Updated Daily

Case Law Database

Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. MISSING

Regular Panel Decision

Jan 28, 2015

In re Bioscrip, Inc. Securities Litigation

This is a securities class action where lead plaintiffs, Fresno County Employees’ Retirement Association and West Palm Beach Police Pension Fund, allege that BioScrip, its officers, directors, and underwriters engaged in deception. The plaintiffs claim BioScrip failed to disclose a government investigation into alleged Anti-Kickback Statute and False Claims Act violations related to its specialty pharmacy division. They also allege the company concealed the rapid decline of its PBM Services segment, misleading investors. The court partially grants and partially denies the defendants' motions to dismiss, allowing claims related to the government investigation and certain PBM Services misstatements to proceed, while dismissing others.

Securities FraudClass ActionFinancial MisrepresentationCorporate GovernanceAnti-Kickback StatuteFalse Claims ActGovernment InvestigationPBM ServicesStock DropEarnings Guidance

References

104

Case No. KP-0480

Regular Panel Decision

Feb 05, 2025

Untitled Texas Attorney General Opinion: KP-0480

Enacted by House Bill 1763 and House Bill 1919, subchapter M and subchapter L of chapter 1369 of the Texas Insurance Code regulate certain contracts with pharmacists and pharmacies and certain referral and solicitation practices concerning affiliated providers. Under United States Supreme Court precedent, neither subchapter has an impermissible connection with ERISA plans as they do not dictate plan choices or add requirements to beneficiary status. The two subchapters also do not refer to ERISA plans as they neither exclusively apply to those plans nor are ERISA plans essential to the laws’ operation. Therefore, a court would likely conclude that ERISA does not preempt either subchapter. In addition, nothing in the language of either subchapter limits their applicability to plans domiciled in Texas. Thus, a court would likely conclude that both subchapters are enforceable against an issuer or PBM that satisfy the statutory definitions and administer a plan covering Texas residents or contracting with Texas pharmacy providers regardless of where the plan is domiciled.

ERISA PreemptionTexas Insurance CodePharmacy Benefit Managers (PBMs)Health Benefit PlansState Law EnforceabilityHouse Bill 1763House Bill 1919Regulatory CompliancePharmacy Reimbursement RatesReferral Practices

References

Case No. MISSING

Regular Panel Decision

Oct 29, 2009

APOLLO ENTERPRISES, INC. v. ScripNet, Inc.

This appeal examines the exclusive jurisdiction of the Texas Division of Workers’ Compensation over disputes concerning payment amounts due from workers’ compensation insurance carriers to pharmacies. Appellants Apollo Enterprises, Inc. and WorkingRx, Inc. (collectively, WorkingRx) are companies that purchase assignments of workers’ compensation reimbursement claims from pharmacies. Appellee ScripNet, Inc. is a pharmacy benefits management company (PBM) that contracts with insurers to process and pay pharmacy reimbursement bills. WorkingRx sued ScripNet alleging tortious interference and civil conspiracy, primarily claiming that ScripNet caused carriers to underpay on reimbursement claims or diverted claims away from WorkingRx. The district court dismissed all of WorkingRx’s tort claims based on exclusive jurisdiction and exhaustion-of-remedies. The appellate court affirmed the dismissal of WorkingRx’s claims related to incorrect U&C estimates and erroneous application of ScripNet contract rates, finding these to be medical fee disputes falling under the Division’s exclusive jurisdiction. However, the court reversed and remanded the dismissal of WorkingRx’s claims that ScripNet wrongfully caused pharmacies to bind themselves to ScripNet contract rates and wrongfully “diverted” pharmacy reimbursement claims, concluding these claims do not fall within the Division's exclusive jurisdiction as they do not constitute medical fee disputes over amounts due from carriers under the workers’ compensation act and rules.

Workers' CompensationExclusive JurisdictionMedical Fee DisputesPharmacy Benefits ManagerTortious InterferenceCivil ConspiracyAdministrative RemediesStatutory InterpretationReimbursement RatesAssignment of Claims

References

Showing 1-3 of 3 results

Ready to streamline your practice?

Apply these legal strategies instantly. CompFox helps you find decisions, analyze reports, and draft pleadings in minutes.

In re Bioscrip, Inc. Securities Litigation

Securities FraudClass ActionFinancial MisrepresentationCorporate GovernanceAnti-Kickback StatuteFalse Claims ActGovernment InvestigationPBM ServicesStock DropEarnings Guidance

Untitled Texas Attorney General Opinion: KP-0480

APOLLO ENTERPRISES, INC. v. ScripNet, Inc.