Mealey's Health Care / ACA

  • April 27, 2017

    United States Tells Court ACA Risk Corridor Isn’t Open-Ended Liability

    WASHINGTON, D.C. — The Patient Protection and Affordable Care Act (ACA) risk corridors are not now and were never intended to be an unlimited source of funds for covering insurers’ losses, as the text and history of the law make clear, the United States told a federal appeals court on April 24 (Land of Lincoln Mutual Health Insurance Co. v. The United States of America, No. 17-1224, Fed. Cir.).

  • April 27, 2017

    Justice Seeks Objections To Referees In Liquidation Of Insolvent ACA Insurer

    NEW YORK — Claimants and parties interested in the liquidation of Health Republic Insurance of New York Corp. (HRINY) should show cause for objections to the appointments of referees for the review of liquidation estate claim appeals, a New York trial justice ordered April 14 (In the matter of the liquidation of Health Republic Insurance of New York Corp., No. 450500/2016, N.Y. Sup., New York Co.).

  • April 26, 2017

    Iowa Top Court Rejects Chiropractors’ Unequal Pay Claim Against Insurer

    DES MOINES, Iowa — Iowa state law does not require insurers to compensate chiropractors at the same rate as other medical professionals and would be preempted by ERISA if it did, the Iowa Supreme Court held April 21 (Lyle H. Abbas, et al. v. Iowa Insurance Division, Wellmark Inc., et al., No. 15-1248, Iowa Sup., 2017 Iowa Sup. LEXIS 39).

  • April 26, 2017

    Insurer Tells Court ‘Identical’ Risk-Corridor Case Doesn’t Warrant Stay

    WASHINGTON, D.C. — Having already filed briefs in cases it contends are identical, the United States cannot reasonably claim that it is so burdened by litigating a Patient Protection and Affordable Care Act (ACA) risk-corridor case that the court must stay it, an insurer told a federal judge on April 24 (Sanford Health Plan v. The United States of America, No. 17-357, Fed. Clms.).

  • April 25, 2017

    Transgender Employees Say University Of Wisconsin Illegally Limits Insurance

    MADISON, Wis. — The University of Wisconsin, its insurer and various associated entities illegally deny health care coverage for gender dysphoria, discriminating against transgender individuals in violation of the Patient Protection and Affordable Care Act (ACA) and other statutes, a pair of employees claim in an April 7 complaint in federal court (Alina Boyden and Shannon Andrews v. State of Wisconsin Department of Employee Trust Funds, et al., No. 17-264, W.D. Wis.).

  • April 24, 2017

    Government Asks Court To Stay, Delay ACA Risk-Corridor Suit

    WASHINGTON, D.C. — The interests of justice warrant staying an insurer’s Patient Protection and Affordable Care Act (ACA) risk-corridor lawsuit until the judge rules on essentially identical issues in an already briefed case, the United States told a judge on April 20 (Sanford Health Plan v. The United States of America, No. 17-357, Fed. Clms.).

  • April 20, 2017

    Judge Finds Jurisdiction, But No Plausible Claim In ACA Risk-Corridor Case

    WASHINGTON, D.C. — An insurer’s claims arising from the government’s failure to make full payments under the Patient Protection and Affordable Care Act (ACA) risk-corridor program are properly before the court, but the company has not stated a plausible claim on which it can obtain relief, a federal judge held April 18 (Blue Cross and Blue Shield of North Carolina v. The United States of America, No. 16-651, Fed. Clms.).

  • April 20, 2017

    Transgender Man: Hospital Violated California Law By Denying Hysterectomy

    SAN DIEGO — A medical center declined to allow a hysterectomy the day before the scheduled procedure after learning that the patient was transgender, a man claims in a complaint filed in the San Francisco County Superior Court on April 19 (Evan Minton v. Dignity Health, et al., No. N/A, Calif. Super., San Francisco Co.).

  • April 18, 2017

    Insurer, Government Spar Over ACA Risk-Corridor Liabilities

    WASHINGTON, D.C. — An insurer and the United States of America faced off in March and April briefs seeking summary judgment over how the Patient Protection and Affordable Care Act (ACA) handles risk-corridor program payments (Health Republic Insurance Co. v. The United States of America, No. 16-259, Fed. Clms.).

  • April 18, 2017

    U.S. Supreme Court Rejects West Virginia’s ACA Administrative Fix Case

    WASHINGTON, D.C. — The U.S. Supreme Court on April 17 declined to review West Virginia’s case claiming that it suffered injury to its state sovereignty when the federal government placed political accountability for the implementation of the Patient Protection and Affordable Care Act (ACA)’s insurance policy standards on the states, according to the court’s docket (State of West Virginia, ex rel. Patrick Morrisey v. United States Department of Health and Human Services, No. 16-721, U.S. Sup.).

  • April 18, 2017

    Government, Insurer Brief Appropriations’ Impact On Risk-Corridor Case

    WASHINGTON, D.C. — Congress’ subsequent limitations on funding for the Patient Protection and Affordable Care Act (ACA) risk-corridor program evidenced the program’s limited nature or a post hoc rationalization, according to supplemental briefing filed April 10 with a federal judge (Maine Community Health Options v. The United States of America, No. 16-967, Fed. Clms.).

  • April 18, 2017

    Insurer Seeks Payment Of $9 Million Owed Under ACA Risk-Corridor Program

    WASHINGTON, D.C. — Despite a clear mandate that payments be prompt, the government continues to withhold more than $9 million it owes for 2014 and 2015 under the Patient Protection and Affordable Care Act (ACA) risk-corridor program, an insurer alleges in a March 22 motion for summary judgment in the U.S. Court for Federal Claims (Sanford Health Plan v. The United States of America, No. 17-357, U.S. Fed. Clms.).

  • April 18, 2017

    Federal Appeals Court Receives Briefing In Medicaid Remedy Case

    WASHINGTON, D.C. — Briefing continues in a federal appeals court over whether a judge had the authority to add further injunctive relief to a prospective remedy reached in a 2009 settlement involving the District of Columbia’s failure to properly process Medicaid applications (Oscar Salazar, et al. v. District of Columbia, et al., Nos. 16-7065, 16-7085, 16-7100, D.C. Cir.).

  • April 18, 2017

    Failed ACA Insurer Claims HHS Improperly Withholds Reinsurance Funds

    COLUMBIA, S.C. — The government is improperly withholding payments from, and setting off debts owed by, a failed South Carolina Patient Protection and Affordable Care Act (ACA) co-operative insurer, illegally placing its own interests before those of policyholders and others entitled to priority, the insurer’s liquidator allege in an April 12 federal complaint filed in South Carolina (Raymond G. Farmer, et al. v. The United States of America, et al., No. 17-956, D. S.C.).

  • April 13, 2017

    Judge Finds ERISA Governs, Preempts, Dorsal Root Ganglion Coverage Spat

    SAN DIEGO — A man’s claim that an insurer improperly denied coverage for dorsal root ganglion (DRG) stimulation as a treatment for his debilitating pain invokes the Employee Retirement Income Security Act, a federal judge in California held April 10 in denying remand and dismissing the claims as preempted (Jesse Stevenson v. Aetna Health of California Inc.; Sharp Rees Stealy Medical Group, and DOES 1 to 10, inclusive, No. 17-107, S.D. Calif., 2017 U.S. Dist. LEXIS 55515).

  • April 13, 2017

    Washington Settles Class Suit Over Denial Of Hepatitis C Medication

    SEATTLE — A Washington federal judge on April 10 issued an order granting final approval of a settlement under which the Washington State Health Care Authority (WHCA) has agreed to provide coverage for direct-acting antiviral medications for the treatment of hepatitis C (HCV) for Medicaid enrollees who claimed that they were previously denied the drugs due to the cost (B.E., et al. v. Dorothy F. Teeter, No. 16-227, W.D. Wash.).

  • April 10, 2017

    Lack Of Private Enforcement Dooms Ex-Football Coach’s ACA Action, Judge Says

    OKLAHOMA CITY. — The Patient Protection and Affordable Care Act (ACA) lacks a private enforcement provision based on the limited amount of case law available, which dooms a former coach’s lawsuit against his collegiate employer, a federal judge in Oklahoma held April 5 (Dominique S. Ellis v. Regents for Oklahoma State University and Agricultural and Mechanical Colleges, No. 17-58, W.D. Okla., 2017 U.S. Dist. LEXIS 51661).

  • April 6, 2017

    Judge Finds Provider’s State Law Claims Preempted By ERISA

    NEWARK, N.J. — A medical provider’s state law claims attempting to recover almost $98,000 clawed back by an insurer implicate claims-processing issues governed by the Employee Retirement Income Security Act and are preempted, a federal judge in New Jersey held March 31 (Jason D. Cohen, M.D., FACS and professional orthopaedic Associates, et al. v. Horizon Blue Cross Blue Shield of New Jersey, No. 15-4528, D. N.J., 2017 U.S. Dist. LEXIS 49291).

  • April 6, 2017

    Consumer Group Defends ACA Pricing Data Injunction In Appeals Court Brief

    WASHINGTON, D.C. — An injunction requiring annual disclosure of Patient Protection and Affordable Care Act (ACA) insurance plan pricing data is necessary given past difficulties and the short time frame in which the data can conceivably help shoppers, a consumer group told a federal appeals court on March 15 (Center for the Study of Services d/b/a Consumers’ Checkbook v. United States Department of Health and Human Services, et al., No. 16-5296, D.C. Cir.).

  • April 6, 2017

    Judge Rejects Antitrust Claims In Cardiac Device Denial Of Coverage Case

    PHILADELPHIA — There is no evidence that an insurance group’s decision denying coverage for certain cardiac telemetry devices is anything more than a business decision, a federal judge in Pennsylvania held April 3 in dismissing antitrust claims with prejudice (LifeWatch Services Inc. v. Highmark Inc., et al., No. 12-5146, E.D. Pa., 2017 U.S. Dist. LEXIS 50176).