Mealey's Health Care / ACA : Mealey's : Legal News & Analysis

Mealey's Health Care / ACA

April 15, 2024
Blue Cross: Claim Denials Done With Plan In Mind, Not Discriminatory Intent

PASADENA, Calif. — A third-party administrator tells the Ninth Circuit U.S. Court of Appeals in an April 12 opening brief that it was simply fulfilling its fiduciary duty under the Employee Retirement Income Security Act when it denied claims for transgender care and cannot be held liable under the Patient Protection and Affordable Care Act for any allegedly discriminatory plan details.
April 15, 2024
U.S. Supreme Court Denies Review Bid Over 4th Circuit ERISA Surcharge Ruling

WASHINGTON, D.C. — The U.S. Supreme Court on April 15 declined to review a case over a heart transplant denial, which concerns whether surcharge is available under an Employee Retirement Income Security Act provision that allows equitable relief.
April 12, 2024
9th Circuit Discusses Parity Act Pleading Standard In Partly Reviving ERISA Case

PASADENA, Calif. — Addressing “what pleading standard applies to cases alleging an improper internal process” under the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA or Parity Act), a Ninth Circuit U.S. Court of Appeals panel on April 11 partly reversed dismissal of a putative class case over mental health and substance use disorder (MH/SUD) treatment coverage.
April 11, 2024
Insurer Accused Of Using AI Software To Deny Claims ‘En Masse’ In Class Suit

OAKLAND, Calif. — An insured filed a putative class action in California state court accusing his insurer of violating California’s insurance regulations and its unfair competition law (UCL) by using artificial intelligence (AI) software to deny claims for coverage.
April 08, 2024
Medical Coding, Damages Testimony Largely Admitted In Labs’ Compensation Case

BRIDGEPORT, Conn. — Experts may largely testify about medical coding practices and the resulting damages labs incurred from an insurer’s denials of the labs’ claims because they go beyond a layperson’s knowledge and are based on solid calculations, a federal judge in Connecticut said in excluding only portions based on flawed data provided to the damages expert and the medical coder’s testimony about whether the labs attempted to collect from patients.
April 08, 2024
Judge Allows Some Claims In ACA Hearing Loss Proxy Discrimination Case

SEATTLE — Proxy discrimination and injunctive relief claims based on exclusions or limitations in health insurance coverage for hearing aids that allegedly targeted people with disabilities in violation of the Patient Protection and Affordable Care Act (ACA) may proceed, but other claims appear to be barred by state law, a federal judge in Washington said in partially granting a motion to dismiss.
April 08, 2024
ACA Fertility Discrimination Claims Survive Dismissal, Federal Judge Says

NEW HAVEN, Conn. — A woman who claims that an insurer’s policy on what constitutes infertility discriminates against non-heterosexual individuals assigned female at birth enjoys standing under the Patient Protection and Affordable Care Act, but since she no longer participates in the plan, she cannot proceed on a declaratory relief claim, a federal judge in Connecticut said in partly granting the insurer’s motion to dismiss.
April 02, 2024
Judge Finds No Suprises Act Portal’s Reopening Moots Medical Provider’s Challenge

BROOKLYN, N.Y. — The reopening of the No Suprises Act (NSA) arbitration portal moots a case challenging the process because it now appears fully capable of handling any problems that arise, and a medical provider may not proceed based on “an entirely speculative possibility that complained-of conduct may occur in the future,” a federal judge in New York said.
April 02, 2024
Judge Sends Air Ambulances’ $5M Arbitration Award Cases To Connecticut

AUSTIN, Texas — Because two actions alleging that insurers failed to make timely payments required by the No Surprises Act’s arbitration process involve alleged conduct by the insurers in Connecticut, a Texas court is not the proper venue, a federal judge in Texas said in granting motions to dismiss but transferring the actions.
April 02, 2024
Judge ‘Appalled’ At AI’s Use In Research, Affirms Denial Of AD&D Claim

CHICAGO — A federal judge in Illinois said that despite an attorney’s clear violation of a court order prohibiting the use of artificial intelligence, she would assume that ChatGPT was not used to author the entire brief, while dismissing an Employee Retirement Income Security Act claim alleging that an insurer improperly denied an accidental death and dismemberment claim after a fatal car fire.
April 01, 2024
Railway Says Montana Asbestos Screener Stuck ‘Head In Sand’

MISSOULA, Mont. — Evidence introduced at trial showed a Libby, Mont., medical facility must have known the B-read-only and other claims it submitted to a special asbestos-related Patient Protection and Affordable Care Act (ACA) program were not a diagnosis and were fraudulent, and it cannot avoid liability by claiming it was simply doing its best when in reality it was sticking its head in the sand over the program’s requirements, a railway tells the Ninth Circuit U.S. Court of Appeals in a March 29 answering brief.
April 01, 2024
California Court Affirms Insurer’s Summary Judgment In Medical Air Transport Case

LOS ANGELES — Insureds seeking compensation for medical transport never produced evidence of disputed facts or sufficiently cited to the record, a California appellate court said March 29 in affirming summary judgment to the insurer.
March 26, 2024
Preliminary Injunction Over Illinois Temp Worker Provision Draws Appeal

CHICAGO — After an Illinois federal judge ruled that the Employee Retirement Income Security Act likely preempts an “equivalent benefits” amendment to the Illinois Day and Temporary Labor Services Act (DTLSA) and then issued a preliminary injunction prohibiting enforcement of that amendment, the leader of an Illinois regulatory department on March 25 filed notice of interlocutory appeal.
March 25, 2024
6th Circuit Vacates Dismissal Of ERISA Preemption Case Against Tennessee Pharmacy

CINCINNATI — In an unpublished opinion, a Sixth Circuit U.S. Court of Appeals panel vacated and remanded dismissal of a suit in which a bakery that wants to keep a pharmacy out of network for its self-funded health plan argued that the Employee Retirement Income Security Act preempts Tennessee’s “any willing pharmacy” laws.
March 22, 2024
HHS Defends Rule Barring Health Providers’ Use Of Tracking Tech Under HIPAA

FORT WORTH, Texas — Two U.S. Department of Health and Human Services officials on March 21 asked a Texas federal court to grant them summary judgment on four health care plaintiffs’ claims that a recently released bulletin violates the Health Insurance Portability and Accountability Act of 1996 (HIPAA) or the Administrative Procedure Act (APA), explaining that the bulletin properly served as a reminder to health care providers that the use of certain third-party website technologies violates HIPAA’s privacy protections by sharing users’ individually identifiable health information (IIHI).
March 22, 2024
Parties Debate Reconsideration, Appeal In No Surprises Act Arbitration Case

HOUSTON — A health insurer dismissed from a No Surprises Act (NSA) arbitration dispute opposed reconsideration on March 21, telling a federal judge in Texas that it is a necessary party for resolution of related claims against the arbitrator and that an interlocutory appeal will not materially advance the case.
March 19, 2024
Judge Will Grant Preliminary Injunction For Illinois Temp Worker Provision

CHICAGO — Ruling that trade associations and staffing agencies are likely to succeed on the merits of their argument that the Employee Retirement Income Security Act preempts one of three challenged amendments to the Illinois Day and Temporary Labor Services Act (DTLSA), an Illinois federal judge agreed to grant a preliminary injunction enjoining enforcement of that “equal pay” amendment.
March 19, 2024
Untimely Cert Petition By COVID-19 Test Provider Denied By U.S. Supreme Court

WASHINGTON, D.C. — The U.S. Supreme Court on March 18 denied a motion to direct the clerk to file a petition for a writ of certiorari out of time submitted by a COVID-19 test provider after a panel of the Ninth Circuit U.S. Court of Appeals affirmed the judgment of a California federal court dismissing five complaints brought by the provider seeking reimbursement from an insurer for COVID testing services under the Coronavirus Aid, Relief and Economic Security (CARES) Act.
March 15, 2024
Respondents To High Court: Deny Review Of 4th Circuit ERISA Surcharge Ruling

WASHINGTON, D.C. — Arguing that the case is a poor vehicle and that a purported circuit conflict is “illusory,” an employer and related respondents urge the U.S. Supreme Court to deny review and summary reversal in a suit concerning whether surcharge is available under an Employee Retirement Income Security Act provision that allows equitable relief.
March 14, 2024
Labs Seek Reconsideration In ERISA Preemption, Florida Payment Laws Case

NEW HAVEN, Conn. — Defendant laboratories in a battle over compensation for care provided to insureds filed a motion urging a federal judge in Connecticut to reconsider a finding that the Employee Retirement Income Security Act preempts certain claims, saying that Florida law creates a separate payment mandate that makes exploration of the plan language unnecessary.
March 13, 2024
Arkansas Pharmacy Law Isn’t Preempted, Panel Says In Section 340B Drug Case

ST. LOUIS — Arkansas law requiring Section 340B discount drug manufacturers to permit distribution through contract pharmacies does not conflict with the law, which is silent on distribution methods, or a second law governing highly regulated medications, the Eighth Circuit U.S. Court of Appeals said March 12 in affirming summary judgment for the state insurance commissioner and a pair of intervenors in the case.
March 12, 2024
Judge Grants But Reduces Fees, Expenses In ACA Discrimination Case

GREENSBORO, N.C. — Blind individuals and advocacy groups clearly constitute the prevailing party in a Patient Protection and Affordable Care Act (ACA) suit after receiving significant equitable relief from the court and are entitled to fees and expenses as a result, but they did not receive all the relief they sought and at least some of the complexity in the case arose from their own conduct, a federal judge in North Carolina said in granting but reducing a requested award.
March 08, 2024
8th Circuit Sets Argument In ERISA Case Over Cross-Plan Offsetting

ST. LOUIS — The Eighth Circuit U.S. Court of Appeals has set argument for March 14 in an Employee Retirement Income Security Act appeal where health plan participants challenging the practice known as “cross-plan offsetting” are seeking revival of their putative class suit, which was dismissed for failure to plead an injury in fact.
March 07, 2024
Christian Employment Group, Members Have Standing In ACA Challenge, Judge Says

BISMARCK, N.D. — Both the individual members of a Christian employers’ group and the association itself have standing in the face of imminent and concrete injury from a Patient Protection and Affordable Care Act (ACA) rule including gender identity under the definitions of discrimination, a federal judge in North Dakota said in granting the plaintiffs summary judgment on Religious Freedom Restoration Act (RFRA) claims.
March 07, 2024
Briefing On Tolling In Opt-In Class Cases Ordered In Consolidated ACA Suits

WASHINGTON, D.C. — Saying “issues important to the resolution of the [government’s dismissal] Motion remain unaddressed,” a U.S. Court of Federal Claims judge ordered supplemental briefing in consolidated cases of group health plans that allege that contributions were illegally exacted from them under the Transitional Reinsurance Program (TRP) of the Patient Protection and Affordable Care Act (ACA).