SEATTLE — An insurer on May 31 noticed an appeal challenging a $123,849 judgment awarded to plaintiffs who prevailed in their case claiming improper denial of residential treatment under the Employee Retirement Income Security Act (Todd R., et al. v. Premera Blue Cross Blue Shield of Alaska, No. 17-1041, W.D. Wash.).
WASHINGTON, D.C. — The Kentucky Supreme Court erred in concluding that a Medicaid recipient’s lack of financial interest left her without standing to a pursue a fair hearing as required by a federal program, a woman argues in a May 15 petition asking the U.S Supreme Court for a writ of certiorari. The insurer on May 29 told the court that it would not respond to the petition (Lettie Sexton, et al. v. Commonwealth of Kentucky, et al., No. 18-1446, U.S. Sup.).
BOULDER, Colo. — A federal judge on May 24 granted a motion for fees, costs and final approval to a settlement resolving claims that an insurer reimbursed out-of-network providers of behavioral health care differently than in-network providers (Laural O’Dowd, et al. v. Anthem Inc., et al., No. 14-2787, D. Colo., 2019 U.S. Dist. LEXIS 88292).
FORT LAUDERDALE, Fla. — An out-of-network health care provider’s state law claims will proceed after a federal judge in Florida on May 28 issued a one-page order adopting a report and recommendation over the objections of the insurer (GVB MD LLC, et al. v. United Healthcare Insurance Co., No. 19-20727, S.D. Fla.).
WASHINGTON, D.C. — The United States never grapples with the disastrous consequences and far-reaching impact a decision allowing the government to simply skip out on Patient Protection and Affordable Care Act (ACA) risk-corridor obligations, a pair of insurers tell the U.S. Supreme Court in reply briefs filed May 22 and May 24 (Land of Lincoln Mutual Health Insurance Co. v. United States, No. 18-1038, Moda Health Plan Inc., et al. v. United States, No. 18-1028, Maine Community Health Options v. United States, No. 18-1023, U.S. Sup.).
SACRAMENTO, Calif. — A newly issued rule permits doctors and staff to deny basic health care based on hunches, violating federal and state laws ensuring patient safety and access to care, the state of California claims in a May 21 complaint (State of California, et al. v. Alex M. Azar, et al., No. 19-2769, N.D. Calif.).
FRANKFORT, Ky. — A health care provider must pay for an insurer’s costs in preparing for a second deposition after its original corporate witness’s near total failure to prepare, a federal judge in Kentucky said May 21 (PremierTox 2.0 Inc. v. Coventry Health and Life Insurance Co., No. 15-127, W.D. Ky., 2019 U.S. Dist. LEXIS 85017).
ATLANTA — Insubstantial procedural errors do not require anything other than the capricious and arbitrary standard in an Employee Retirement Income Security Act case challenging an insurer’s denial of coverage for eating disorder treatments, an 11th Circuit U.S. Court of Appeals panel held May 15 (O.D. v. Jones Lang LaSalle Medical PPO Plus Plan, No. 17-13060, 11th Cir., 2019 U.S. App. LEXIS 14385).
EVANSVILLE, Ind. — A company tasked with paying health insurance claims cannot be liable in a hospital’s case against the issuer of a stop-loss policy, a federal judge in Indiana said May 13 (Memorial Hospital and Health Care Center v. Houston International Insurance Group, et al., No, 18-225, S.D. Ind., 2019 U.S. Dist. LEXIS 80522).
MIAMI — Defendants portrayed health insurance products as comprehensive plans compliant with the Patient Protection and Affordable Care Act (ACA) when in reality they offered little to no coverage, a federal judge in Florida held May 14 in granting a motion for injunction, asset freeze and continued receivership (Federal Trade Commission v. Simple Health Plans LLC, et al., No. 18-62593, S.D. Fla.).
WASHINGTON, D.C. — The Supreme Court again confronts the question of whether the Patient Protection and Affordable Care Act (ACA)’s contraceptive mandate infringes on religious objectors’ rights under federal law, as it receives dueling briefs in the latest development in the litigation. California filed its response to the Supreme Court petition for certiorari review on May 13 (Little Sisters of the Poor Jeanne Jugan Residence v. California, et al., No. 18-1192, U.S. Sup.).
WASHINGTON, D.C. — Congress never appropriated funds for the Patient Protection and Affordable Care Act (ACA) cost-sharing reduction program and, thus, never created a duty to make those payments, the United States tells a U.S. Court of Federal Claims judge in a May 9 reply (Blue Cross And Blue Shield of North Dakota v. The United States, No. 18-1983C, Fed. Clms.).
FORT LAUDERDALE, Fla. — A medical provider’s Employee Retirement Income Security Act claims fail because it has not shown that it exhausted its administrative remedies, but its state law claims are not preempted simply because some may invoke ERISA and largely may proceed, a federal judge in Florida said May 9 (GVB MD LLC, et al. v. United Healthcare Insurance Co., No. 19-20727, S.D. Fla.).
WASHINGTON, D.C. — The United States told the Supreme Court on May 8 that the Patient Protection and Affordable Care Act’s risk corridor never entitled insurers — some of them now defunct — to subsidies and that Congress’ latter actions erased any duty the law imposed (Land of Lincoln Mutual Health Insurance Co. v. United States, No. 18-1038, Moda Health Plan Inc., et al. v. United States, No. 18-1028, Maine Community Health Options v. United States, No. 18-1023, U.S. Sup.).
RALEIGH, N.C. — The little guidance on a North Carolina law requiring that insurers treat pharmacies equally does not support the conclusion that denying access for failing to meet the network standards violates the statute, a federal judge in North Carolina held May 7 (Senderra RX Partners LLC v. Blue Cross Blue Shield of North Carolina, No. 18-871, M.D. N.C.).
LOS ANGELES — Various anti-assignment provisions largely preclude 24 of the 164 claims brought by out-of-network health care providers, a federal judge in California held May 3 (Infoneuro Group, et al. v. Aetna Life Insurance Co., No. 16-5083, C.D. Calif.).
BOSTON — While the exact amount of Massachusetts’ alleged injury from rules granting expanded employers expanded exemptions to the Patient Protection and Affordable Care Act (ACT) may not be known, it stands to reason that it is not zero and provides injury and standing, a First Circuit U.S. Court of Appeal panel held May 2 (Massachusetts v. United States Department of Health and Human Services, et al., No. 18-1514, 1st Cir., 2019 U.S. App. LEXIS 13293).
SAN FRANCISCO — A judge’s conclusion that an insurer violated the standards of care in denying coverage for intensive residential health care and substance abuse treatments requires changes to its business practices and court instruction on the processing of claims, plaintiffs in two Employee Retirement Income Security Act class actions told a federal judge in California on May 3. But in a motion seeking decertification of the class filed the same day, the insurer says the plaintiffs have not shown that common issues dominate the case (David and Natasha Wit, et al. v. United Behavioral Health, No. 14-02346, Gary Alexander, et al. v. United Behavioral Health, No. 14-5337, N.D. Calif.).
WASHINGTON, D.C. — The Department of Labor on May 1 appealed to the District of Columbia Circuit U.S. Court of Appeals a ruling invalidating a Patient Protection and Affordable Care Act (ACA) rule expanding the availability of association health plans that the court found did “violence” to the Employee Retirement Income Security (ERISA) definition of an employer (New York, et al. v. U.S. Department of Labor, et al., No. 19-5125, D.C. Cir.).
MIAMI — United Healthcare Insurance Co. (UHC) improperly categorizes proton beam radiation therapy (PBRT) as experimental in an effort to save money despite decades of its use as a prostate cancer treatment, a putative class alleges in an April 22 complaint in Florida federal court (Richard Cole, et al. v. United Healthcare Insurance Co., No. 19-21258, S.D. Fla.).