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Mealey's Health Care / ACA

  • June 20, 2018

    Insurer Says ERISA Preempts Hospital Group’s Case; Facts Don’t Support Claims

    SALT LAKE CITY — The Employee Retirement Income Security Act preempts a hospital group’s claims alleging underpayment of medical bills, but the claims would fail in any case because they involve insurer-insured rights and cannot be assigned to third parties, an insurer tells a federal judge in Utah in a June 15 memo (IHC Health Services Inc., et al. v. Blue Cross and Blue Shield of Texas Inc., No. 18-277, D. Utah).

  • June 18, 2018

    Plethora Of Interest Groups Urge Court Not To Enjoin ACA

    FORT WORTH, Texas — Striking down the Patient Protection and Affordable Care Act (ACA) because the government will no longer impose sanctions for not complying with the law’s individual mandate would harm public health and the economy and do violence to the separation of powers, a slew of medical, legal, business, economic, and social benefit amici argue in briefs filed in a federal court in Texas on June 14 (Texas, et al. v. U.S.A., et al., No. 18-167, N.D. Texas).

  • June 18, 2018

    Judge Finds Jurisdiction Over Deaf Man’s ACA Discrimination Claims Lacking

    BIRMINGHAM, Ala. — A man musters “no authority even remotely” suggesting that personal jurisdiction can arise from simply registering to do business in a state, a federal judge in Alabama held June 13 in dismissing Patient Protection and Affordable Care Act (ACA) and other claims against hospital entities for allegedly failing to provide a deaf man with an interpreter (Teddy Beasley v. Providence Hospital, et al., No. 18-0004, S.D. Ala., 2018 U.S. Dist. LEXIS 99572).

  • June 18, 2018

    Supreme Court Won’t Review ERISA Ruling Allowing Insured To Sue Hospital

    WASHINGTON, D.C. — The U.S. Supreme Court on June 18 declined to review a ruling by Oklahoma’s top court finding an insured’s class action challenging a health care provider’s billing practices outside of the Employee Retirement Income Security Act’s preemptive powers (INTEGRIS Health Inc. v. Elizabeth Cates, et al., No. 17-1501, U.S. Sup.).

  • June 15, 2018

    Appeals Court Says Insurers Can’t Recover ACA Risk-Corridor Payments

    WASHINGTON, D.C. — Health insurers may not collect billions in Patient Protection and Affordable Care Act (ACA) risk-corridor funds because Congress specifically blocked payments, a majority of the Federal Circuit U.S. Court of Appeals said June 14 (Land of Lincoln Mutual Health Insurance Co. v. United States, Moda Health Plan Inc. v. United States, Nos. 2017-1224, 2017-1994, Fed. Cir.).

  • June 14, 2018

    Spine Center’s Insurance Claims Belong In Ohio, Federal Judge Says

    TRENTON, N.J. — A spine center’s Employee Retirement Income Security Act suit seeking hundreds of thousands of dollars from a health insurance plan offered by an Ohio insurer and administered in that state should be litigated in the state as well, a New Jersey federal judge held in transferring the case June 12 (University Spine Center v. Anthem Blue Cross and Blue Shield, No. 17-8676, D. N.J., 2018 U.S. Dist. LEXIS 97947).

  • June 8, 2018

    9th Circuit: Mental Health Law Mandates Inpatient Room And Board Coverage

    SAN FRANCISCO — Health insurance plans covering room and board for medical and surgical procedures must do so for inpatient mental health stays as well under federal law, a Ninth Circuit U.S. Court of Appeals panel held June 6 in reinstating an Employee Retirement Income Security Act action (Danny P., et al. v. Catholic Health Initiatives, No. 16-35609, 9th Cir.).

  • June 6, 2018

    Amici Warn Of Domino Effect, Higher Health Costs If ERISA Preemption Ruling Stands

    WASHINGTON, D.C. — An Oklahoma Supreme Court ruling finding an insured’s suit against a provider outside ERISA’s preemption powers could topple the first domino in a chain leading to higher prices for health care generally, an amicus curiae group warns the nation’s top court in a June 4 brief urging it to review the ruling (INTEGRIS Health Inc. v. Elizabeth Cates, et al., No. 17-1501, U.S. Sup.).

  • June 6, 2018

    Court: UCL Claim Escapes ERISA Preemption, But Not Summary Judgment

    LOS ANGELES — Intentional tort claims escape ERISA preemption, but the failure to allege that insurance defendants denied payments specifically to assist a competing provider dooms a chiropractic care provider’s unfair competition law (UCL) claim, a California appeals court held in an opinion published June 1 (Port Medical Wellness Inc. v. Connecticut General Life Insurance Co., et al., No. B275874, Calif. App., 2nd Dist.).

  • June 1, 2018

    Amici Parties Urge 9th Circuit To Affirm Injunction In ACA Rules Case

    SAN FRANCISCO — States have standing to challenge federal rules expanding exemptions to the Patient Protection and Affordable Care Act (ACA) contraceptive mandate that were improperly enacted and will directly impact states’ budgets and residents, a flurry of amici curiae told the Ninth Circuit U.S. Court of Appeals on May 29 (California, et al. v. Alex M. Azar II, et al., Nos. 18-15144, 18-15166, 18-15255, 9th Cir.).

  • June 1, 2018

    Law Barring Review Cuts Off ACA Payment Denial Challenge, Judge Says

    WASHINGTON, D.C. — Federal law bars review of a government agency’s misclassification of a primary care doctor, dooming his attempt at recovering tens of thousands of dollars in incentive funds to which he is rightly entitled under the Patient Protection and Affordable Care Act (ACA), a judge in the U.S. Court of Federal Claims held May 30 (Robert E. Feiss, M.D., v. The United States, No. 17-1263C, Fed. Clms., 2018 U.S. Claims LEXIS 599).

  • June 1, 2018

    Air Evacuation Provider’s ACA, ERISA Suit Against Insurer Grounded, Judge Says

    LITTLE ROCK, Ark. — An emergency air evacuation company abandoned attempts to independently enforce the Patient Protection and Affordable Care Act (ACA), is not a plan beneficiary or participant and is precluded from trying to enforce the ACA through ERISA, a federal judge in Arkansas held May 29 (Air Evac EMS Inc. v. Usable Mutual Insurance Co., et al., No. 16-266, E.D. Ark., 2018 U.S. Dist. LEXIS 88919).

  • May 31, 2018

    Class Can’t Establish ACA Right Of Action, Companies Tell Federal Judge

    YAKIMA, Wash. — In the clear absence of an explicit private right of action, a class of insureds has not shown the Patient Protection and Affordable Care Act (ACA) includes an implied private right of action, three related entities told a federal judge in Washington in a trio of briefs in support of their motions to dismiss May 29 (Cynthia Harvey, et al. v. Centene Corp., et al., No. 18-12, E.D. Wash.).

  • May 30, 2018

    Medicare Preemption Doesn’t Reach Private Contracts, Hospital Group Says

    LOS ANGELES — Finding that private contracts are preempted under Medicare’s statutory and regulatory scheme would thwart Congress’ attempt at introducing market efficiencies in the program, a hospital group told a California judge May 25 (Prime Healthcare Services Inc. v. Humana Insurance Co., et al., No. 16-1097, C.D. Calif.).

  • May 30, 2018

    Federal Judge Dismisses Consumer Protection Claim In Health Coverage Spat

    CHICAGO — Allegations that a health insurer continued verifying insurance coverage and eligibility for a provider’s procedures despite flagging the account with the intent to deny coverage alleges no injury to patients or consumers, a federal judge in Illinois held May 24 in dismissing a consumer fraud claim (Connecticut General Life Insurance Co., et al. v. Southwest Surgery Center LLC, et al., No. 14-8777, N.D. Ill., 2018 U.S. Dist. LEXIS 87551).

  • May 29, 2018

    3rd Circuit Assignment Clause Ruling Ends Health Care Provider’s Suit

    NEWARK, N.J. — Recent Third Circuit U.S. Court of Appeals precedent makes it evident that a clear anti-assignment provision bars a spinal surgery center’s suit against a patient’s insurer, a New Jersey federal judge held May 24 (University Spine Center, et al. v. Anthem Blue Cross Blue Shield, No. 18-01103, D. N.J., 2018 U.S. Dist. LEXIS 86994).

  • May 29, 2018

    Florida Treatments, Payments Didn’t Put Maryland Insurer Before Court, Court Says

    FORT LAUDERDALE, Fla. — Blue Card Program participation ensuring a Maryland company’s insureds could receive care nationwide does not subject the company to personal jurisdiction in Florida simply because people sought care there, a state appeals court held May 23 (CareFirst of Maryland Inc. v. Recovery Village at Umatilla LLC, et al., No. 4D17-2247, Fla. App., 4th Dist., 2018 Fla. App. LEXIS 7271).

  • May 29, 2018

    In-Network Provider Says Communications With Insurer Created Implied Contract

    LOS ANGELES — An insurer and in-network provider of medical care participated in an ongoing discussion regarding a patient’s nearly monthlong care, creating an implied contract and supporting a quantum meruit claim, a provider tells a California federal judge in opposing dismissal on May 17 (Long Beach Memorial Medical Center v. Blue Cross and Blue Shield of South Carolina Inc., et al., No. 17-8181, C.D. Calif.).

  • May 21, 2018

    Health Insurer Says It Doesn’t Owe Billed Charges For 3-Month Contract Hiatus

    LOS ANGELES — A contract’s expiration did not create an implied agreement under which an insurer would pay a hospital its fully billed amount, the insurer tells a California judge in a May 16 memo seeking dismissal of the claims (El Camino Hospital v. Blue Cross of California, et al., No. 18-2103, N.D. Calif.).

  • May 21, 2018

    Insurer Says CPAP Purchase Isn’t Covered By Medical Plan

    PHILADELPHIA — A medical provider seeks recovery for an insured’s purchase of a CPAP machine, but the device isn’t covered under his plan, an insurer argues in a May 16 motion seeking dismissal of Employee Retirement Income Security Act claims (Florida Apnea Diagnostics, et al. v. Aetna Inc., et al., No. 18-1160, E.D. Pa.).