Scholarly and News Articles on Health

Health and AG's: In the News

Attorney General Doug Gansler has asked the his state insurance regulators to freeze any health insurance rate increases above 5 percent.
In a recent nonbinding legal opinion Mississippi Attorney General expressed that Governor Phil Bryant does not have the authority to operate the state’s Medicaid division by executive order.
Oregon Attorney General Ellen Rosenblum has sent a letter to state lawmakers encouraging them to pass HB 3460 which would create a registry of state-licensed medical marijuana retailers. While the state is already home to an estimated 53,000 patients who can obtain medical marijuana, the established outlets are not regulated by the state.
North Carolina Attorney General Roy Cooper has urged the state legislature to pass bills urged the legislature to make hospital bills easier to understand and to control in aggressive bill-collecting practices. Cooper also wants hospitals to notify his office and the Federal Trade Commission before they acquire other hospitals or physician practices, a frequent occurrence both nationally and in North Carolina. Cooper’s proposals were incorporated into a bill that was introduced last month to require hospitals to publicly disclose their prices on their most common medical procedures.
After a federal judge struck down a Missouri law exempting moral objectors from mandatory birth control insurance coverage, state attorney general Chris Koster has asked the judge to clarify the intended scope of the decision. Koster’s office released a statement arguing that the ruling has created vague uncertainties for insurers and individuals.
The state attorneys general of Alabama, Colorado, Florida, Georgia, Idaho, Kansas, Montana, Nebraska, Ohio, Oklahoma, South Carolina, Texas and West Virginia have sent a letter to the U.S. Department of Health and Human Services asking that broaden the religious exemptions in the Patient Protection and Affordable Care Act.
The Attorneys General of forty-eight states have signed a letter prepared by the National Association of Attorneys General urging the Food and Drug Administration (FDA) to adopt design requirements for prescription pain medication. The attorneys general expressed concern of the possibility that generic versions of extended-release opioid prescription drugs and other non-tamper-resistant products may reach the market. The letter highlighted new physical and chemical features to prescription opioids that can be included in their design to deter abuse and thereby reduce misuse of the drugs and the possibility deadly consequences. 
After Florida Governor Rick Scott announced his support for temporarily expanding Medicaid, Attorney General Pam Bondi stated her opposition towards to the potential move. Scott has long been against the Affordable Care Act, also known as “Obamacare,” yet said he would be willing to try enlarging on a three-year trial period. Bondi is joined by Agriculture Commissioner Adam Putnam in opposing the idea. Select committees in the Florida House and Senate are set to meet on the issue in early March.
Maine Attorney General Janet Mills warned the public of a scam targeting Medicare recipients. Scammers have been contacting Medicare recipients claiming to be issuing new Medicare cards and asking for Medicare numbers and bank account information. Mills advised Mainers to “protect themselves by never giving any personal information to anyone over the phone," and to review their Medicare statements carefully and report any questionable calls to the Maine Attorney General Consumer Protection Hotline.
Attorneys General of 38 states announced a $90 million settlement with GlaxoSmithKline, a pharmaceuticals company, over allegations of unlawful promotion of the diabetes drug Avandia. The lawsuit alleged that GlaxoSmithKline engaged in unfair and deceptive market practices when it misrepresented the effects Avandia would have on patients’ cholesterol levels and cardiovascular health. Under the settlement GlaxoSmithKline is prohibited from: making false, misleading or deceptive claims about diabetes drugs; making safety claims not supported by substantial evidence or substantial clinical experience; presenting favorable information of drugs that have been proven invalid; promoting drugs before they have received approval from the U.S. Food and Drug Administration; or misusing statistics or otherwise misrepresenting the nature, applicability or significance of clinical trials. States included in the settlement are: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, the District of Columbia, Florida, Hawaii, Idaho, Illinois, Iowa, Kansas, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Jersey, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Tennessee, Texas, Vermont, Washington, and Wisconsin.
The Office of California Attorney General Kamala Harris, is seeking information regarding the increasing concentration of medical providers and subsequent effects.  Increased consolidation has raised the concern that the mergers of hospitals and physician groups could raise the costs of treatment. While the Patient Protection and Affordable Care Act encourages medical providers to collaborate more on patient care in an effort to reduce costs, the increase in acquisitions raises the concern that consolidations will result in lesser competition in certain markets.
The Maryland Attorney General’s Office announced its receipt of $717,000 in federal grants to aid state residents make health care decisions. The grant is for the Health Education and Advocacy Unit of the Attorney General Office to start or bolster existing programs that allow consumers to have more influence on their health care decisions.   The funds are part of the Center for Consumer Information & Insurance Oversight’s (CCIIO) Consumer Assistance Program Grants. To date, the Health Education and Advocacy Unit has received a total of $1.5 million in funds from CCIIO.
Florida Attorney General Pam Bondi, has announced that her office will begin an investigation into allegations made in a New York Times report that at hospitals owned by Hospital Corporation of America (HCA), the nation’s largest for-profit operator of health care facilities, some cardiac surgeries were unjustifiable between 2002 and 2010. These allegations came to light as a result of a 2010 internal review which showed that half of the invasive diagnostic procedures were done on patients “without significant heart disease.” The internal review was prompted by a registered nurse who was later fired allegedly in retaliation for bringing the procedures to light.
Minnesota Attorney General, Lori Swanson, announced in a press release that her office had settled with Accretive Health Solutions a hospital billing and debt collection contractor over aggressive collection techniques. Swanson had brought suit against Accretive alleging that Accretive employees badgered patients over billing while still in hospital. As part of the settlement Accretive has agree to not do business in Minnesota for six years and has agreed to pay $2.6 million.  Accretive does not admit to wrongdoing or liability and agreed to settle with Swanson to "prevent this matter from being a continued distraction."
In an effort to combat prescription drug abuse, West Virginia Attorney General Darrell McGraw announced lawsuits against 14 out of state drug distributors over their supplying certain drug stores with drugs that were over prescribed for non-legitimate medical purposes. McGraw stated, "These out of state drug distributors have substantially contributed to, benefited from and gained improperly from prescription drug abuse in West Virginia… We now ask them to accept responsibility and pay for their illicit actions just as our office has done with others."
Minnesota Attorney General, Lori Swanson, has moved to broaden the lawsuit against Accretive Health over aggressive hospital bill collection methods after more patients have come forward. The Chicago-based Accretive handles billing and collections for hospitals and health systems including Fairview Health Services in Minneapolis.   Swanson released a report in April outlining the extent of the alleged aggressive practices done on behalf of Accretive employees in collecting past due hospital bills.
Minnesota Attorney General Issues Report on Aggressive Collection Tactics in Hospitals (April 26, 2012)
Minnesota Attorney General, Lori Swanson, released a report focusing on the practices of an Illinois medical debt collection company in Minnesota. Swanson had filed a lawsuit against Chicago-based Accretive Health Inc. in January asserting misuse of private patient information and creating “high-pressure, boiler room-style sales atmospheres” in which employees were coached to aggressively collect debt. Accretive has contracts with two Minnesota based hospitals. The allegations are detailed in a six volume report release by the Swanson’s office.
Minnesota’s Compliance Review of Fairview Health Services' Management Contracts with Accretive Health, Inc.
Vol. 1 The Accretive Management Contracts
Vol. 2 Culture Wars
Vol. 3 The Attorney General Agreement
Vol. 4 Privacy Violations
Vol. 5 Violations of Federal and State Debt Collection Laws
Vol. 6 Compliance Issues
Circuit Judge Tim Fox ordered Johnson and Johnson to pay Arkansas $1.2 billion after it was found that the company hid risks caused by an antipsychotic drug. The case was pursued by Arkansas Attorney General Dustin McDaniels in order to protect consumers from “fraud and abuse.” McDaniels called the decision a “big win” for Arkansas and was caused by “The companies put[ting] profits before people, and they are rightfully being held responsible for their actions.” The decision is one of the largest state fines recorded on a drug company.
The Attorneys General of Massachusetts, Martha Coakley, and Virginia, Ken Cuccinelli, have led a National Press Club Newsmaker debate on the Patient Protection and Affordable Care Act (ACA). Four questions concerning the ACA will be present to the Supreme Court for oral argument from March 26-28. The attorneys general discussed several aspects of the ACA including the insurance coverage mandate, the tax basis, the general welfare aspect, expansion of Medicaid, severability, the law’s provisions and other areas.
The attorneys general of California, Connecticut, Delaware, Hawaii, Illinois, Iowa, Maryland, New Mexico, New York, Oregon, Vermont, the District of Columbia and the Virgin Islands have filed a joint amicus curiae brief supporting the constitutionality of the Patient Protection and Affordable Care Act with the Supreme Court.  The brief focused on the constitutionality of the minimum-coverage provision, commonly called the individual mandate, requiring non-exempt individuals to have health insurance coverage or pay a penalty. Four questions are before the Supreme Court with oral arguments scheduled for March 26th to March 28th.
The Supreme Court on Monday announced the schedule for oral arguments concerning the Patient Protection and Affordable Care Act. Arguments will take place over three days from March 26th to the 28thFour questions are being presented to the court: whether the minimum coverage provision is constitutional, whether the minimum coverage provision is severable, whether the suit brough to challenge the minimum coverage provision is barred by the Anti-Injunction Act, and whether the Medicaid expansion provisions are constitutional.
The Eleventh Circuit Court of Appeals ruled on Dec. 9 that state action doctrine immunized the hospital merger of Phoebe Putney Health System and Palmyra Park Hospital in Albany, Georgia from antitrust laws.  Together the hospitals control 86 percent of the relevant market.  The FTC argued that the merger would "cause consumers and employers in the Albany region to pay dramatically higher rates for vital health care services, and will likely reduce the quality and choice of services available in the community as well."  The hospitals did not dispute the monopoly charge but argued instead that they were immune under the state-action doctrine. Memorial was not a private hospital but operated by a regional hospital authority, which the Georgia legislature authorized in a 1941 law. Thus, the court ruled, the issue was whether the state authorized the action for policy reasons that one would reasonably anticipate had a foreseeable anticompetitive effect.
New Jersey Attorney General, Paula T. Dow, announced the approval of the merger of St. Luke’s Hospital and Health Network and Warren Hospital in Phillipsburg. The owner of Easton Hospital, Community Health Systems, had objected to the merger claiming to have offered a better deal. The merger must still be approved by the New Jersey Superior Court before it can be finalized.
The Supreme Court Order List issued Monday Morning included three petitions for certiorari concerning challenges to the Patient Protection and Affordable Care Act.  The Supreme Court has set a total of five and a half hours to hear three questions before the court: 1) Whether Congress had the power under Article I of the Constitution to enact the minimum coverage provision; 2) Whether the ACA must be invalidated in its entirety because it is nonseverable from the individual mandate that exceeds Congress’ limited and enumerated powers under the Constitution; and 3) Whether the suit brought by respondents to chal­lenge the minimum coverage provision of the Patient Protection and Affordable Care Act is barred by the Anti-Injunction Act, 26 U.S.C. 7421(a).  To date three U.S. appellate courts have upheld the constitutionality of the individual and two have ruled it unconstitutional.
Justice Department spokeswoman, Tracey Schmaler, stated that the administration would not appeal to the 11th Circuit Court of Appeals en banc in Florida v. U.S. Dep’t of Health and Human Services, N.D. Fla. 3:10-cv-00091-RV-EMT (Jan. 31, 2011) No. 11-11021 (11th Cir. filed Mar. 9, 2011) and No. 11-11067, (11th Cir. filed Mar. 11, 2011).  26 states are challenging the constitutionality of the individual mandate requiring every U.S. citizen to have health insurance within the Patient Protection and Affordable Care Act.  The decision by the administration makes it more likely that the U.S. Supreme Court will hear the case in the next term.
Three judges on the United States Court of Appeals for the Fourth Circuit dismissed a lawsuit by Virginia Attorney General Ken Cuccinelli, determining that Virginia lacked standing to sue. Cuccinelli filed suit against the federal government over the individual health insurance mandate portion of the new federal health-care laws. This lawsuit was separate from one filed by 26 other states. Cuccinelli argued that Virginia had standing to challenge the new law since it directly conflicted with a state law that prohibits requiring residents to purchase insurance. In a statement about the decision Cuccinelli said, “Our disappointment not only stems from the fact that the court ruled against us but also that the court did not even reach the merits on the key question of Virginia’s lawsuit — whether Congress has a power never before recognized in American history: the power to force one citizen to purchase a good or service from another citizen.” Cuccinelli says his office plans to appeal to the U.S. Supreme Court. 
A county judge awarded the state of Mississippi more than $38 million dollars as the result of lawsuit filed by Mississippi Attorney General Jim Hood against pharmaceutical manufacturer Sandoz Inc. In the lawsuit, Hood accused Sandoz of inflating the average wholesale prices of drugs, which resulted in inflated reimbursements to pharmacies by the Mississippi Division of Medicaid. In a press release about the judgment Hood said, "Sandoz, with its greed for more profits, caused Mississippi to overpay on drug prescriptions and some of our neediest citizens were being denied health care due to cost overruns.” Under the terms of the judgment, Sandoz must pay the state $23,661,618 in compensation, $11,830,809 in punitive damages, and $2,699,000 in penalties. 
Virginia Attorney General Ken Cuccinelli’s office says they are cracking down on both Medicaid fraud and elder abuse. Cuccinelli has expanded the Medicaid Fraud Control Unit by almost doubling the amount of employees working in the unit since 2010. According to Cuccinelli, his office is working with seniors groups and law enforcement as part of a joint effort known as “Triad” to educate seniors on elder abuse, as well as how to identify and report Medicaid fraud. In an interview Cuccinelli said, "We're not an accounting firm — this isn't about getting dollars. It's about stopping criminal activity and fraud and making sure that as many people in Virginia can trust the bill they get at their health-care providers, and that it isn't tainted by somebody stealing."
The Washington Supreme Court found in favor of Washington Attorney General Rob McKenna, ruling that the City of Seattle cannot force McKenna to withdraw from a challenge to the Obama administration backed health care overhaul.  The justices did, however, say the Governor may be able to intervene but declined to rule on that issue. In a statement about the ruling McKenna said, "It's important that the state's constitutionally-established, independently-elected Attorney General — whomever it may be — have the authority to protect the legal rights of the state and its people in the years to come.”
Texas Attorney General Greg Abbott announced an agreement with Par Pharmaceutical Inc. over allegations of inflated prescription drug pricing for Medicaid patients. The agreement follows charges of fraud filed against the company by Abbott’s office in 2008. Under the terms of the agreement, Par must pay $24 million to the state. 
Following an investigation by New York Attorney General Eric Schneiderman’s office, James T. Pickard was sentenced to five years of probation and 250 hours of community service for alleged Medicaid fraud. According to the Medicaid Fraud Control Unit of Schneiderman’s office, Pickard forged bids on the letterhead of other contractors’ as part of a bid-rigging scheme to wrongfully receive $541,671.11 in Medicaid funds. Pickard allegedly would submit two high bids on the forged letterhead, then submit his own lower bid to win contracts through the New York State Medicaid Traumatic Brain Injury Waiver program. This program helps Medicaid recipients modify houses to allow them to live independently.  Pickard also paid restitution for the payments he received from Medicaid. 
The 11th Circuit Court of Appeals issued an opinion in Florida v. U.S. Dep’t of Health and Human Services, N.D. Fla. 3:10-cv-00091-RV-EMT (Jan. 31, 2011) No. 11-11021 (11th Cir. filed Mar. 9, 2011) and No. 11-11067, (11th Cir. filed Mar. 11, 2011).  In a split decision the court ruled 2-1, that the individual mandate within the Affordable Care Act requiring individuals to have health insurance is unconstitutional.  The court did not go as far as District Judge Roger Vinson’s ruling that held that the entire bill are unconstitutional.  26 states brought suit against the Federal Government. The Federal Government has 90 days to appeal to the Supreme Court.
Idaho Attorney General Lawrence Wasden announced a $2.5 million settlement with pharmaceutical manufacturer AstraZeneca Plc for allegations related to Medicaid pricing. Wasden’s office alleged that AstraZeneca inflated its average wholesale drug pricing, causing Idaho to pay more for prescription drugs through the Medicaid program. Government health programs use the average wholesale prices to set reimbursement rates for prescription drugs. According to Wasden, the difference between the listed price and the actual price of one drug manufactured by AstraZeneca was 26 percent. In his statement Wasden said, “Where published prices are false or misleading, the taxpayers are significantly harmed by excessive Medicaid reimbursements.” AstraZeneca will pay $2.5 million to Idaho but denies any wrongdoing.     
Massachusetts Attorney General Martha Coakley announced a civil judgment of $2.4 million against two companies, Consumer Health Benefit Association and National Benefits Consultants LLC. Coakley’s office sued the companies for alleged fraud by marketing and selling discount health plans as health insurance and as being sufficient to meet the state’s mandatory insurance coverage law. As part of the judgment, the companies are required to pay $586,960.95 in restitution to consumers, $1,780,000 in civil penalties, and $99,000 in attorneys’ fees. The companies are also permanently prohibited from representing a discount health plan or insurance as meeting the state’s mandatory insurance coverage requirements when they do not.  
Connecticut Attorney General George Jepsen announced that two health insurance agreed to reprocess chiropractic benefit claims they previously denied. In July, Jepsen’s office raised questions with the insurance companies, Aetna and American Specialty Health Networks Inc., after receiving several complaints regarding denial of chiropractic services claims. According to allegations by chiropractic providers, the companies improperly denied claims under Connecticut law. In Connecticut, health insurance plans are required to cover services by licensed chiropractors, such as X-rays and preventative care, to the same extent the plan would cover those services as provided by physicians. Aetna said it would update the claim system, review claims filed since July 1, and reprocess any improperly denied claims. 
Massachusetts Attorney General Martha Coakley’s office filed suit against Ortho-McNeil-Janssen, a drug manufacturer, for illegally marketing Risperdal. Coakley alleges that the manufacturer promoted the antipsychotic medication Risperdal for a number of uses not approved by the U.S. Food and Drug Administration. These uses included treating elderly dementia and adolescent conduct disorders. Coakley also alleges Janssen failed to disclose serious side effects of the drugs, including weight gain, diabetes, and an increased risk of death in elderly dementia patients. In a statement from her office Coakley alleges, "Janssen put profits ahead of patient safety by promoting Risperdal for uses that had not been approved and by failing to disclose serious risks associated with Risperdal's use."
Oklahoma Attorney General Scott Pruitt released an opinion determining that municipalities in Oklahoma cannot require prescriptions for cold medicines containing pseudoephedrine. According to Pruitt, no state statute authorizes municipalities to regulate dispensing, sale, or distribution of pseudoephedrine. Pruitt issued the opinion at a state representative's request in response to several municipalities requiring prescriptions for the cold medicines. In his announcement Pruitt states, “A municipality that undertakes to enact an ordinance prohibiting the dispensing, sale or distribution of pseudoephedrine except upon the order of a lawful prescription removes an option carefully preserved by the Legislature for persons desiring to lawfully obtain pseudoephedrine without the necessity or burden of obtaining a prescription."    
New Jersey Attorney General Paula Dow has charged 11 people, including three chiropractors, of operating two separate schemes involving “runners” to fraudulently recruit patients to the chiropractors’ practices.  According to investigators, the chiropractors used runners to identify and contact individuals who had recently been involved in motor vehicle accidents, recruiting them to undergo chiropractic treatment.  The recruitment of patients by the runners, and the subsequent treatment, enabled the chiropractors to file claims for payment from multiple insurance companies.  New Jersey law, however, includes an "anti-running statute," which imposes criminal penalties for acting as a runner or using, directing, or employing a runner.  "These alleged schemes involved chiropractors recruiting runners and runners recruiting patients, all in the name of greed," said Attorney General Dow. "Such conduct corrupts the insurance system because it gives powerful financial incentives that can influence a doctor's treatment decisions to maximize insurance billings."
Massachusetts Attorney General Martha Coakley announced Rite Aid will pay $2.1 million to the commonwealth for allegedly overcharging for prescription drugs. Coakley’s office alleged that Rite Aid overcharged cities, towns, and state agencies for prescriptions filled through the workers compensation insurance program. One million dollars of the settlement will be split between 100 cities and towns in Massachusetts and $1.05 million will go to the commonwealth itself. This is the fifth case Coakley’s office has handled involving prescription overcharges and the total recovery from these cases to date is $7.9 million. 
Kentucky Attorney General Jack Conway has announced that Passport Health Plan improperly paid four of its member organizations $26.4 million as part of a settlement, and that the money must be repaid. Attorney General Conway alleges member organizations, including Jewish and St. Mary’s Inc., Norton Hospital, University Physicians Associates, and University Medical Center, received $30.5 million in disbursements in 2008 and 2009. Passport, a nonprofit care organization that provides health care to the indigent, made these disbursements illegally, as nonprofit corporations cannot pay dividends to its members. Portions of the disbursement that were used to serve Medicaid patients will not be repaid to Passport. If the money is not repaid to Passport in a timely fashion, Conway can triple the amount the members owe.
New York Attorney General Eric Schneiderman announced a number of arrests stemming from an investigation into a network of fake nursing schools accused of defrauding immigrants. According to Schneiderman, this network, made up of five schools in Brooklyn, Queens, and Long Island, accepted money from mostly Caribbean immigrants and awarded them fake nursing certifications. Students paid between $7,000 and $20,000 to attend these schools, some spending up to two years in the programs. The total amount defrauded from students by these fake schools is estimated to be $6 million. Schneiderman’s office states four of the schools have already been shut down and authorities are trying to close the fifth. 
Kentucky Attorney General Jack Conway says a settlement has been reached in which hospitals and healthcare groups will repay Passport Health Care Plan, which provides health care for about 165,000 low-income and disabled Medicaid patients in Kentucky, $26.4 million that was taken from the plan’s surplus funds in 2008 and 2009 and paid to health providers on Passport's board.  Conway said an investigation found that the payouts violated state and federal law, since nonprofits like Passport can't pay cash dividends to members.
Massachusetts Attorney General Martha Coakley has announced that Walgreen Co. has agreed to pay $2.8 million to the state and to various Massachusetts cities and towns to resolve allegations that it overcharged for prescription drugs. According to a press release,  the company overcharged an estimated $1.4 million since 2002 by filling prescriptions for workers’ compensation claimants at prices higher than those permitted by Massachusetts law. The company has agreed to pay the overcharges, as awell as an additional $1.4 million.
Iowa Attorney General Tom Miller announced that Sioux Pharm, a pharmaceutical company, has been assessed a $20,000 civil penalty by a district court judge for wastewater violations. Miller sued Sioux Pharm in 2009, alleging a number of wastewater violations, including illegal discharge of wastewater into groundwater. Sioux Pharm was further ordered to permanently close their wastewater storage facility and level it.
Michigan Attorney General, Bill Schuette, says that an agreement with Blue Cross Blue Shield of Michigan is resulting in reductions in proposed insurance rate premiums for seniors.  Blue Cross was seeking an average rate increase of 27.1 percent on all Medigap subscribers and a sliding scale rate increase up to 94 percent, depending on a subscribers' income. The agreement eliminates the sliding rate and keeps the overall rate increase at a minimum of 9 percent.
Indiana Attorney General, Greg Zoeller, filed a notice of appeal with the U.S. 7th Circuit Court of Appeals in Chicago on Tuesday appealing a preliminary injunction that blocked a state law restricting public funding for Planned Parenthood because Planned Parenthood provides abortions. The law was signed by Indiana Governor Mitch Daniels on May 10, cutting off $1.4 million in funding to Planned Parenthood and denied Medicaid funds. Zoeller is arguing that although Medicaid funds are not used directly for abortions, the funds subsidize the procedures. The White House has threatened to cut off all Medicaid funds to the state totaling $5 billion.
Massachusetts Attorney General Martha Coakley called for limits on what hospitals can charge for health care services in her second report on health care costs. State lawmakers have indicated that they want to lower health care costs by putting patients and doctors on annual budgets. However, Coakley argues that this approach cannot work unless prices are capped first. Some reports have shown that one health care provider might charge twice as much as another for providing the same service. As a result, Coakley has requested “temporary restrictions on how much prices may vary for comparable services.”
Fallon, a non-profit group practice based in Massachussetts, will affiliate with Atrius Health, the state's largest private medical practice group. However, as part of the deal Massachusetts Attorney General Martha Coakley has required Fallon and Atrius to provide her office with contract terms and financial analysis 30 days before making any contract with health insurance companies. This agreement with the Attorney General's office will last for 10 years or two contract cycles. "At a time when healthcare costs are a major concern for individuals and businesses throughout the Commonwealth, my office will continue to examine market affiliations to ensure potential benefits to consumers outweigh potential anticompetitive effects," Coakley said. 
New Hampshire’s Supreme Court has issued a unanimous slip opinion stating that the legislature can not force New Hampshire Attorney General Michael Delaney to join a multistate lawsuit challenging the constitutionality of the Patient Protection and Affordable Care Act. The New Hampshire Senate had sought the opinion of the court concerning the constitutionality of a bill passed by the state House of Representatives. The court stated that the bill violated the separation of powers clause and was unconstitutional since the bill, “"which removes entirely from the executive branch the decision as to whether to join the state as a party to litigation, would usurp the executive branch's power to execute and enforce the law."  
California Attorney General, Kamala Harris, warned Anthem Blue Cross that imposing a $15 convenience fee upon customers for making payments with credit cards may violate state law. Anthem has announced that it will reconsider the proposed fees that may violate California Civil Code Section 1748.1, which forbids business from charging higher prices for using credit cards. Anthem intends to end automatic credit card payments beginning in August, but members will still be able to pay by check or have payments deducted from checking accounts directly online.
Delaware Attorney General Beau Biden ordered Blue Cross Blue Shield of Delaware to create a health care fund for the State’s uninsured in order to complete its merger with Highmark, a health insurer with for-profit subsidiaries. Biden is relying on an untested 2004 law to compel the creation of the fund. Under this law, the AG has the authority to decide if a deal involving a non-profit health care provider constitutes a conversion. If there is a conversion, a foundation for the uninsured must be created for the deal to proceed. Biden has not yet revealed how much Blue Cross Blue Shield would be required to pay.
14 Attorneys General have filed an amicus curiae brief in support of a challenge to the federal health care law. The case, Seven-Sky v. Holder, is currently in the Court of Appeals for the DC circuit. The amicus brief supports the plaintiffs’ appeal against the district court’s holding that the individual mandate to buy insurance was constitutional. The 14 states argue that the "extraordinary law... rests on unprecedented assertions of federal authority, pushing even the most expansive conception of the federal government's constitutional powers past the breaking point." Oral arguments are scheduled for September 23.
Anheuser-Bush has decided to reduce the alcohol content of “Tilt” from 12% to 8% in a move welcomed by George Jepson, the Connecticut Attorney General. Earlier this year, Jepson, along with other state attorneys general, raised health concerns about “binge-in-a-can products.”
New Hampshire Attorney General, Michael Delaney, has filed a brief with the State Supreme Court to challenge the efforts of the state legislature to force him to join the 26 states that are now urging a federal court of appeals to strike down the federal health care law. The New Hampshire House of Representatives voted in March to compel the Attorney General to join the coalition of states and assert that the individual mandate provision violates the US Constitution. The Attorney General argues that this would violate the separation of power clause in the state constitution.
Washington Attorney General Plans to Cut Tobacco Sales to Minors (May 17, 2011)
Washington Attorney General Robert McKenna said that he joined 39 other state attorneys general in a bold plan to cut down tobacco sales to minors at convenience stores. The Assurance of Voluntary Compliance is an agreement with Circle K Stores, Inc. and Mac’s Convenience Stores LLC, owners of Circle K, Dairymart, and On The Run convenience stores, to enforce more stringent ID verification and eliminate marketing that targets minors. One of the measures will require the stores to eliminate outdoor advertising of tobacco products for stores located within 500 feet of playgrounds or schools.
Florida Attorney General, Pam Bondi, hosted a round table discussion on what can be done to stop the growing problem.  In Florida an estimated 1,300 babies were treated for withdrawal in 2010 and 15-20% of babies admitted to neonatal care units were treated for withdrawal from prescription drugs like oxycodone, methadone, and Xanax.  Legislation was introduced this session to increase reporting requirements to a prescription drug database, increase penalties for doctors that overprescribe, and implement dosage caps dispensed from pharmacies.
23 Attorneys General have filed a brief in Florida v. U.S. Dep’t of Health and Human Services, No. 11-11021 (11th Cir. filed Mar. 9, 2011) and No. 11-11067, (11th Cir. filed Mar. 11, 2011) being heard in the Eleventh Circuit Court of Appeals. In total, 26 states filed the brief asking the appellate court to affirm an earlier decision that found the Patient Protection and Affordable Care Act’s provision requiring an individual mandate to purchase health insurance. Oral arguments are scheduled for June 8.
Massachusetts Attorney General, Martha Coakley, has settled a case with a subsidiary of insurance company American International Group over the sale of faulty health insurance products. United States Life Insurance Co. sold insurance products in Massachusetts that did not cover state mandated benefits including mental health, maternity care, infertility care, mammography, pap test screening, and preventive care for children up to age 6.  U.S. Life agreed to pay a total of $760,000 consisting of $500,000 in premium refunds and $260,000 as a fine to the state.
The Supreme Court rejected Virginia Attorney General’s, Ken Cuccinelli, request to expedite Virginia’s challenge to the constitutionality of the Patient Protection and Affordable Care Act.  The case will be heard in the U.S. Court of Appeals for the 4th Circuit in Richmond on May 10.  Cuccinelli had sought to expedite the case due to the amounts of money being spent by the states on implementation.
Georgia’s Attorney General, Sam Olens, and the FTC have challenged Phoebe Putney Health System’s merger with Palmyra Medical Center as being anti-competitive.  The complaint alleges that the merger would violate federal law by eliminating “vigorous competition” in a six-county area of Georgia.  The complaint also alleges that Phoebe Putney sought to use the Hospital Authority of Albany-Dougherty County to exempt the merger from federal antitrust scrutiny under the “state action” doctrine.  If the merger were to go forward there would be only one other independently operated hospital in the six-county area resulting in Phoebe Putney having a market share of 85%.
Massachusetts Attorney General, Martha Coakley, has filed an amicus curiae brief in support of the Affordable Care Act (ACA) in Florida v. U.S. Department of Health and Human Services being heard in the Eleventh Circuit Court of Appeals.  The brief cites Massachusetts’ healthcare reform as proof of the ACA’s constitutionality, arguing “that Congress had a rational basis for concluding that free-riding by individuals, taken in aggregate, has a substantial effect upon interstate commerce, and that reducing or eliminating free-riding has a salutary impact on the health insurance market as a whole.”
Missouri Attorney General, Chris Koster, has filed an amicus curiae brief supporting the plaintiff Attorneys General in Florida v. U.S. Department of Health and Human Services.  Koster argued that the Affordable Care Act (ACA) should be ruled unconstitutional where it requires citizens to purchase health insurance, but Koster did not join the ongoing litigation now in the Eleventh Circuit Court of Appeals.
Amidst allegations that Beth Israel Deaconess Medical Center CEO Paul Levy acted inappropriately in handling his personal relationship with a female subordinate, Massachusetts Attorney General Martha Coakley has urged that the hospital consider replacing Levy. After news of the relationship between Levy and the employee first surfaced in April, Beth Israel's board fined Levy $50,000 and issued a statement of disapproval. The state attorney general's office, charged with overseeing nonprofit organizations such as Beth Israel, found no evidence of misuse of charitable funds in its investigation, but suggested that the hospital's senior management deliberately acted slowly in investigating the situation out of deference to Levy.
After an investigation into advertising for Kellogg's Rice Krispies cereal that dubiously claimed the cereal boosted children's immunity, the FTC has announced that Kellogg has agreed to restrictions on claims made in their advertising. Kellogg had previously been investigated by the FTC in 2009 for advertising misleading claims that Frosted Mini-Wheats cereal improved children's cognitive abilities. In a joint statement, FTC Chairman Jon Leibowitz and Commissioner Julie Brill remarked that "as a trusted, long-established company with a presence in millions of American homes, Kellogg must not shirk its responsibility to do the right thing when it advertises the food we feed our children."
Carington Health Systems overstated Medicaid reimbursements for more than 20 nursing home facilities across Ohio, alleges state Attorney General Richard Cordray.  The lawsuit seeks triple the amount of damages for each deceptive claim. 
Within minutes of President Barack Obama's signing of the Patient Protection and Affordable Care Act, attorneys general representing 13 states filed suit against the federal government in the U.S. District Court for the Northern District of Florida in Pensacola. The states have claimed that provisions in the act which mandate that citizens procure health insurance is unconstitutional. Other attorneys general are expected to either join this coalition or file suit independently.
A report released by the office of Massachusetts Attorney General Martha Coakley shows that the state’s most prominent hospital groups have demanded higher fees from insurers without increasing the quality of care offered or the amount paid to doctors. Investigators found that cost of care can vary as much as 100% among hospitals.
Vermont Court Holds R.J. Reynolds Accountable for Misleading Ads (March 12, 2010)
On Wednesday March 10, a Vermont Superior Court  ruled that R.J. Reynolds Tobacco Co. violated the state's consumer protection laws by making false and misleading marketing claims that their Eclipse cigarette brand was a "reduced risk" product.  The case was brought by the Vermont Attorney General, William H. Sorrell.
California Attorney General Subpoenas Big Health Insurers' Financial Records (February 25, 2010)
The California state attorney general's office said Thursday that it had subpoenaed financial records of California's seven largest health insurance companies as part of an investigation into whether they illegally raised customer premiums and denied payment of legitimate claims.
The office of New Jersey Attorney General Paula T. Dow is looking, in the latest of a series of investigations involving Perth Amboy, is investigating the city school board insurance contracts. The investigation is largely pertaining to health insurance over a period of four or five years, starting in about 2004.
California Attorney General Jerry Brown has asked Target Corp. to pull its Valentine's Day "Message Bears" from store shelves based on tests of the holiday toys that revealed lead levels that violate federal law. Target spokeswoman Beth Hanson says the Minneapolis-based company will pull the bears, which were made in China, from store shelves while it investigates.
Virginia Attorney General Ken Cuccinelli II is pushing legislation that would allow doctors to order patients into outpatient treatment after they are stabilized in a hospital or institution. The legislation also proposes to give patients more time to stabilize by increasing the time allowed for mental-health professionals to examine and evaluate people once they are taken into custody.
Due to a settlement with the North Carolina Attorney General Roy Cooper, Blue Cross and Blue Shield of North Carolina and has agreed to stop making automated phone calls and pay the state of North Carolina $95,000 in penalties. The company commissioned so-called “robo calls” to 100,000 North Carolina residents last October without following state law, which mandates that a live operator announce the automated message and give recipients the chance to refuse the call.
Connecticut Attorney General Richard Blumenthal has sued the healthcare company Health Net for failing to secure the records of thousands of its members. The company lost private information – including social security and bank account numbers – of 446,000 enrollees last May but did not alert its members until six months later.
Louisiana Attorney General James Caldwell has filed a lawsuit against building supply manufacturers over 1.1 million sheets of toxic drywall used in buildings after Hurricane Katrina in 2005.  The drywall may cause various health problems, including asthma attacks and heart disease.
New York Attorney General Andrew Cuomo has fined two hospitals and three nursing homes for flushing pharmaceutical waste in Delaware and Putnam counties, which supply part of New York City’s drinking water. Ten other facilities are under similar investigation.
The Food and Drug Administration has sent letters alerting the food company Nestle that selling the children’s drinks Juicy Juice and Boost as “medical food” was a violation of FDA regulations. The letters also criticize Nestle’s Juicy Juice Brain Development Fruit Juice Beverage, claiming that certain label statements violate regulations against nutrient content claims regarding food intended for children under 2.
Tennessee Attorney General Robert Cooper is suing Pronalci, a Colombian cigarette manufacturer, for cigarettes sold in his state last year. Cooper says the company must pay $300,000 to an escrow account to reimburse the state for health care to treat smokers.
On Thursday, December 17th, Arizona Attorney General Terry Goddard will announce a statewide initiative against domestic violence. Goddard has teamed up with the Arizona Coalition Against Domestic Violence, a non-profit organization aimed at increasing public awareness about the issue.
State Attorney General Bill McCollum announced that Florida would receive $8.5 million from a settlement resolving a Medicaid fraud lawsuit with pharmaceutical company Roxane Laboratories. The settlement resolves allegations that Roxane’s requests for Medicaid reimbursements inflated the prices of various medications, causing the Florida Medicaid Program to overpay millions of dollars.

A Harrisburg-based health insurance company accused of improperly rejecting claims for emergency room treatment has agreed to reprocess claims and pay bills for more than 600 Pennsylvania consumers as part of a settlement with the Attorney General's Health Care Section.
Illinois Attorney General Lisa Madigan has sued “Nu U Med Spas,” a Chicago-area spa chain, for offering unapproved and unsupervised cosmetic and weight treatments that left some patients with lasting pain and injuries. The company also allegedly pressured customers into questionable treatments without fully informing them of the costs and health risks of the procedures.
New Jersey Attorney General Anne Milgram released a report from her office’s Division of Consumer Affairs recommending new regulations to curb conflicts of between doctors and pharmaceutical companies and medical device manufacturers. The report recommends banning gifts and free meals and mandating disclosure of financial ties between doctors and drug companies.
In 22 states, businesses that purchased vitamins from certain manufacturers will see refunds following a $25 million multistate settlement over vitamin price-fixing allegations. Settlement funds will also be distributed by the attorneys general for each state to government or non-profit organizations to address nutrition and health matters as approved by the court.
Suspecting some pharmacies have been charging high out-of-pocket prices for flu medicine, Connecticut Attorney General Richard Blumenthal has asked CVS, Rite Aid, and Walgreens for information about how they have been pricing the drug. Blumenthal also requested information about why the pharmacies may have changed the price of the drug over the last year.
Montana Attorney General Steve Bullock held a summit called “Prescription Drug Abuse: the Silent Epidemic” to address prescription drug abuse, which killed more Montanans than methamphetamine last year. Having already launched a six-person prescription drug diversion unit earlier this fall, Bullock has prioritized the establishment of a statewide prescription drug-monitoring program.
In a letter sent to six major retailers selling in California, state Attorney General Jerry Brown warned of a number of toys that were found to contain dangerous amounts of lead. Children are particularly susceptible to the risk of lead poisoning and may ingest lead when they put toys in their mouths or transfer the lead from their hands to their mouths or to food.
New York Attorney General Andrew Cuomo announced that drug store chain CVS has agreed to pay $875,000 to settle charges that the company sold products as late as two years past their expiration dates.  Over-the-counter drugs, eggs, milk, and baby formula were among the items sold at over 142 CVS stores in New York after their expiration dates had lapsed.
Connecticut Attorney General Richard Blumenthal contacted 13 makers and distributers of seasonal flu vaccines over allegations of high price fixing and preferred treatment for big retailers. The seasonal flu vaccines are in short supply due to the switch made by drug makers to produce the H1N1 vaccine.
New York Attorney General Andrew Cuomo filed a lawsuit with 14 other states in federal court in Massachusetts accusing Amgen Inc. and Amerisource of encouraging doctors to bill third-party insurers for samples they received for free.  The companies also allegedly offered medical professionals kickbacks or weekend retreats for selling its drug.
One hundred million dollars from settlements with over a dozen insurance companies will go toward a new national database to help consumers understand insurance company reimbursements for out-of-network fees, New York Attorney General Andrew Cuomo said on Tuesday. Mr. Cuomo’s office had conducted an investigation into Ingenix and health insurance companies and determined that the industry systematically understated doctor’s fees for over a decade. Within a year, a nonprofit company, FAIR Health, will be set up to take the place of the private database and provide consumers with accurate information.
Several lawsuits brought by the Department of Justice against four pharmaceutical companies for failing to pay appropriate rebates to state Medicaid programs resulted in a $124 million settlement.  The Attorneys General of New York, New Hampshire, and Ohio assisted with the investigation.
Martha Coakley, the Attorney General of Massachusetts, has filed lawsuits against four companies allegedly using deceptive practices to market discount medical plans that do not actually meet the state’s standard of minimum creditable coverage. Coakley’s office has proposed reforms to require sellers of health insurance in Massachusetts to fully disclose how their plans work.
In a letter to Kellogg’s, General Mills, and PepsiCo, Connecticut AG Richard Blumenthal raised concern about “Smart Choices” labels. Meant to designate nutritional foods, the labels have been used on many seemingly unhealthy products including sugary breakfast cereals and mayonnaise.   Blumenthal’s investigation will ascertain whether the labeling campaign violates the state’s consumer protection law, which bars misleading or false product claims.
Two lawsuits have been filed by Minnesota Attorney General Lori Swanson against companies that allegedly sold non-insurance health products to consumers disguised as credible insurance to consumers.  The companies targeted Minnesotans in need of coverage.
California Attorney General Jerry Brown is looking into claims that the state's top health insurers reject about 20 percent of medical claims.  He has stated that a high denial rate suggest the system itself is dysfunctional.
The West Virginia Attorney General’s filed a lawsuit against CVS Pharmacy, Kmart, Kroger, Walgreen Pharmacy and Target alleging that they all violated a state law designed to promote use of generic equivalents for brand-name prescription drugs. The lawsuit contends that rather than pass on the savings to consumers from the substitution of less-expensive generic drugs, the pharmacies have instead pocketed them.
Texas Attorney General Greg Abbot reached a settlement agreement after Alpha Therapeutic Corp. falsely reported inflated prices to the Medicaid program thus over-reimbursing providers for their drugs. The result was increased profits to providers and an unlawful market niche for the drug company throughout the 1990’s.
Following a 2005 lawsuit filed against Baxter Healthcare Corporation based on allegations that the drug makers fraudulently published inflated Average Wholesale Prices, which Medicaid programs used to determine the reimbursement amounts for drugs prescribed to Medicaid patients, Illinois State Attorney General Lisa Madigan announced that her office has recovered $6.8 million for the State through a settlement agreement.
Tennessee Attorney General Bob Cooper has agreed to a $1.3 million settlement from a pharmaceutical company to settle claims that the company violated the state’s False Claim Act. Kindred Healthcare, Inc. and its partner PharMerica had been under investigation for overcharging pharmaceuticals sold to a Tennessee-based healthcare provider.
As part of a settlement forged by a multistate coalition of attorneys general and federal officials, pharmaceutical company Eli Lilly will pay $22.5 million to the Massachussetts Medicaid Program. The national settlement, the largest ever for a health fraud investigation, has resulted in over $1 billion being paid to state Medicaid programs and other federal programs.
A guest column in the Kalamazoo Gazette by Michigan Attorney General Mike Cox, in which he advocates for a number of reforms of Blue Cross Blue Shield of Michigan, including increased state governmental oversight and other reforms.
Coverage of the ongoing dispute between members of the Tennessee press and state officials over the release of the results of state investigations of abuse and neglect allegations at The Winfrey Center, a facility for patients with severe mental disabilities.
An expansive overview of recent efforts undertaken by attorneys general across the country to litigate against health care mismanagement and support health care reform legislation.


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Scholarly Articles

"Examination of Health Care Cost Trends and Cost Drivers."  Office of Attorney General Martha Coakley.
"Cereal Facts: Evaluating the Nutrition Quality and Marketing of Children’s Cereals." Jennifer L. Harris, Marlene B. Schwartz, Kelly D. Brownell, Vishnudas Sarda, Megan E. Weinberg, Sarah Speers, Jackie Thomspon, Amy Ustjanauskas, Andrew Cheyne, Eliana, Bukofzer, Lori Dorfman, Hannah Byrnes-Enoch

Cereal FACTS, presents a comprehensive and independent science-based evaluation of cereal company marketing to children and adolescents in 2008 through early 2009. This study was conducted by the Yale's Rudd Center on Food Policy and Obesity.

"The Effect of Fast-Food Restaurants on Obesity," Janet Currie, Stefano DellaVigna, Enrico Moretti, and Vikram Pathani
Researchers at Columbia University and the University of California, Berkeley, concluded that 9th grade students were more likely to be obese when their schools were within a tenth of a mile of a fast food restaurant.
"Proximity of Fast-Food Restaurants to Schools and Adolescent Obesity," Brennan Davis, PhD, and Christopher Carpenter, PhD

An additional study demonstrating that children who lived and went to school in close proximity to fast-food restaurants more likely to consume unhealthier diets and become overweight. The researchers recommend policy changes to limit the number of fast-food restaurants near schools.
One of four papers that resulted from the 2008 National Summit on Legal Preparedness for Obesity Prevention and Control, this paper addresses gaps in laws pertaining to healthy lifestyles, places, and societies and presents applicable laws and legal authorities that can close those gaps.
"A Legal Primer for the Obesity Prevention Movement." Seth E. Mermin, JD, MEd, and Samantha K. Graff, JD
With the goal of helping policymakers to avoid potential constitutional problems in the formulation of obesity policy, this paper outlines the legal principles most relevant to obesity policy: police power; allocation of federal power among federal, state, and local governments; freedom of speech; property rights, privacy, equal protection, and contract rights.
"A Crisis in the Marketplace: How Food Marketing Contributes to Childhood Obesity and What Can Be Done." Jennifer L. Harris, Jennifer L. Pomeranz, Tim Lobstein, and Kelly D. Brownell
This article reviews existing knowledge of the impact of marketing and addresses the value of various legal, legislative, regulatory, and industry-based approaches to changing massively expanding food marketing practices that attempt to promote unhealthy foods by targeting children.
A comparative analysis of the tobacco and food industries that finds significant similarities in the actions that these industries have taken in response to concern that their products cause harm.
"Obesity — The New Frontier of Public Health Law." Michelle M. Mello, J.D., Ph.D., David M. Studdert, LL.B., Sc.D., M.P.H., and Troyen A. Brennan, M.D., J.D., M.P.H.
A review of the rationale for regulatory action to combat obesity that examines legal issues raised by initiatives to date and comments on
the prospects for public health law in the area of obesity.
A discussion of the public health rationale the government’s legal authority for the enactment of menu-labelinglaws in restaurants, which concludes that the legislative climate surrounding menulabeling laws is currently positive and part of a larger effort to address issues of diet and obesity.
Annual Montana Hospital Surveys.  Lawrence L. White, Jr., MHA, FACHE, Amanda L. Golbeck, Ph.D., Emily Michalik River, M.Ed.
Annual report released in conjunction with Montana Attorneys General office surveying nonprofit hospitals in the state.  The most recent survey includes questions on the hospitals' foundations and the specific community benefits defined by the Internal Revenue Service (IRS).
Report on Physician Compensation and Arrangements.  Office of New Jersey Attorney General Anne Milgram.
Report released by the Division of Consumer Affairs from the office of the New Jersey Attorney General.  Recommends banning free gifts and meals and mandating disclosure of financial ties between doctors and drug companies.


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Student Papers

Frisbie, Allison
Kagle, Abigail
Patel, Jaykant
Sadowsky, Justin
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