Justia Health Law Opinion Summaries

Articles Posted in North Carolina Supreme Court
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In this case concerning civil liability based on insurer conduct affecting chiropractic services, the Supreme Court affirmed the order of the trial court dismissing all claims in this case, relying on and incorporating its reasoning in a companion case, Sykes v. Health Network Solutions, Inc., __ S.E.2d __ (N.C. 2019)(Sykes I), in holding that the decision in Sykes I met the criteria for collateral estoppel. This case was one of two putative class actions alleging that defendant insurers contracted with Health Network Solutions, Inc. (HNS) to provide or restrict insured chiropractic services in violation of state insurance and antitrust laws. Plaintiffs chose to bring this action against insurers separately from their claims against against HNS and its individual owners in Sykes I, but both actions presented essentially the same claims and relied on the same theories. The trial court dismissed Plaintiffs' claims in this case. The Supreme Court affirmed, holding that collateral estoppel barred Plaintiffs from litigating these matters given the Court's resolution of the issues in Sykes I. View "Sykes v. Blue Cross & Blue Shield of North Carolina" on Justia Law

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The Supreme Court affirmed the Business Court's dismissal of Plaintiffs' claims against Defendants Health Network Solutions, Inc. (HNS) and HNS's individual owners alleging that HNS committed antitrust and other violations in its role as intermediary between individual chiropractors and several insurance companies and third-party administrators, holding that the Business Court did not err in dismissing Plaintiffs' entire complaint. Plaintiffs were licensed chiropractic providers in North Carolina who alleged that Defendants engaged in unlawful price fixing resulting in a reduction of output of chiropractic services in North Carolina. The Business Court granted in part and denied in part Defendants' motions to dismiss and for partial summary judgment and then dismissed Plaintiffs' remaining claims under N.C. R. Civ. P. 12(b)(6). The Supreme Court affirmed, holding that the Business Court did not err in dismissing each of Plaintiffs' substantive claims and their derivative claims. The Business Court's dismissal of Plaintiffs' antitrust claims, including the derivative claim of civil conspiracy, stands without presidential value because the members of the Court were equally divided as to these claims. View "Sykes v. Health Network Solutions, Inc." on Justia Law

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The Supreme Court reversed the decision of the court of appeals concluding that N.C. Gen. Stat. 122C-266(a) imposes a statutory mandate that automatically preserves violation of that subsection for appellate review regardless of a failure to object in the trial court and that Respondent was automatically entitled to relief without having to demonstrate that she was prejudiced by the violation of section 122C-266(a), holding that Respondent's issue was not preserved for appellate review. Here, Respondent, who was involuntarily committed to a state health facility, did not receive an examination by a second physician, as mandated by section 122C-266(a). The court of appeals held that Respondent was not required to make a showing of prejudice resulting from the violation of the statue in order to have vacated the trial court's order authorizing her continued commitment. The Supreme Court reversed without deciding whether prejudice must be shown to obtain relief on appeal, holding (1) the alleged violation of section 122C-266(a) was not automatically preserved; and (2) Respondent failed to preserve the issue when she did not raise it during the district court hearing on her involuntary commitment. View "In re E.D." on Justia Law

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The trial court did not err in dismissing Plaintiffs’ action for lack of subject matter jurisdiction due to Plaintiffs’ failure to exhaust administrative remedies in seeking damages for denied Medicaid reimbursement claims. The court of appeals reversed the trial court’s order, ruling that the trial court erred in dismissing Plaintiffs’ complaint without resolving certain factual issues and that Plaintiffs sufficiently demonstrated that it would be futile to pursue administrative remedies. The Supreme Court reversed, holding that the court of appeals erred in reversing the dismissal of Plaintiffs’ claims where Plaintiffs failed to exhaust their administrative remedies prior to filing suit and failed to demonstrate futility of the available remedies at this time. View "Abrons Family Practice & Urgent Care, PA v. North Carolina Department of Human Services" on Justia Law

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The trial court did not err in dismissing Plaintiffs’ action for lack of subject matter jurisdiction due to Plaintiffs’ failure to exhaust administrative remedies in seeking damages for denied Medicaid reimbursement claims. The court of appeals reversed the trial court’s order, ruling that the trial court erred in dismissing Plaintiffs’ complaint without resolving certain factual issues and that Plaintiffs sufficiently demonstrated that it would be futile to pursue administrative remedies. The Supreme Court reversed, holding that the court of appeals erred in reversing the dismissal of Plaintiffs’ claims where Plaintiffs failed to exhaust their administrative remedies prior to filing suit and failed to demonstrate futility of the available remedies at this time. View "Abrons Family Practice & Urgent Care, PA v. North Carolina Department of Human Services" on Justia Law

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Plaintiff, medical center, sued Defendant, former patient, seeking to recover the value of medical services Plaintiff provided Defendant while he was admitted to its medical center. Plaintiff moved for summary judgment against Defendant in the amount of $14,419 for the medical care he had received, supporting its contention it should receive that amount by submitting several affidavits. The trial court entered summary judgment for Plaintiff on the issue of damages. The court of appeals reversed, stating that although Defendant did not contest liability, an issue of material fact remained on the amount owed. The Supreme Court reversed, holding (1) the medical center's affidavits from its employees that stated the amount of its bill and asserted the amount was reasonable were minimally sufficient of its right to payment; and (2) the patient's affidavit illustrating the differences between the retail price of, and the amount charged by the medical center for, certain medications failed to show that an issue of material fact remained for trial. View "Charlotte-Mecklenburg Hosp. Auth. v Talford" on Justia Law