Mealey's Health Care / ACA

  • July 14, 2020

    Judge Finds Allegations Support As-Applied Parity Act Claim

    SALT LAKE CITY — Plaintiffs’ claims that a health insurer imposes short-term stays and more stringent care guidelines for residential treatment centers than it does in other medical settings adequately allege a Parity Act violation, even where the plan itself does not facially create such a disparity, a federal judge in Utah said June 24 in declining to dismiss the action (James C., et al. v. Anthem Blue Cross and Blue Shield, No. 19-38, D. Utah, 2020 U.S. Dist. LEXIS 111689).

  • July 14, 2020

    U.S. House Passes Bill Creating $100 Billion Reinsurance Program

    WASHINGTON, D.C. — A bill calling for $100 billion for state reinsurance programs designed to enhance Patient Protection and Affordable Care Act (ACA) protections and encourage state adoption of the Medicaid expansion passed the U.S. House of Representatives on June 29 on a 234-179 vote.

  • July 14, 2020

    ACA Mandates Lactation Services Coverage, Not Provider List, 8th Circuit Says

    ST. LOUIS — The Patient Protection and Affordable Care Act (ACA) mandates that insurers cover out-of-network lactation services if they do not offer in-network care, but nothing in the law requires them to expand their networks or provide a list of services offered by each covered provider, the Eighth Circuit U.S. Court of Appeals said July 13 (Jillian York, et al. v. Wellmark Inc., et al., No. 19-1705, 8th Cir.).

  • July 14, 2020

    Federal Judge Enjoins Separate Billing Rule As Contrary To ACA

    BALTIMORE — A Health and Human Services rule requiring insurers to bill premiums for abortion services separately violates the Patient Protection and Affordable Care Act (ACA) prohibition on erecting barriers to care and is arbitrary and capricious, a federal judge in Maryland held July 9 in enjoining the rule (Planned Parenthood of Maryland Inc., et al. v. Alex M. Azar II, et al., No. 20-361, D. Md., 2020 U.S. Dist. LEXIS 121163).

  • July 14, 2020

    Florida Rehab Facility Largely Loses Payment Case Against Insurer

    MIAMI — A drug rehabilitation facility’s now abandoned claim that it represents patients in a suit against an insurer resulted in years of costly litigation, but more problematic is the fact that it does not appear to have the power to bring suit at all, a federal judge in Florida said June 30 (Chiron Recovery Center LLC, et al. v. United Healthcare Services Inc., et al., No. 18-81761, S.D. Fla., 2020 U.S. Dist. LEXIS 114353).

  • July 10, 2020

    Judge:  Insured, Provider Didn’t Cure Flaws In Appeal In Time

    SALT LAKE CITY — A provider’s appeal lacked the necessary approval from the insured, and the period for appeals expired before they remedied the flaws, a federal judge in Utah said July 6 in granting judgment in an Employee Retirement Income Security Act case (C.L., et al. v. Newmont USA Limited, et al., No. 18-192, D. Utah).

  • July 08, 2020

    Supreme Court Reverses Injunction In ACA Birth Control Exception Rules Case

    WASHINGTON, D.C. — The Patient Protection and Affordable Care Act (ACA) granted government agencies “virtually unbridled discretion” over what constitutes preventive care, including the power to issue exemptions for religious and moral objectors to the law’s contraceptive mandate, the U.S. Supreme Court said July 8 in a 7-2 opinion, reversing the Third Circuit and dissolving a nationwide injunction (Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania, et al., Donald J. Trump, et al. v. Pennsylvania, Nos. 19-431, 19-454, U.S. Sup.).

  • July 06, 2020

    Virginia Judge: Emergency Care Statute’s Private Right Of Action Permits Suit

    FAIRFAX, Va. — Virginia law requiring insurers to pay for emergent care includes a private right of action allowing a provider to sue a patient’s insurer, a Virginia state judge said June 30 (Dominion Surgical Specialties LLC v. Anthem Healthkeepers Inc., No. CL-2019-0010310, Va. Cir., Fairfax Co., 2020 Va. Cir. LEXIS 87).

  • July 06, 2020

    Judge Approves California Competition Law Balance Billing Class Settlement

    LOS ANGELES — A federal judge in California on June 30 granted final approval of a California unfair competition law class action settlement resolving claims that patients who visited in-network hospitals were subject to balance billing after receiving treatment from out-of-network providers (Renee MacLaughlan Bozarth, et al. v. Envision Healthcare Corp., et al., No. 17-1935, C.D. Calif., 2020 U.S. Dist. LEXIS 117294).

  • July 06, 2020

    5th Circuit Denies Bid For Fees, Says ERISA Claimant Needs ‘Success On Merits’

    NEW ORLEANS — A woman who won a “procedural” victory in a federal appeal over an insurer’s partial denial of coverage for hospitalization to treat an eating disorder will have to score a win on the merits of her claim before she seeks an attorney fee award for the cost of that appeal, a panel of the Fifth Circuit U.S. Court of Appeals ruled June 29 (Katherine P. v. Humana Health Plan, Inc., No. 19-50276, 5th Cir., 2020 U.S. App. LEXIS 20404).

  • June 29, 2020

    Judge Finds No Error In Parity Act, ERISA Discovery Case Ruling

    SALT LAKE CITY — A magistrate judge did not err in granting discovery into Parity Act and Employee Retirement Income Security Act document production issues in a residential treatment case, a federal judge in Utah said June 26 (Jane Doe v. Intermountain Healthcare Inc., et al., No. 18-00807, D. Utah, 2020 U.S. Dist. LEXIS 112772).

  • June 26, 2020

    Administration Tells Supreme Court Entire ACA Must Fall

    WASHINGTON, D.C. — Absent a tax on those who fail to comply with the Patient Protection and Affordable Care Act (ACA) individual mandate, the logic upholding the provision fails, and the entire law falls as a result, the administration told the U.S. Supreme Court in a June 25 brief (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.).

  • June 26, 2020

    Amicus States Say Pandemic Requires Opening ACA Health Exchanges

    WASHINGTON, D.C. — The novel coronavirus poses the type of “exceptional circumstance” requiring that Patient Protection and Affordable Care Act (ACA) health care insurance exchanges be opened for a special enrollment period, California and 13 other states tell a federal judge in the District of Columbia in a June 22 amicus curiae brief (Chicago v. Alex M. Azar II, et al., No. 20-1566, D. D.C.).

  • June 25, 2020

    LGBTQ Protection Rollback Violates ACA, Supreme Court Precedent, Lawsuit Claims

    WASHINGTON, D.C. — A rule rolling back health care protections for LGBTQ individuals violates the Patient Protection and Affordable Care Act (ACA) prohibition on discrimination as well as recent precedent in Bostock v. Clayton Cty., Ga. finding that the definition of sex covers transgendered individuals, a host of providers and rights groups seeking injunctive and declaratory relief in a federal court in the District of Columbia say in a June 22 lawsuit (Whitman-Walker Clinic, et al. v. U.S. Department of Health and Human Services, et al., No. 20-1630, D. D.C.).

  • June 25, 2020

    Government Prevails In ACA Hospital Pricing Rule Challenge

    WASHINGTON, D.C. — Hospital price disclosure rules crafted in furtherance of the Patient Protection and Affordable Care Act (ACA) and transparency are legal, as are enforcement measures, a federal judge in the District of Columbia said June 23 (The American Hospital Association, et al. v. Alex M. Azar II, et al., No. 19-3619, D. D.C., 2020 U.S. Dist. LEXIS 110130).

  • June 23, 2020

    Parity Act Discovery Exceeds That Of ERISA, Federal Judge Says

    SALT LAKE CITY — While Employee Retirement Income Security Act cases strictly limit discovery, plaintiffs are entitled to more when alleging distinct Parity Act claims, a federal judge in Utah said June 19 (Michael W., et al. v. United Behavioral Health, et al., No. 18-818, D. Utah, 2020 U.S. Dist. LEXIS 108103).

  • June 22, 2020

    Parity Act Permits Discovery; Claim Survives Dismissal, Federal Judge Says

    SALT LAKE CITY — The existence of an Employee Retirement Income Security Act claim does not preclude discovery into a Parity Act claim, and nothing prevents plaintiffs from pleading the latter as an alternative to the former, a federal judge in Utah said June 18 (Denise M., et al. v. Cigna Health and Life Insurance Co., et al., No. 19-975, D. Utah, 2020 U.S. Dist. LEXIS 108097).

  • June 22, 2020

    High Court Denies Cert Over Denial Of Attorney Fees After ‘Procedural’ Win

    WASHINGTON, D.C. — The U.S. Supreme Court revealed in a June 22 orders list that it will not weigh in on claims that the Fifth U.S. Circuit Court of Appeals wrongly denied an attorney fees award to a plan participant who, in an earlier appeal, won a “procedural” victory over health benefits governed by the Employee Retirement Income Security Act (Ariana M. v. Humana Health Plan of Texas, Inc., No. 19-980, U.S. Sup.).

  • June 22, 2020

    Judge Denies Man’s Request To Transfer Criminal Health Care Fraud Suit

    HARTFORD, Conn.  — A federal judge in Connecticut on June 18 denied a motion to transfer filed by a former substance abuse clinic owner who is accused of conspiracy to commit health care fraud, health care fraud and wire fraud, finding that California is not a better venue for the action and that the novel coronavirus pandemic does not weigh in favor of transfer (United States v. R. Jeffrey Yates, No. 19-cr-266, D. Conn., 2020 U.S. Dist. LEXIS 107339).

  • June 19, 2020

    ACA Dispute Between Insolvent Insurer, U.S. Government Remanded

    WASHINGTON, D.C. — The Federal Circuit U.S. Court of Appeals on June 18 remanded an insolvent insurer’s case against the government over Patient Protection and Affordable Care Act (ACA) risk-corridor funds after a high court ruling allowing the pursuit of billions of dollars in lost payment (Land of Lincoln Mutual Health Insurance Co. v. United States, No. 17-1224, Fed. Cir.).

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