Mealey's Health Care / ACA

  • October 25, 2019

    Judge Awards ACA Cost-Sharing Insurer Class $1.58B

    WASHINGTON, D.C. — A federal claims judge on Oct. 22 awarded a class of health insurers nearly $1.6 billion in Patient Protection and Affordable Care Act (ACA) cost-sharing reduction payments for 2017 and 2018 (Common Ground Healthcare Cooperative v. The United States, No. 17-877, Fed. Clms.).

  • October 24, 2019

    Judge Says Air Transport Provider, Insurer Never Agreed To Settlement

    GRAND RAPIDS, Mich. — Because a health insurer’s agent never signed a proposed settlement with an emergency air transport company, no formal agreement exists, the provider cannot claim to have relied on later statements in providing the service and the Employee Retirement Income Security Act preempts the lone other claim, a federal judge in Michigan held Oct. 2 (Air Trek Inc. v. Capital Steel & Wire Inc., et al., No. 17-1145, W.D. Mich., 2019 U.S. Dist. LEXIS 171716).

  • October 24, 2019

    Judge Adopts Report Denying Judgment, Remanding Health Care Case

    CENTRAL ISLIP, N.Y. — An action challenging the amount of a payment does not invoke the Employee Retirement Income Security Act, and without that claim, no reason exists to keep the case in federal court, a federal judge in New York said Oct. 9 in adopting a magistrate judge’s report and recommendation (Long Island Thoracic Surgery, et al. v. Building Service 32BJ Health Fund, No. 17-163, E.D. N.Y., 2019 U.S. Dist. LEXIS 150761).

  • October 24, 2019

    States Want More Time To Respond To Petition In ACA Birth Control Rules Case

    WASHINGTON, D.C. — Seeking to simultaneously respond to two petitions for writ of certiorari challenging a nationwide injunction on rules expanding moral and religious exemptions from the Patient Protection and Affordable Care Act (ACA) contraceptive mandate, the states of Pennsylvania and New Jersey on Oct. 22 asked the U.S. Supreme Court for additional time to file a response (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.).

  • October 23, 2019

    9th Circuit Keeps ACA Contraceptive Rules Injunction In Place

    SAN FRANCISCO — Rules expanding religious and moral exemptions to the Patient Protection and Affordable Care Act (ACA) contraceptive mandate overstep the law’s reach, and a federal judge properly granted a preliminary injunction, a majority of the Ninth Circuit U.S. Court of Appeals held Oct. 22 (State of California, et al. v. U.S. Department of Health & Human Services, et al., No. 19-15072, 9th Cir., 2019 U.S. App. LEXIS 31389).

  • October 23, 2019

    United Says Individual Issues Doom Facility-Fee Class Action

    NEW YORK — The individualized analysis needed to determine whether providers or patients hold rights under the Employee Retirement Income Security Act dooms a class action, an insurer argues in an Oct. 21 motion, asking a federal judge in New York to reconsider certifying the class (The Medical Society of the State of New York, et al. v. UnitedHealth Group Inc., et al., No. 16-5265, S.D. N.Y.).

  • October 21, 2019

    High Court Will Not Review Ruling Denying Woman’s Appearance At Hearing

    WASHINGTON, D.C. — The U.S. Supreme Court on Oct. 21 denied a woman’s petition for a writ of certiorari seeking review of a Kentucky Supreme Court’s ruling that she could not appear at a hearing challenging her managed care organization (MCO) provider’s denial of benefits her because she lacked standing and was not financially liable (Lettie Sexton, et al. v. Commonwealth of Kentucky, et al., No. 18-1446, U.S. Sup.).

  • October 16, 2019

    Washington Court Reverses Judgment In Proton Beam Coverage Denial Case

    SEATTLE — An insurer erred when it denied coverage for proton beam therapy as not medically necessary to treat for a man’s prostate cancer, a divided Washington Supreme Court held Oct. 3 (John Strauss, et al. v. Premera Blue Cross, No. 74600-6-I, Wash. Sup., 2019 Wash. LEXIS 593).

  • October 15, 2019

    United, Class Brief Reconsideration In Facility-Fee Class Case

    NEW YORK — Whether assignment of Employee Retirement Income Security Act rights requires reversing class certification of a group of surgery providers claiming that the insurer denied payment for facility fees without regard for whether coverage existed under specific plan language came before a New York federal judge on Oct. 14 as the parties briefed a motion for reconsideration (The Medical Society of the State of New York, et al. v. UnitedHealth Group Inc., et al., No. 16-5265, S.D. N.Y.).

  • October 15, 2019

    U.S. High Court Considers Petition Challenging Kentucky Medicaid Hearing Denial

    WASHINGTON, D.C. — If a state court may simply deny a federally mandated right to a Medicaid hearing, it is in reality no right at all, a woman argues in a reply brief as the U.S. Supreme Court justices prepare to convene and consider her petition for a writ of certiorari on Oct. 18 (Lettie Sexton, et al. v. Kentucky, et al., No. 18-1446, U.S. Sup.).

  • October 15, 2019

    Judge: Anti-Assignment Precedent Dooms Health Care Case, Amendment Attempt

    TRENTON, N.J. — Recent Third Circuit U.S. Court of Appeals precedent finding anti-assignment provisions in Employee Retirement Income Security Act health plans enforceable strips a court of jurisdiction over a health care reimbursement case and precludes the court from considering the insured’s belated power of attorney arguments, a federal judge in New Jersey said Oct. 2 (University Spine Center, et al. v. Anthem Blue Cross Blue Shield, No. 17-11725, D. N.J., 2019 U.S. Dist. LEXIS 170788).

  • October 14, 2019

    5th Circuit Doesn’t Want 2nd Look At Dialysis Provider’s Suit

    NEW ORLEANS — The Fifth Circuit U.S. Court of Appeals denied a motion for rehearing Oct. 10, letting stand a decision finding a health care plan’s anti-assignment provision prevented a health care provider from suing an insurer (Dialysis Newco Inc., et al. v. Community Health Systems Group Health Plan, et al., No. 18-40863, 5th Cir.).

  • October 11, 2019

    New York Risk-Corridor Spat Parties Brief Impact Of U.S. Amicus Brief

    NEW YORK —  The United States’ amicus brief leaves no question about whether New York’s risk-adjustment program violates the Patient Protection and Affordable Care Act (ACA), an insurer tells the Second Circuit U.S. Court of Appeals in a Sept. 23 brief.  But New York says in its own letter brief that the panel should ignore the government’s attempt to recharacterize its earlier position (UnitedHealthcare of New York Inc., et al. v. Linda Lacewell, et al., No. 18-2583, 2nd Cir.).

  • October 09, 2019

    Limited Partnership Action Seeks Labor Department Opinion On Health Care Plan Status

    DALLAS — A limited partnership filed suit in Texas federal court on Oct. 4, seeking to force the U.S. Department of Labor (DOL) to issue an advisory opinion declaring that the self-insured health plan it offers common-law employees and limited partners is not a multiple welfare arrangement (MEWA) under the Employee Retirement Income Security Act (Data Marketing Partnership LP v. United States Department of Labor, et al., No. 19-800, N.D. Texas).

  • October 07, 2019

    HHS Barred Under Colorado Law From Offsetting Insolvent Insurer’s Debt, Court Says

    WASHINGTON, D.C. — Colorado insurance liquidation law precludes the U.S. Department of Health and Human Services (HHS) from using money owed to an insolvent Colorado insurer to pay debts owed under the Patient Protection and Affordable Care Act’s (ACA) reinsurance and risk-adjustment programs, a judge in the U.S. Court of Federal Claims ruled Oct. 3 (Michael Conway v. The United States, No. 18-1623, Fed. Clms., 2019 U.S. Claims LEXIS 1306).

  • October 07, 2019

    Top Court Denies Review In ERISA Health Care Rights-Assignment Spat

    WASHINGTON, D.C. — The U.S. Supreme Court on Oct. 7 denied a health care insurer’s petition for review, leaving stand a Fifth Circuit U.S. Court of Appeals ruling finding that direct payments to a provider waived an Employee Retirement Income Security Act plan’s anti-assignment provision protections (Louisiana Health Service & Indemnity Co. v. Encompass Office Solutions, Inc., No. 19-196, U.S. Sup.).

  • October 07, 2019

    Medicare Recipients: Denied Appeal Rights Of Designation Violates Due Process Clause

    HARTFORD, Conn. — A class of Medicare recipients in a Sept. 19 post-trial brief tell a Connecticut federal court that they have been deprived of a protected property interest by state action without due process of law and that the failure of the secretary of Health and Human Services to allow them to appeal to Medicare the issue of the classification of their hospital services under Medicare rules violates the Fifth Amendment’s due process clause (Christina Alexander, et al. v. Alex M. Azar II, No. 11-1703, D. Conn.).

  • October 02, 2019

    Judge Adopts Report Finding Conflicting Evidence Dooms Mental Health ERISA Claim

    BROOKLYN, N.Y. — Conflicting medical opinions and evidence do not support the conclusion that an insurer acted improperly when it denied coverage for mental health treatments after a suicide attempt, a New York judge held Sept. 30 in adopting a magistrate judge’s report and recommendation (Samuel Halberg, et al. v. United Behavioral Health, et al., No. 16-6622, E.D. N.Y., 2019 U.S. Dist. LEXIS 169679).

  • October 01, 2019

    Plaintiffs Have Standing, But Not Support For Parity Act Case, Judge Says

    SALT LAKE CITY — A man who claims that he spent $340,000 on his daughter’s mental health treatments after an insurer improperly denied coverage has standing but has not adequately alleged a violation of the Mental Health Parity and Addiction Equity Act, a federal judge in Utah said Sept. 27 (Jeff N., et al. v. United Healthcare Insurance Co., No. 18-710, D. Utah, 2019 U.S. Dist. LEXIS 167420).

  • October 01, 2019

    After Paring Claims, Judge Leaves Parity Act Claims In Wilderness Therapy Case

    SALT LAKE CITY — A family’s class action allegations involving the denial of coverage for wilderness treatment under an Employee Retirement Income Security Act health plan are duplicative or fail to state a claim, but their claims involving allegedly disparate treatment in the mental health setting may continue, a federal judge in Utah said Sept. 27 (K.H.B., et al. v. UnitedHealthCare Insurance Co., No. 18-795, D. Utah, 2019 U.S. Dist. LEXIS 167183).

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