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Mealey's Health Care / ACA

  • February 27, 2020

    Judge:  Insurer Never Requested Procedures, Dooming Provider’s Quantum Meruit Claim

    SAN JOSE, Calif. — There is no evidence that an insurer requested that a spine surgery provider perform procedures on insureds, dooming the provider’s quantum meruit claim, a California federal judge held Feb. 24 (California Spine and Neurosurgery Institute v. United Healthcare Insurance Co., et al., No. 19-2417, N.D. Calif., 2020 U.S. Dist. LEXIS 32056).

  • February 24, 2020

    ACA Mandate Petitioners: Cross-Petition Is Wrong, But Appropriate

    WASHINGTON, D.C. — While wrong on the merits, various states’ cross-petition provides the opportunity for consideration of all issues surrounding a Patient Protection and Affordable Care Act (ACA) individual mandate challenge, two petitioners told the U.S. Supreme Court in letter briefs filed Feb. 19 (Texas, et al. v. State of California, et al., No 19-1019, U.S. Sup.).

  • February 20, 2020

    Insured Still Can’t Link Payment Claims, Health Plan, Judge Says

    TRENTON, N.J. — In once again dismissing an action seeking additional compensation under a health plan for reconstructive breast surgery, a federal judge in New Jersey said Feb. 18 that the conclusory allegations do not give rise to an Employee Retirement Income Security Act claim (K.S. v. Thales USA Inc., et al., No. 17-7489, D. N.J., 2020 U.S. Dist. LEXIS 26812).

  • February 20, 2020

    Medical Provider’s Boilerplate Pleading Goes Too Far, Judge Says

    TRENTON, N.J. — Two medical providers’ suit takes “boilerplate pleading too far” by never adequately alleging standing to pursue an Employee Retirement Income Security Act suit, or even any relationship between the patient and insurer, a federal judge in New Jersey held Feb. 18 (University Spine Center, et al. v. Anthem Blue Cross of California, et al., No. 19-12639, D. N.J., 2020 U.S. Dist. LEXIS 27549).

  • February 19, 2020

    Judge Enjoins Title X Abortion Rules In Maryland

    BALTIMORE — A federal judge in Maryland on Feb. 14 enjoined rules governing Title X funding and the separation of abortion services from other medical services after largely finding for the plaintiffs.  An appeal of an earlier ruling that the rules violated the Patient Protection and Affordable Care Act (ACA) remains pending before the Fourth Circuit U.S. Court of Appeals (Mayor and City Council of Baltimore v. Alex M. Azar II, et al., No. 19-1103, D. Md., 2020 U.S. Dist. LEXIS 26061).

  • February 18, 2020

    Deaf Woman Takes ACA Discrimination Suit To 2nd Circuit

    NEW YORK — A deaf woman on Jan. 23 filed a notice of appeal indicating that she would take to the Second Circuit U.S. Court of Appeals a judge’s ruling applying New York state’s three-year statute of limitations to her Patient Protection and Affordable Care Act (ACA) discrimination case (Lissette Vega-Ruiz v. Northwell Health, et al., No. 19-537, S.D. N.Y.).

  • February 13, 2020

    Magistrate Judge Recommends Remanding Insurance Billing Spat

    FORT LAUDERDALE, Fla. — An orthopedic specialist challenges only the rate of compensation and seeks payment under Florida law, putting it outside the reach of the Employee Retirement Income Security Act, a federal magistrate judge said Feb. 10 in recommending remand (Orthopaedic Care Specialists v. Aetna Life Insurance Co., No. 19-81381, S.D. Fla., 2020 U.S. Dist. LEXIS 23983).

  • February 13, 2020

    Florida Federal Judge Allows Some Claims Despite ‘Shotgun Pleading’

    FORT LAUDERDALE, Fla. — Only the portion of an orthopedic surgery provider’s claims based on health insurance plans without an anti-assignment provision may proceed, a federal judge in Florida said Feb. 6 in again warning the plaintiff not to continue with its “shotgun pleading” style (Columna Inc. v. Cigna Health and Life Insurance Co., No. 19-80170, S.D. Fla.).

  • February 12, 2020

    Parity Act, ERISA Claims Proceed In Mental Health Coverage Case, Judge Says

    SALT LAKE CITY — Father-daughter plaintiffs adequately allege that their health insurer applies different standards to mental health and substance abuse claims than they would medical and surgical claims when making coverage decisions, a federal judge in Utah said Feb. 7 (David P., et al. v. United Healthcare Insurance Co., et al., No. 19-225, D. Utah).

  • February 12, 2020

    Categorical Exclusions Keep Parity Act Claims Alive, Federal Judge Says

    SALT LAKE CITY — An action alleging that a health insurer categorically denies coverage for wilderness and substance abuse programs may go forward after a federal judge in Utah on Feb. 7 declined to dismiss the claims (Johnathan Z., et al. v. Oxford Health Plans, No. 18-383, D. Utah., 2020 U.S. Dist. LEXIS 21968).

  • February 11, 2020

    Magistrate Judge Dismisses Hospital’s Underpayment Case Against Insurer

    MIAMI — Nothing mandates that health insurance policies incorporate Patient Protection and Affordable Care Act (ACA) protections or state law governing emergency care payments, and a hospital’s suit seeking unpaid bills largely fails, a federal magistrate judge in Florida said Feb. 6 (Boca Raton Regional Hospital Inc., et al. v. Celtic Insurance Co., et al., No. 19-80650, S.D. Fla., 2020 U.S. Dist. LEXIS 21612).

  • February 06, 2020

    CalPERS Escapes Hospital’s Payment Suit, Court Says

    LOS ANGELES — A contract between California’s public retirement system and an insurer does not confer benefits on a health care provider, and the provider’s own contract with the insurer does not create a payment obligation on the part of the system, a California appeals court held Feb. 5 (County of Monterey v. California Employees Retirement System, No. H045977, Calif. App., 6th Dist., 2020 Cal. App. Unpub. LEXIS 848).

  • February 05, 2020

    Respondents: Supreme Court Should Wait To Review ACA Individual Mandate Case

    WASHINGTON, D.C. — There is no need for the U.S. Supreme Court to weigh in on an interlocutory order finding standing and that the individual mandate is unconstitutional when it can simply bide its time and address a more full record later, three respondents and an amicus curiae party tell the court in Feb. 3 briefs (California, et al. v. Texas, et al, No. 19-840, United States House of Representatives v. Texas, et al., No. 19-841, U.S. Sup.).

  • January 30, 2020

    5th Circuit Won’t Take ACA Individual Mandate Case En Banc

    NEW ORLEANS — The Fifth Circuit U.S. Court of Appeals on Jan. 29 declined en banc rehearing in a Patient Protection and Affordable Care Act (ACA) individual mandate case after one of its members asked that the court be polled on the question.  A pair of petitions for review are pending before the U.S. Supreme Court (Texas, et al. v. United States, et al., No. 19-10011, 5th Cir.).

  • January 30, 2020

    More Briefs Sought In Dispute Over Out-Of-Pocket Nursing Home Costs

    HARTFORD, Conn. — A class of Medicare recipients and the Secretary of Health and Human Services (HHS) were asked by a federal judge in Connecticut on Jan. 28 to brief a new series of questions in a lawsuit over out-of-pocket costs for admission to a skilled nursing facility (SNF) after being designated as outpatients receiving observation (Christina Alexander, et al. v. Alex M. Azar II, No. 11-1703, D. Conn.).

  • January 29, 2020

    ACA Discrimination Claim Untimely Under Borrowed Statute, Judge Says

    BATON ROUGE, La. — The Patient Protection and Affordable Care Act (ACA) borrows from other statutes to ban discrimination, and this borrowing includes the underlying statutes of limitations, a federal judge in Louisiana held Jan. 24 in granting summary judgment (Tracy D. Ward v. Our Lady of the Lake, et al., No. 18-454, M.D. La., 2020 U.S. Dist. LEXIS 12258).

  • January 28, 2020

    ACA Can’t Support Emotion Distress Damages, 5th Circuit Says

    NEW ORLEANS — The Patient Protection and Affordable Care Act (ACA) does not permit damages for emotional distress for a deaf and blind woman’s alleged discrimination, a Fifth Circuit U.S. Court of Appeals panel said Jan. 24 (Jane Cummings v. Premier Rehab Keller PLLC, et al., No. 19-10169, 5th Cir., 2020 U.S. App. LEXIS 2250).

  • January 24, 2020

    Magistrate Judge Finds Insurer Violated ERISA, Improperly Denied Coverage

    CLEVELAND — An insurer’s procedural errors violated the Employee Retirement Income Security Act, and it improperly denied coverage for spinal surgery, a federal magistrate judge in Ohio said Jan. 22 (Keith W. Canter v. Alkermes Blue Care Elect Preferred Provider Plan, et al., No. 17-399, S.D. Ohio).

  • January 23, 2020

    Judge: Forum Clause Needs Briefing In Toxicology Provider’s ERISA Suit

    FORT LAUDERDALE, Fla. — Anti-assignment provisions largely doom a toxicology service provider’s suit seeking payment, but the parties must brief the court on how to handle one surviving defendant’s forum-selection clause requiring litigation in California, a federal judge in Florida said Jan. 17 (Apex Toxicology LLC v. United Healthcare Services Inc., et al., No. 17-61840, S.D. Fla., 2020 U.S. Dist. LEXIS 9992).

  • January 22, 2020

    Lactation Services Plaintiffs Lose Expert Testimony, Class Certification Motion

    CHICAGO — An Illinois federal judge on Jan. 21 stripped plaintiffs suing their insurer over lactation services coverage under the Patient Protection and Affordable Care Act (ACA) of their expert witness testimony for lack of reliability and then denied their bid for class certification for lack of common issues (Laura Briscoe, et al. v. Health Care Service Corporation, et al., No. 1:16-cv-10294, N.D. Ill., 2020 U.S. Dist. LEXIS 9447).