Mealey's Health Care / ACA

  • May 14, 2021

    6th Circuit Takes Up ACA Discrimination Statute Of Limitation Case

    CINCINNATI — The Sixth Circuit U.S. Court of Appeals on April 30 agreed to decide whether Patient Protection and Affordable Care Act (ACA) discrimination claims are subject to the four-year statute of limitations under federal law or the applicable state law for personal injury actions.

  • May 14, 2021

    Hospital Group Takes Charity Care Mandate Case To California High Court

    SACRAMENTO, Calif. — There was no way to foresee the dramatic reduction in uninsured care created by the regulatory wave that post-dated the Patient Protection and Affordable Care Act (ACA) or even whether the law would survive the myriad legal challenges it faced, a hospital group told the California Supreme Court on April 22 in urging review of its challenge to charity care obligations imposed as a condition of its purchase of a nonprofit hospital (Deanco Healthcare LLC, et al. v. Xavier Becerra, et al., No. S268383, Calif. Sup.).

  • May 12, 2021

    Proposed Intervenors Tell High Court Title X Abortion Rule Case Remains Live

    WASHINGTON, D.C. — The government’s attempts to issue a new rule and abandon an existing 2019 rule governing abortion counseling in Title X cases does not render the issue dead  as litigation and guidance from the court will remain a focal point, two proposed intervenors in a trio of cases told the U.S. Supreme Court May 10 in arguing that a live issue remained for review.

  • May 12, 2021

    Judge: Vague Allegations Can’t Sustain Hospitals’ Out-Of-Network Care Claims

    MIAMI — A group of hospitals’ vague allegations lack any specifics regarding treatments, insureds or dates of care, rendering it impossible to determine whether standing exists as to any of the state law claims alleging under-compensation for out-of-network care, a federal judge in Florida said May 10 in dismissing a suit.

  • May 12, 2021

    Emergency Care Coverage Case Invoking ACA Belongs In State Court, Judge Says

    KEY WEST, Fla. — A Patient Protection and Affordable Care Act (ACA) provision governing coverage for emergency medical care does not create a private right of action or give rise to a federal question in a case challenging denial of coverage, a federal judge in Florida said May 10 in remanding.

  • May 06, 2021

    Insurer: No Need For Texas Top Court Certified Question In Emergency Care Case

    HOUSTON — Texas law clearly rejects the creation of an implied right of action in the state’s emergency care law, but a certified question to the Texas Supreme Court is unwarranted anyway because a federal appeals court can decide the case on the question of preemption under the Employee Retirement Income Security Act, an insurer argues in a May 3 response to a request that the Fifth Circuit U.S. Circuit Court of Appeals certify a question.

  • April 29, 2021

    Federal Employee’s Proton Beam Coverage Case Fails, Judge Says

    HOUSTON — A federal employee’s state law claims arising from denial of her insurance claim for proton beam therapy are preempted by federal law, a federal judge in Texas said April 26 in granting two motions to dismiss.

  • April 22, 2021

    Federal Judge Allows Claims To Proceed In Dispute Involving Insolvent Health Plan

    CHICAGO — A federal judge in Illinois on March 31 granted in part and denied in part insurance brokers’ motion to dismiss a lawsuit alleging that they breached their duty of care because they knew or should have known that a multiple employer welfare arrangement (MEWA) was not in compliance with its structural requirements and was not financially sound.

  • April 21, 2021

    ERISA Preempts Orthopedic Provider’s State, Common-Law Claims, Judge Says

    CAMDEN, N.J. — Because resolution of both common-law and state law claims involving alleged underpayment for medical service would require reference to Employee Retirement Income Security Act plans, that law preempts the case, a federal judge in New Jersey said April 19 in granting dismissal.

  • April 21, 2021

    E&O Coverage Suit Stayed Following Liquidation Order Against Excess Insurer

    KANSAS CITY, Kan. — A federal magistrate judge in Kansas on April 7 granted Blue Cross Blue Shield of Kansas Inc.’s motion to stay a consolidated lawsuit brought by primary and excess managed care organization errors and omissions insurers disputing coverage for underlying antitrust class actions after a Pennsylvania court granted the state’s insurance commissioner’s liquidation order against the excess insurer.

  • April 19, 2021

    Judge: Health Care Providers’ ERISA, UCL Claims Survive Dismissal

    LOS ANGELES — Substance abuse providers’ allegation that they lost revenue as a result of an insurers’ pricing scheme keeps a California unfair competition law (UCL) claim alive, and vague references to an appeals process are not enough to require administrative exhaustion before suit under the Employee Retirement Income Security Act, a federal judge in California said April 14 in partially denying motions to dismiss.

  • April 16, 2021

    Insolvent Insurers, U.S. Jointly Move To Divide Subclass, Request $23M Judgment

    WASHINGTON, D.C. — A dispute subclass of insolvent insurers and the U.S. government on April 13 jointly moved to divide a dispute subclass into two subclasses and requested that the U.S. Court of Federal Claims enter a $23,301,140.37 judgment in favor of the newly created subclass in the insurers’ lawsuit seeking declaratory judgment that the government owes them millions of dollars under the Patient Protection and Affordable Care Act (ACA) risk-corridor program.

  • April 15, 2021

    Health Care Provider Has Standing, Was In Network, Missouri Court Says

    KANSAS CITY, Mo. — Assignment of benefits gives a health care provider standing for a claims reimbursement suit, and it provided in-network care as a member of MultiPlan Inc., a Missouri appeals court said April 13 in partially reversing several summary judgment rulings.

  • April 15, 2021

    Insurer Says ERISA Merits Determination Case Doesn’t Warrant Top Court Review

    BOSTON — Regardless of differences in how courts describe the process for deciding Employee Retirement Income Security Act cases, the reality is that they all follow the same basic procedure, and a woman waived complaints about reliance on deciding her case through summary judgment process by advocating for that outcome, a health insurer tells the U.S. Supreme Court in an April 14 brief opposing review.

  • April 12, 2021

    United States Says Precedent Supports ACA Cost-Sharing Offsets

    WASHINGTON, D.C. — Offsetting damages from the failure to make payments under the Patient Protection and Affordable Care Act (ACA) with the benefits insurers gained from tax credits under “silver loading” is completely in keeping with limitations under applicable contract law, the government tells the U.S. Supreme Court April 9 in opposing a petition for review.

  • April 12, 2021

    Divided 5th Circuit Denies Rehearing In ACA-Medicaid Actuarial Fee Case

    NEW ORLEANS — A revised Fifth Circuit U.S. Court of Appeals panel ruling finding the certification rule imposed on Medicaid managed care organization under the Patient Protection and Affordable Care Act (ACA) lawful stands after the court denied en banc review in a divided vote on April 9.  In dissenting from the denial, a judge of the court said the decision allowing delegation of congressional power to a private entity “desecrates the entire premise of our constitutional democracy.”

  • April 12, 2021

    Insurer, Amicus Say ERISA Plaintiffs, Judge Missed Key Causation Requirements

    SAN FRANCISCO — A federal judge’s narrow focus on certain plan language and process violations under the Employee Retirement Income Security Act delinked an insurer’s coverage decision from any actual harm to insureds, an insurer and its amicus argue in March 26 and March 15 briefs asking the Ninth Circuit U.S. Court of Appeals to reverse the judge’s liability ruling in favor of the insureds.

  • April 12, 2021

    Insurer Appeals After Judge Bases Health Benefits Award On Nonparty Agreements

    BOZEMAN, Mont. — An insurer on April 5 appealed to the Ninth Circuit U.S. Court of Appeals a Montana federal judge’s grant of reconsideration and conclusion that a mental health provider’s agreement with other Blue Cross entities could serve as the benchmark for an award of benefits in an Employee Retirement Income Security Act benefits case.

  • April 12, 2021

    Insurer Petitions 5th Circuit On Texas Emergency Care Laws, ERISA Preemption

    HOUSTON —  A health insurance company has asked the Fifth Circuit U.S. Circuit Court of Appeals whether Texas’ emergency care laws create an implied private right of action and whether the Employee Retirement Income Security Act preempts claims under those laws in a Feb. 23 petition for permission to appeal on certified questions.

  • April 09, 2021

    Georgia Court To Decide Whether Filed-Rate Doctrine Bars Insurance Plan Fraud Case

    ATLANTA — The Georgia Court of Appeals on March 31 agreed to decide whether the filed-rate doctrine precludes claims that an insurer fraudulently inflated its in-network provider list for Patient Protection and Affordable Care Act (ACA)-compliant plans.