FAL), Cal. Bus. & Prof. Code 17500 et seq., by marketing Complete MoisturePlus as a product that cleaned and disinfected lenses. The district court ruled that plaintiffs lacked standing. Defendant argued that the ruling was not in error and that even if it was, the suit was properly dismissed because the class' claims were preempted by 21 U.S.C. 360k(a) of the Medical Devices Amendments of 1976 (MDA), 21 U.S.C. 360(c) et seq. The court held that the district court was incorrect to conclude that this class of plaintiffs lacked standing where they had demonstrated economic harm, but the court held that it could affirm the district court's summary judgment on any ground supported by the record. Therefore, the court held that the record demonstrated that the class' claims were preempted, so the court affirmed the grant of summary judgment.

Following a 2007 train derailment and three-day fire that allegedly exposed a small Ohio town to cancer-causing agents, plaintiffs sought damages on behalf of a putative class. Plaintiffs' expert testified that the normal background level of dioxin is four parts per trillion and that the range within area homes was from 11.7 to 274 ppt. A doctor testified about increased risk of cancer. The district court granted summary judgment for the train company, finding that plaintiffs had not established general or specific causation and, as a matter of law, any increased risk of cancer or other diseases was too insignificant to warrant the court's ordering a lengthy period of medical monitoring. The Sixth Circuit affirmed, noting the absence of conclusive medical evidence that plaintiffs faced even a one-in-a-million increased risk of cancer.

Plaintiffs in these four cases appealed from a judgment of the district court granting summary judgment in favor of defendant and dismissing their product liability claims for injuries allegedly caused by defendant's prescription drug, Fosamax. Plaintiffs appealed the district court's decision concluding that their product liability claims, brought under Virginia law, were not tolled by the pendency of a putative federal class action that raised identical claims and dismissing plaintiffs' claims as time-barred. The court held that the availability of "cross jurisdictional tolling" in this context raised questions of Virginia law that were appropriately certified to the Supreme Court of Virginia.

Plaintiff filed suit against Liberty Mutual, both personally and on behalf of a putative class of similarly situated individuals, alleging that the company's failure to disburse "medical payments" coverage (MedPay) benefits to her constituted a breach of contract, a breach of implied covenant of good faith and fair dealing, and a violation of G.L.c. 93A, 2. At issue was whether a claimant could seek medical expense benefits under the MedPay of a standard Massachusetts automobile insurance policy where she had already recovered for those expenses under a separate policy of health insurance. The court held that plaintiff's complaint and the extrinsic materials submitted by Liberty Mutual contained alleged facts sufficient to "raise a right to relief above the speculative level." The court also held that Liberty Mutual had not demonstrated as a matter of law that plaintiff could not receive MedPay benefits when she already had received medical expense benefits under her policy of health insurance. Accordingly, the order allowing Liberty Mutual's motion to dismiss was reversed and the matter remanded.

This appeal involved a putative class action filed by three Pennsylvania Medicaid beneficiaries subject to the Pennsylvania Department of Public Welfare's (DPW) liens against future settlements or judgments. At issue was whether state agencies responsible for administering the Medicaid program have the authority to assert such liens and, if so, whether Pennsylvania's statutory framework was consistent with the Supreme Court's decision in Arkansas Department of Health and Human Services v. Ahlborn. The court examined the text, structure, history, and purpose of the Social Security Act, 42 U.S.C. 301 et seq., and held that liens limited to medical costs were not prohibited by the anti-lien and anti-recovery provisions of the Act, 42 U.S.C. 1396p(a)-(b). Accordingly, the court upheld Pennsylvania's longstanding practice of imposing such liens. The court also held that Pennsylvania's current statutory framework, which afforded Medicaid recipients a right of appeal from the default allocation, was a permissible default apportionment scheme.