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.
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.).
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.”
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.
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.
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.
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.