Mealey's Health Care / ACA
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February 13, 2020
Magistrate Judge Recommends Remanding Insurance Billing Spat
FORT LAUDERDALE, Fla. — An orthopedic specialist challenges only the rate of compensation and seeks payment under Florida law, putting it outside the reach of the Employee Retirement Income Security Act, a federal magistrate judge said Feb. 10 in recommending remand (Orthopaedic Care Specialists v. Aetna Life Insurance Co., No. 19-81381, S.D. Fla., 2020 U.S. Dist. LEXIS 23983).
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February 13, 2020
Florida Federal Judge Allows Some Claims Despite ‘Shotgun Pleading’
FORT LAUDERDALE, Fla. — Only the portion of an orthopedic surgery provider’s claims based on health insurance plans without an anti-assignment provision may proceed, a federal judge in Florida said Feb. 6 in again warning the plaintiff not to continue with its “shotgun pleading” style (Columna Inc. v. Cigna Health and Life Insurance Co., No. 19-80170, S.D. Fla.).
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February 12, 2020
Parity Act, ERISA Claims Proceed In Mental Health Coverage Case, Judge Says
SALT LAKE CITY — Father-daughter plaintiffs adequately allege that their health insurer applies different standards to mental health and substance abuse claims than they would medical and surgical claims when making coverage decisions, a federal judge in Utah said Feb. 7 (David P., et al. v. United Healthcare Insurance Co., et al., No. 19-225, D. Utah).
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February 12, 2020
Categorical Exclusions Keep Parity Act Claims Alive, Federal Judge Says
SALT LAKE CITY — An action alleging that a health insurer categorically denies coverage for wilderness and substance abuse programs may go forward after a federal judge in Utah on Feb. 7 declined to dismiss the claims (Johnathan Z., et al. v. Oxford Health Plans, No. 18-383, D. Utah., 2020 U.S. Dist. LEXIS 21968).
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February 11, 2020
Magistrate Judge Dismisses Hospital’s Underpayment Case Against Insurer
MIAMI — Nothing mandates that health insurance policies incorporate Patient Protection and Affordable Care Act (ACA) protections or state law governing emergency care payments, and a hospital’s suit seeking unpaid bills largely fails, a federal magistrate judge in Florida said Feb. 6 (Boca Raton Regional Hospital Inc., et al. v. Celtic Insurance Co., et al., No. 19-80650, S.D. Fla., 2020 U.S. Dist. LEXIS 21612).
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February 06, 2020
CalPERS Escapes Hospital’s Payment Suit, Court Says
LOS ANGELES — A contract between California’s public retirement system and an insurer does not confer benefits on a health care provider, and the provider’s own contract with the insurer does not create a payment obligation on the part of the system, a California appeals court held Feb. 5 (County of Monterey v. California Employees Retirement System, No. H045977, Calif. App., 6th Dist., 2020 Cal. App. Unpub. LEXIS 848).
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February 05, 2020
Respondents: Supreme Court Should Wait To Review ACA Individual Mandate Case
WASHINGTON, D.C. — There is no need for the U.S. Supreme Court to weigh in on an interlocutory order finding standing and that the individual mandate is unconstitutional when it can simply bide its time and address a more full record later, three respondents and an amicus curiae party tell the court in Feb. 3 briefs (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.).
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January 30, 2020
5th Circuit Won’t Take ACA Individual Mandate Case En Banc
NEW ORLEANS — The Fifth Circuit U.S. Court of Appeals on Jan. 29 declined en banc rehearing in a Patient Protection and Affordable Care Act (ACA) individual mandate case after one of its members asked that the court be polled on the question. A pair of petitions for review are pending before the U.S. Supreme Court (Texas, et al. v. United States, et al., No. 19-10011, 5th Cir.).
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January 30, 2020
More Briefs Sought In Dispute Over Out-Of-Pocket Nursing Home Costs
HARTFORD, Conn. — A class of Medicare recipients and the Secretary of Health and Human Services (HHS) were asked by a federal judge in Connecticut on Jan. 28 to brief a new series of questions in a lawsuit over out-of-pocket costs for admission to a skilled nursing facility (SNF) after being designated as outpatients receiving observation (Christina Alexander, et al. v. Alex M. Azar II, No. 11-1703, D. Conn.).
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January 29, 2020
ACA Discrimination Claim Untimely Under Borrowed Statute, Judge Says
BATON ROUGE, La. — The Patient Protection and Affordable Care Act (ACA) borrows from other statutes to ban discrimination, and this borrowing includes the underlying statutes of limitations, a federal judge in Louisiana held Jan. 24 in granting summary judgment (Tracy D. Ward v. Our Lady of the Lake, et al., No. 18-454, M.D. La., 2020 U.S. Dist. LEXIS 12258).
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January 28, 2020
ACA Can’t Support Emotion Distress Damages, 5th Circuit Says
NEW ORLEANS — The Patient Protection and Affordable Care Act (ACA) does not permit damages for emotional distress for a deaf and blind woman’s alleged discrimination, a Fifth Circuit U.S. Court of Appeals panel said Jan. 24 (Jane Cummings v. Premier Rehab Keller PLLC, et al., No. 19-10169, 5th Cir., 2020 U.S. App. LEXIS 2250).
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January 24, 2020
Magistrate Judge Finds Insurer Violated ERISA, Improperly Denied Coverage
CLEVELAND — An insurer’s procedural errors violated the Employee Retirement Income Security Act, and it improperly denied coverage for spinal surgery, a federal magistrate judge in Ohio said Jan. 22 (Keith W. Canter v. Alkermes Blue Care Elect Preferred Provider Plan, et al., No. 17-399, S.D. Ohio).
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January 23, 2020
Judge: Forum Clause Needs Briefing In Toxicology Provider’s ERISA Suit
FORT LAUDERDALE, Fla. — Anti-assignment provisions largely doom a toxicology service provider’s suit seeking payment, but the parties must brief the court on how to handle one surviving defendant’s forum-selection clause requiring litigation in California, a federal judge in Florida said Jan. 17 (Apex Toxicology LLC v. United Healthcare Services Inc., et al., No. 17-61840, S.D. Fla., 2020 U.S. Dist. LEXIS 9992).
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January 22, 2020
Lactation Services Plaintiffs Lose Expert Testimony, Class Certification Motion
CHICAGO — An Illinois federal judge on Jan. 21 stripped plaintiffs suing their insurer over lactation services coverage under the Patient Protection and Affordable Care Act (ACA) of their expert witness testimony for lack of reliability and then denied their bid for class certification for lack of common issues (Laura Briscoe, et al. v. Health Care Service Corporation, et al., No. 1:16-cv-10294, N.D. Ill., 2020 U.S. Dist. LEXIS 9447).
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January 21, 2020
U.S. Supreme Court Won’t Expedite ACA Individual Mandate Case
WASHINGTON, D.C. — The U.S. Supreme Court on Jan. 21 declined to expedite consideration of a ruling finding the Patient Protection and Affordable Care Act (ACA) unconstitutional after being told that the underlying ruling presented no immediate impact (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.).
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January 21, 2020
Medicare ‘Not Less Than’ Provision Doesn’t Cover Prescription Drugs, Court Says
WASHINGTON, D.C. —Medicare does not mandate that private insurers pay providers at the same rates they pay private providers for pharmaceuticals, a federal appeals court in the District of Columbia said Dec. 20 (Cares Community Health v. HHS, No. 18-5319, D.C. Cir.).
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January 21, 2020
Class Wins Partial Certification In ACA Lactation Support Case
SAN FRANCISCO — “Incomprehensible” denial letters sent in reference to out-of-network lactation care form the basis for class certification, but allegations claiming that an insurer’s “woefully inadequate” efforts constituted a uniform effort at evading Patient Protection and Affordable Care Act (ACA) standards fail, a federal judge in California held Dec. 23 (Rachel Condry, et al. v. UnitedHealth Group Inc., et al., No. 17-183, N.D. Calif., 2019 U.S. Dist. LEXIS 220287).
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January 21, 2020
U.S. Supreme Court Accepts ACA Birth Control Case
WASHINGTON, D.C. — Six years after partially punting on the issue and in the face of new regulations, the U.S. Supreme Court on Jan. 17 agreed to once again wade into the debate involving abortion and the Patient Protection and Affordable Care Act (ACA) contraceptive mandate (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.).
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January 16, 2020
Judge Remands Insolvent Insurer’s Liquidator’s Breach Of Fiduciary Duty Case
SALT LAKE CITY — A federal judge in Utah on Jan. 13 remanded to the liquidation court an insolvent health insurer’s liquidator’s breach of fiduciary and negligence lawsuit against the insurer’s executives because the executives failed to establish that the case necessarily raises or involves a substantial issue of federal law for purposes of jurisdiction (Stillman Consulting Services, LLC v. Shaun Greene, et al., No. 19-668, D. Utah, 2020 U.S. Dist. LEXIS 6274).
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January 14, 2020
U.S. Supreme Court Told Not To Rush To Judgment In ACA Individual Mandate Case
WASHINGTON, D.C. — Rulings that found the Patient Protection and Affordable Care Act (ACA) individual mandate unconstitutional present no immediate impact and do not need to be addressed in an expedited fashion, a trio of Supreme Court respondents told the court Jan. 10 (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.).