Mealey's Health Care / ACA

  • June 05, 2019

    6th Circuit Affirms Insurer’s HIV Drug Policy Isn’t Discrimination

    CINCINNATI — The Patient Protection and Affordable Care Act (ACA) limits a plaintiff to the standard governing the type of discrimination he is alleging and he may not pick and choose which statute’s standard he wishes to apply, a Sixth Circuit U.S. Court of Appeals panel held June 4 (John Doe v. BlueCross BlueShield of Tennessee Inc., No. 18-5897, 6th Cir., 2019 U.S. App. LEXIS 16785).

  • June 04, 2019

    Class Certification Denied In ACA Lactation Support Insurance Case

    SAN FRANCISCO — Three proposed classes in a Patient Protection and Affordable Care Act (ACA) case challenging insurance coverage for lactation specialists are overly broad, and while Employee Retirement Income Security Act allegations are less problematic, they too are overly broad and do not make clear the relief that could be granted, a federal judge in California said May 23 in denying class certification (Rachel Condry, et al. v. UnitedHealth Group Inc., et al., No. 17-183, N.D. Calif.).

  • June 03, 2019

    Government Wants Association Health Plan Ruling Reversed

    WASHINGTON, D.C. — States lack standing to challenge a Patient Protection and Affordable Care Act (ACA) rule expanding association health plans, and in any case, a judge erred in finding the rule did “violence” to the Employee Retirement Income Security Act (ERISA) definition of an employer, the Department of Labor tells the District of Columbia Circuit U.S. Court of Appeals in an opening brief May 31 (New York, et al. v. U.S. Department of Labor, et al., No. 19-5125, D.C. Cir.).

  • June 03, 2019

    Insurer Appeals After Entry Of $123,849 Judgment In ERISA Benefits Case

    SEATTLE — An insurer on May 31 noticed an appeal challenging a $123,849 judgment awarded to plaintiffs who prevailed in their case claiming improper denial of residential treatment under the Employee Retirement Income Security Act (Todd R., et al. v. Premera Blue Cross Blue Shield of Alaska, No. 17-1041, W.D. Wash.).

  • May 31, 2019

    Insurer Stands Pat In Medicaid Fair Hearing Supreme Court Challenge

    WASHINGTON, D.C. — The Kentucky Supreme Court erred in concluding that a Medicaid recipient’s lack of financial interest left her without standing to a pursue a fair hearing as required by a federal program, a woman argues in a May 15 petition asking the U.S Supreme Court for a writ of certiorari.  The insurer on May 29 told the court that it would not respond to the petition (Lettie Sexton, et al. v. Commonwealth of Kentucky, et al., No. 18-1446, U.S. Sup.).

  • May 30, 2019

    Judge Approves Settlement In Behavioral Health Care Reimbursement Case

    BOULDER, Colo. — A federal judge on May 24 granted a motion for fees, costs and final approval to a settlement resolving claims that an insurer reimbursed out-of-network providers of behavioral health care differently than in-network providers (Laural O’Dowd, et al. v. Anthem Inc., et al., No. 14-2787, D. Colo., 2019 U.S. Dist. LEXIS 88292).

  • May 29, 2019

    Insurer Objects, But Judge Adopts Report Keeping State Law Health Care Claims

    FORT LAUDERDALE, Fla. — An out-of-network health care provider’s state law claims will proceed after a federal judge in Florida on May 28 issued a one-page order adopting a report and recommendation over the objections of the insurer (GVB MD LLC, et al. v. United Healthcare Insurance Co., No. 19-20727, S.D. Fla.).

  • May 24, 2019

    Insurers: United States Ignores Adverse Impact Of Risk-Corridor Ruling

    WASHINGTON, D.C. — The United States never grapples with the disastrous consequences and far-reaching impact a decision allowing the government to simply skip out on Patient Protection and Affordable Care Act (ACA) risk-corridor obligations, a pair of insurers tell the U.S. Supreme Court in reply briefs filed May 22 and May 24 (Land of Lincoln Mutual Health Insurance Co. v. United States, No. 18-1038, Moda Health Plan Inc., et al. v. United States, No. 18-1028, Maine Community Health Options v. United States, No. 18-1023, U.S. Sup.).

  • May 24, 2019

    California Says New Rule Sanctions Health Care Discrimination, Violates ACA

    SACRAMENTO, Calif. — A newly issued rule permits doctors and staff to deny basic health care based on hunches, violating federal and state laws ensuring patient safety and access to care, the state of California claims in a May 21 complaint (State of California, et al. v. Alex M. Azar, et al., No. 19-2769, N.D. Calif.).

  • May 23, 2019

    Judge Sanctions Drug Testing Company Over Corporate Witness Readiness

    FRANKFORT, Ky. — A health care provider must pay for an insurer’s costs in preparing for a second deposition after its original corporate witness’s near total failure to prepare, a federal judge in Kentucky said May 21 (PremierTox 2.0 Inc. v. Coventry Health and Life Insurance Co., No. 15-127, W.D. Ky., 2019 U.S. Dist. LEXIS 85017).

  • May 17, 2019

    11th Circuit: Procedure Errors Don’t Alter Standard; Insurers’ ERISA Ruling Stands

    ATLANTA — Insubstantial procedural errors do not require anything other than the capricious and arbitrary standard in an Employee Retirement Income Security Act case challenging an insurer’s denial of coverage for eating disorder treatments, an 11th Circuit U.S. Court of Appeals panel held May 15 (O.D. v. Jones Lang LaSalle Medical PPO Plus Plan, No. 17-13060, 11th Cir., 2019 U.S. App. LEXIS 14385).

  • May 16, 2019

    Federal Judge Frees Payment Processor From Insurance Payment Dispute

    EVANSVILLE, Ind. — A company tasked with paying health insurance claims cannot be liable in a hospital’s case against the issuer of a stop-loss policy, a federal judge in Indiana said May 13 (Memorial Hospital and Health Care Center v. Houston International Insurance Group, et al., No, 18-225, S.D. Ind., 2019 U.S. Dist. LEXIS 80522).

  • May 15, 2019

    Federal Judge Continues Receivership Over FTC-Targeted Health Insurer

    MIAMI — Defendants portrayed health insurance products as comprehensive plans compliant with the Patient Protection and Affordable Care Act (ACA) when in reality they offered little to no coverage, a federal judge in Florida held May 14 in granting a motion for injunction, asset freeze and continued receivership (Federal Trade Commission v. Simple Health Plans LLC, et al., No. 18-62593, S.D. Fla.).

  • May 14, 2019

    Religious Order, California Face Off Before Supreme Court In ACA Rules Appeal

    WASHINGTON, D.C. — The Supreme Court again confronts the question of whether the Patient Protection and Affordable Care Act (ACA)’s contraceptive mandate infringes on religious objectors’ rights under federal law, as it receives dueling briefs in the latest development in the litigation.  California filed its response to the Supreme Court petition for certiorari review on May 13 (Little Sisters of the Poor Jeanne Jugan Residence v. California, et al., No. 18-1192, U.S. Sup.).

  • May 13, 2019

    United States Says Congress Never Finalized ACA Cost-Sharing Payments

    WASHINGTON, D.C. — Congress never appropriated funds for the Patient Protection and Affordable Care Act (ACA) cost-sharing reduction program and, thus, never created a duty to make those payments, the United States tells a U.S. Court of Federal Claims judge in a May 9 reply (Blue Cross And Blue Shield of North Dakota v. The United States, No. 18-1983C, Fed. Clms.).

  • May 10, 2019

    Judge: ERISA Claims Fall, But Medical Provider’s State Law Claims Live On

    FORT LAUDERDALE, Fla. — A medical provider’s Employee Retirement Income Security Act claims fail because it has not shown that it exhausted its administrative remedies, but its state law claims are not preempted simply because some may invoke ERISA and largely may proceed, a federal judge in Florida said May 9 (GVB MD LLC, et al. v. United Healthcare Insurance Co., No. 19-20727, S.D. Fla.).

  • May 10, 2019

    Government Says Insurers Can’t Recover ACA Risk-Corridor Funds

    WASHINGTON, D.C. — The United States told the Supreme Court on May 8 that the Patient Protection and Affordable Care Act’s risk corridor never entitled insurers — some of them now defunct — to subsidies and that Congress’ latter actions erased any duty the law imposed (Land of Lincoln Mutual Health Insurance Co. v. United States, No. 18-1038, Moda Health Plan Inc., et al. v. United States, No. 18-1028, Maine Community Health Options v. United States, No. 18-1023, U.S. Sup.).

  • May 08, 2019

    Pharmacy Can’t Support Claims Insurer Applied Disparate Treatment, Judge Says

    RALEIGH, N.C. — The little guidance on a North Carolina law requiring that insurers treat pharmacies equally does not support the conclusion that denying access for failing to meet the network standards violates the statute, a federal judge in North Carolina held May 7 (Senderra RX Partners LLC v. Blue Cross Blue Shield of North Carolina, No. 18-871, M.D. N.C.).

  • May 08, 2019

    Anti-Assignment Provisions Cut Some Claims From Out-Of-Network Providers’ Suit

    LOS ANGELES — Various anti-assignment provisions largely preclude 24 of the 164 claims brought by out-of-network health care providers, a federal judge in California held May 3 (Infoneuro Group, et al. v. Aetna Life Insurance Co., No. 16-5083, C.D. Calif.).

  • May 06, 2019

    1st Circuit Reinstates Challenge To ACA Contraception Rules

    BOSTON — While the exact amount of Massachusetts’ alleged injury from rules granting expanded employers expanded exemptions to the Patient Protection and Affordable Care Act (ACT) may not be known, it stands to reason that it is not zero and provides injury and standing, a First Circuit U.S. Court of Appeal panel held May 2 (Massachusetts v. United States Department of Health and Human Services, et al., No. 18-1514, 1st Cir., 2019 U.S. App. LEXIS 13293).

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