Mealey's Health Care / ACA

  • March 15, 2024

    Respondents To High Court: Deny Review Of 4th Circuit ERISA Surcharge Ruling

    WASHINGTON, D.C. — Arguing that the case is a poor vehicle and that a purported circuit conflict is “illusory,” an employer and related respondents urge the U.S. Supreme Court to deny review and summary reversal in a suit concerning whether surcharge is available under an Employee Retirement Income Security Act provision that allows equitable relief.

  • March 14, 2024

    Labs Seek Reconsideration In ERISA Preemption, Florida Payment Laws Case

    NEW HAVEN, Conn. — Defendant laboratories in a battle over compensation for care provided to insureds filed a motion urging a federal judge in Connecticut to reconsider a finding that the Employee Retirement Income Security Act preempts certain claims, saying that Florida law creates a separate payment mandate that makes exploration of the plan language unnecessary.

  • March 13, 2024

    Arkansas Pharmacy Law Isn’t Preempted, Panel Says In Section 340B Drug Case

    ST. LOUIS — Arkansas law requiring Section 340B discount drug manufacturers to permit distribution through contract pharmacies does not conflict with the law, which is silent on distribution methods, or a second law governing highly regulated medications, the Eighth Circuit U.S. Court of Appeals said March 12 in affirming summary judgment for the state insurance commissioner and a pair of intervenors in the case.

  • March 12, 2024

    Judge Grants But Reduces Fees, Expenses In ACA Discrimination Case

    GREENSBORO, N.C. — Blind individuals and advocacy groups clearly constitute the prevailing party in a Patient Protection and Affordable Care Act (ACA) suit after receiving significant equitable relief from the court and are entitled to fees and expenses as a result, but they did not receive all the relief they sought and at least some of the complexity in the case arose from their own conduct, a federal judge in North Carolina said in granting but reducing a requested award.

  • March 08, 2024

    8th Circuit Sets Argument In ERISA Case Over Cross-Plan Offsetting

    ST. LOUIS — The Eighth Circuit U.S. Court of Appeals has set argument for March 14 in an Employee Retirement Income Security Act appeal where health plan participants challenging the practice known as “cross-plan offsetting” are seeking revival of their putative class suit, which was dismissed for failure to plead an injury in fact.

  • March 07, 2024

    Christian Employment Group, Members Have Standing In ACA Challenge, Judge Says

    BISMARCK, N.D. — Both the individual members of a Christian employers’ group and the association itself have standing in the face of imminent and concrete injury from a Patient Protection and Affordable Care Act (ACA) rule including gender identity under the definitions of discrimination, a federal judge in North Dakota said in granting the plaintiffs summary judgment on Religious Freedom Restoration Act (RFRA) claims.

  • March 07, 2024

    Briefing On Tolling In Opt-In Class Cases Ordered In Consolidated ACA Suits

    WASHINGTON, D.C. — Saying “issues important to the resolution of the [government’s dismissal] Motion remain unaddressed,” a U.S. Court of Federal Claims judge ordered supplemental briefing in consolidated cases of group health plans that allege that contributions were illegally exacted from them under the Transitional Reinsurance Program (TRP) of the Patient Protection and Affordable Care Act (ACA).

  • March 06, 2024

    11th Circuit Again Rules Against Dermatologist In ERISA Assignment Row

    ATLANTA — Saying in an unpublished per curiam opinion that a dermatologist’s “arguments are foreclosed by the prior panel precedent rule,” an 11th Circuit U.S. Court of Appeals panel issued the latest of many rulings against her over patients’ purported assignment of benefits.

  • March 05, 2024

    5th Circuit Hears Arguments Over Viability Of ACA Preventive Care

    NEW ORLEANS — Whether a task force’s members were properly empowered to issue preventive care recommendations under the Patient Protection and Affordable Care Act (ACA) and whether those recommendations or members can be accepted or appointed after the fact came before the Fifth Circuit U.S. Court of Appeals in March 4 oral arguments.

  • March 05, 2024

    DOL Files Amicus Brief In 9th Circuit ERISA Case Involving Tobacco Surcharge

    SAN FRANCISCO — For the third time in recent months — this time in a Ninth Circuit U.S. Court of Appeals case concerning a health plan’s tobacco surcharge — the U.S. Department of Labor (DOL) has filed an amicus curiae brief supporting application of the effective vindication doctrine in an Employee Retirement Income Security Act dispute involving what the DOL calls a representative action waiver.

  • March 04, 2024

    Judge: Lack Of Standing, Property Rights Doom Medicare Drug Pricing Law Challenge

    WILMINGTON, Del. — That a drugmaker’s “unprecedented” argument that incentives altered by the Inflation Reduction Act’s drug price negotiation provision provide standing to challenge the law fails “should come as no surprise,” and because the company lacks a protected right in selling to the government, its due process claim falls as well, a federal judge in Delaware said March 1 in granting summary judgment to the government.

  • March 04, 2024

    Texas High Court Wants Response On Health District Immunity Case

    AUSTIN, Texas — The Texas Supreme Court on March 1 asked a medical provider who claims that it was undercompensated for care by a nonprofit health maintenance organization to respond to a petition for review challenging a lower court ruling finding that the Harris County health district’s creation was not entitled to governmental immunity.

  • February 29, 2024

    Drugmaker, Woman Square Off On ACA’s Impact On Mirena Class Action

    SAN JOSE, Calif. — The Patient Protection and Affordable Care Act (ACA) mandates that insurers cover contraceptive drugs at no out-of-pocket cost, so a woman’s lawyers should have known that she couldn’t have suffered an economic injury sufficient for standing to pursue her claims that she wouldn’t have paid for the drug had she known about its cancer risks, the manufacturer says in seeking sanctions and opposing her motion to amend.  But in reply, the woman says all the evidence in the case suggests that she does have an injury and that adding named plaintiffs who can more readily produce evidence of their own injury won’t prejudice the company.

  • February 29, 2024

    Judge Finds Medicare Act Precludes Drug Pricing Suit, Court Lacks Jurisdiction

    SAN ANTONIO — The Medicare Act precludes a constitutional challenge to recent legislation permitting negotiation over the price the government pays for certain drugs, and dismissal of the lone defendant over which the court had jurisdiction leaves requires dismissal of the remaining two, a federal judge in Texas said in dismissing the case.

  • February 29, 2024

    Parties Brief Corner Post In Health Plans’ Consolidated Illegal Exaction Cases

    WASHINGTON, D.C. — In supplemental briefing in the U.S. Court of Federal Claims, the government and group health plans both say a pending U.S. Supreme Court case will not resolve their dispute in consolidated cases where the plans allege that the government illegally exacted contributions from them under the Transitional Reinsurance Program (TRP) of the Patient Protection and Affordable Care Act (ACA).

  • February 23, 2024

    Vaccine Injury Case Properly Dismissed As Untimely, Federal Circuit Says

    WASHINGTON, D.C. — The Federal Circuit U.S. Court of Appeals found no error in a decision by the U.S. Court of Federal Claims that held that equitable tolling did not apply to a vaccine injury case and that the petition was untimely.

  • February 23, 2024

    Providers Say Pro Se Ruling Provides No Insight Into Arbitration Dispute

    HOUSTON — A ruling in a case involving a pro se litigant having nothing to do with the No Suprises Act (NSA) arbitration process sheds no light on a dispute and wastes the court’s time, air ambulance providers argue in a response to an insurer’s notice of supplemental authority filed in Texas federal court.

  • February 22, 2024

    Judge To Hold Single Argument On Summary Judgment In Drug Pricing Challenges

    TRENTON, N.J. — Oral arguments on summary judgment in four cases challenging the Medicare drug negotiation rules enacted by the Inflation Reduction Act of 2022 (IRA) will be heard together, a federal judge in New Jersey said in a docket-only text order.

  • February 22, 2024

    $169M Deal To Resolve Part Of ACA Reinsurance Row Gets Preliminary OK

    WASHINGTON, D.C. — A U.S. Court of Federal Claims judge on Feb. 21 granted preliminary approval of a class settlement under which the amount the government has to pay to resolve part of a case over the Transitional Reinsurance Program (TRP) of the Patient Protection and Affordable Care Act (ACA) would drop from $185,230,024.42 to $169,022,397.28.

  • February 21, 2024

    Government Would Get Discount Under Class Deal In ACA Reinsurance Row

    WASHINGTON, D.C. — The amount the government has to pay to resolve part of a case over the Transitional Reinsurance Program (TRP) of the Patient Protection and Affordable Care Act (ACA) would drop from $185,230,024.42 to $169,022,397.28 under a class settlement proposed in the U.S. Court of Federal Claims.

  • February 20, 2024

    U.S. High Court Won’t Review ERISA Ruling On Long-Term Residential Coverage

    WASHINGTON, D.C. — The U.S. Supreme Court on Feb. 20 denied a certiorari petition in which a health benefits plan and insurer that administers it challenged two aspects of a 10th Circuit U.S. Court of Appeals ruling concerning long-term residential treatment facility coverage and argued that the opinion improperly “imposes new burdens on” such plans.

  • February 15, 2024

    Woman Can’t Show Coverage For Combo Bariatric-Hernia Surgery, Judge Says

    LOS ANGELES — A woman has not shown that she is entitled to benefits under her Employee Retirement Income Security Act health plan for a hernia surgery performed in conjunction with a gastric sleeve procedure, a federal judge in California said in findings of fact and conclusions of law.

  • February 13, 2024

    Judge Orders Notices On Corner Post In Consolidated Illegal Exaction Cases

    WASHINGTON, D.C. — A U.S. Court of Federal Claims judge has directed notices to be filed on whether a pending U.S. Supreme Court case is relevant to consolidated cases in which group health plans allege that the government illegally exacted contributions from them under the Transitional Reinsurance Program (TRP) of the Patient Protection and Affordable Care Act (ACA).

  • February 12, 2024

    Catholic Group Urges Court To Break Stay-Challenge Cycle In Gender Transition Case

    FARGO, N.D. — Despite years of litigation losses and expenses, the government wants to continue a cycle where it stays a case pending formulation of a new rule governing health insurance discrimination that will only require a new challenge once it issues, a Catholic benefits group told a federal judge in North Dakota in a challenge over gender transition care guidelines.

  • February 08, 2024

    Panel That Upheld Judgment For Insurers In Facility Fees Row Won’t Rehear Case

    NEW YORK — Saying only that it “considered the request,” a Second Circuit U.S. Court of Appeals panel that issued a summary order affirming judgment for a health insurer and related entities in a class suit over reimbursement for facility fees in New York denied a petition for panel rehearing.