NEW ORLEANS — Responding to the U.S. Supreme Court’s June decision finding two individuals and a collection of states lacked standing to challenge the Patient Protection and Affordable Care Act (ACA) individual mandate, the Fifth Circuit U.S. Court of Appeals vacated a federal judge’s ruling and remanded the case for dismissal on July 22.
WASHINGTON, D.C. — The U.S. Supreme Court on July 21 requested that a medical provider respond to a joint petition after the company previously indicated that it would not do so.
ATLANTA — A lawsuit alleging that an insurer overstated the extent of its network never invokes claims that the insurer overcharged for premiums or misled the state into approving the premiums but instead involves breach of contract and deceptive business practices claims that do not implicate the filed-rate doctrine, insureds told a Georgia appeals court on June 22.
GREEN BAY, Wis. — Given the uncertainty around how to plead Parity Act claims, a judge on July 22 said in denying a motion to dismiss that he would rely on recent precedent requiring allegations that an insurer imposes more restrictive standards on mental health and substance abuse claims.
CINCINNATI — The Patient Protection and Affordable Care Act (ACA) incorporates standards from the discrimination statutes from which it borrows, including administrative exhaustion requirements, a court properly admitted experts on the question of the medical appropriateness of an elderly woman’s transfer, and without experts of his own, a son lacks the necessary evidence for his remaining claims, a Sixth Circuit U.S. Court of Appeals panel said July 20 in affirming dismissal and summary judgment rulings.
CINCINNATI — The Patient Protection and Affordable Care Act (ACA) borrows burdens and standards from discrimination laws, not their statute of limitations, and nothing in the law or precedent suggests otherwise, a deaf man tells the Sixth Circuit U.S. Court of Appeals July 20 in urging the court to apply a four-year period to his ACA claim.
WASHINGTON, D.C. — Class counsel on July 20 moved for the U.S. Court of Federal Claims to approve their attorney fee request of 5 percent of a $45,417,643.02 judgment for a subclass that consists of one insolvent insurer in insolvent insurers’ lawsuit seeking a declaratory judgment that the U.S. government owes them millions of dollars under the Patient Protection and Affordable Care Act (ACA) risk-corridor program.
DALLAS — Insureds’ assignment to medical providers included both rights to benefits under the Employee Retirement Income Security Act and legal action and transferred to the trustee upon the providers’ bankruptcy, a federal judge in Texas said July 19 in adopting a magistrate judge’s report recommending denial of a motion to dismiss.
SEATTLE — Insureds have not shown that more than a year of residential treatments were medically necessary under their health plan, a federal judge in Washington said July 15 in granting the insurer judgment after remand from the Ninth Circuit U.S. Court of Appeals.
INDIANAPOLIS — Binding precedent requires finding plaintiffs may pursue a discrimination claim against a recipient of federal funds under the Patient Protection and Affordable Care Act (ACA) and Rehabilitation Act, but the 41-year-old precedent could use a fresh look by the appellate court, a federal judge in Indiana said July 14 in denying reconsideration but granting interlocutory review.
TRENTON, N.J. — Conclusory statements do not establish the existence of assignment of rights where plaintiffs have not produced a single valid document for any of the 11 individuals, a federal judge in New Jersey said July 9 in dismissing Employee Retirement Income Security Act claims in a health insurance coverage case.
LOS ANGELES — An insurer argues in a June 28 response brief to the California Supreme Court that no conflict of law or important issue meriting review exists in a panel’s ruling that a medical association lacked standing to bring a California unfair competition law (UCL) claim against the insurer for restricting physicians from making referrals to out-of-network doctors because the association did not demonstrate that it was injured.
SALT LAKE CITY — A woman’s Parity Act claims alleging improper denial of coverage for residential treatments sufficiently allege that the insurer imposes acute level care requirements in such settings, a federal judge in Utah said June 21 in denying a motion to dismiss.
SAN FRANCISCO — Parties to a dispute over coverage and payment for care at residential treatment centers recently filed post-briefing letters with the Ninth Circuit U.S. Court of Appeals on the impact of the recent U.S. Supreme Court ruling in TransUnion LLC v. Ramirez, No. 20-297 (June 25, 2021) and on whether the insurer misstated the causation issue in its briefs or if the class was simply attempting to file a sur-reply “in the guise of purported error correction.”
NEW ORLEANS — Resolving a medical provider’s claim that the National Football League interfered with economic advantage by directing its insurer to classify health care claims as work related necessarily requires probing an Employee Retirement Income Security Act plan, and the statute completely preempts the state law claim, a Fifth Circuit U.S. Court of Appeals panel said July 1.
WASHINGTON, D.C. — The Supreme Court on July 2 agreed to decide whether emotional distress damages are available in a deaf and blind woman’s Patient Protection and Affordable Care Act (ACA) case alleging that a medical provider breached federal law by discriminating against her.
SAN FRANCISCO — The U.S. Supreme Court on July 2 agreed to review whether the interplay between the Patient Protection and Affordable Care Act (ACA) and the Rehabilitation Act permits disparate impact discrimination claims in a class action alleging that a pharmacy’s restrictions on HIV/AIDS drug delivery discriminated against sufferers.
WASHINGTON, D.C.— The U.S. Court of Federal Claims on June 28 entered a $45,417,643.02 judgment for a subclass that consists of one insolvent insurer in insolvent insurers’ lawsuit seeking a declaratory judgment that the U.S. government owes them millions of dollars under the Patient Protection and Affordable Care Act (ACA) risk-corridor program.
SACRAMENTO, Calif. — A health care company remains subject to a charity care condition attached to its purchase of a hospital after the California Supreme Court on June 30 declined to review whether the Patient Protection and Affordable Care Act (ACA)’s reduction in the number of uninsured was unforeseeable and required reducing the amount of indigent care the facility must provide.
AUSTIN, Texas — A health plan’s anti-assignment provision leaves a mental health and addiction treatment provider without standing to sue, and nothing in the insurer’s actions waived the provision or estops it from asserting the defense, a federal judge in Texas said June 25 in granting the defendants’ motion to dismiss.