Mealey's Health Care / ACA

  • May 14, 2020

    Individual Issues Doom Class Alleging Inferior Provider Network, Judge Says

    YAKIMA, Wash. — A plaintiff credibly alleges that her insurer overstated its provider network, causing her to spend money on out-of-network care, but the individualized issues required for a remedy and the existence of superior methods of seeking relief doom the class, a federal judge in Washington said May 12 (Cynthia Harvey, et al. v. Centene Corp., et al., No. 18-12, E.D. Wash., 2020 U.S. Dist. LEXIS 83642).

  • May 12, 2020

    Judge Allows Provider’s Reimbursement Suit Involving Federal Health Plan

    WASHINGTON, D.C. — Nothing prevents a dialysis provider from pursuing reimbursement claims under a federal health insurance policy as an assignee, a federal judge in the District of Columbia said May 8 (RAI Care Centers of Maryland I v. Office of Personnel Management, No. 18-3151, D. D.C., 2020 U.S. Dist. LEXIS 81431).

  • May 11, 2020

    Consolidated Complaint Says Insurers Failed To Pay For Mental Health Treatments

    LOS ANGELES — A facility provided medically necessary treatments to insureds with plans covering mental health and substance abuse treatments but was not reimbursed for the care, a plaintiff alleges in a May 7 consolidated amended complaint (ABC Services Group Inc v. Health Net of California Inc., et al., No. 19-243, C.D. Calif.).

  • May 08, 2020

    Judge Denies New Trial After Jury Finds For Hospital In ACA Discrimination Case

    NEW YORK — A deaf woman’s testimony at trial that she requested American Sign Language (ASL) interpreters does not entitled her to judgment, and nothing in a trial over alleged discrimination under the Patient Protection and Affordable Care Act (ACA) and other laws warrants granting a new one, a federal judge in New York said March 26 (Lizzette Vega-Ruiz v. Montefiore Medical Center, No. 17-1804, S.D. N.Y., 2020 U.S. Dist. LEXIS 53285).

  • May 08, 2020

    4th Circuit Confronts Title X Case Over Funding, Abortion

    BALTIMORE — The ethical and financial implications of a rule requiring strict separation of medical and abortion services for Title X funding recipients featured heavily in oral arguments before the Fourth Circuit U.S. Court of Appeals on May 7 (Mayor and City Council of Baltimore v. Alex M. Azar II, et al., Nos. 19-1614, 20-1215, 4th Cir.).

  • May 08, 2020

    Federal Judge Grants Discovery In ERISA Mental Health Coverage Case

    SALT LAKE CITY — A woman denied coverage for residential mental health treatments under an Employee Retirement Income Security Act plan is entitled to discovery into documents showing how the insurers calculated reimbursements and imposed nonquantitative treatment limitations, a federal judge in Utah said May 6 (Jane Doe v. Intermountain Healthcare Inc., et al., No. 18-00807, D. Utah, 2020 U.S. Dist. LEXIS 80809).

  • May 06, 2020

    From Afar, Supreme Court Hears ACA Mandate Exemption Rules Challenge

    WASHINGTON, D.C. — The U.S. Supreme Court on May 6 heard telephonic oral arguments over whether the Patient Protection and Affordable Care Act (ACA) and federal law protecting religious beliefs permit rules providing religious and moral objectors exemptions from the statute’s contraceptive mandate, whether the government properly formulated the rules and whether a district court can issue a nationwide injunction blocking the rules (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.).

  • May 06, 2020

    Judge: ACA ‘Intent To Reside’ Policy Rescission Suit Belongs In State Court

    CLEVELAND — Despite involving Patient Protection and Affordable Care Act (ACA) language providing marketplace policies for those with an intent to reside in the United States, a case claiming that a health insurer improperly rescinded a policy on the mistaken belief that the insureds moved to Ohio for treatment with no intent of staying belongs in state court, a federal judge in Ohio said April 22 (Ajit Tolani, et al. v. Medical Mutual of Ohio, No. 19-2388, N.D. Ohio., 2020 U.S. Dist. LEXIS 71098).

  • May 05, 2020

    Federal Judge Allows Amendment After Finding Providers Lack Assignment Of Rights

    TRENTON, N.J. — Emergency care providers fail to plead adequate assignments of rights, which dooms Employee Retirement Income Security Act claims, but the plaintiffs may amend their complaint to cure the defect or move for remand if they do not wish to pursue the claims, a federal judge in New Jersey said April 30 (Emergency Physicians of St. Clare’s LLC, et al. v. Horizon Blue Cross Blue Shield of New Jersey, et al., No. 19-12112, D. N.J., 2020 U.S. Dist. LEXIS 75921).

  • May 01, 2020

    Church Plans Survive Dismissal In Providers’ Compensation Suit

    NEWARK, N.J. — Anti-assignment provisions largely free two of three insurers from providers’ suit seeking compensation, and the providers have failed to state a claim for all but the church-plan-based claims, a federal judge in New Jersey found April 27 (Somerset Orthopedic Associates, et al. v. Horizon Healthcare Services Inc., et al., No. 19-8783, D. N.J.).

  • April 28, 2020

    U.S. Government Challenges Offset Ruling For Insolvent Insurer’s Debt Under ACA

    WASHINGTON, D.C. — An insolvent insurer’s demand for payment under the Patient Protection and Affordable Care Act’s (ACA) reinsurance program fails because it had already been paid based on an offset of the amount owed by the insurer under the ACA’s risk adjustment program, the U.S. government argues in its April 27 opening brief to the Federal Circuit U.S. Court of Appeals (Michael Conway v. The United States, No. 20-1292, Fed. Cir.).

  • April 28, 2020

    5th Circuit Won’t Review ACA Emotional Distress Damages Case

    NEW ORLEANS — The Fifth Circuit U.S. Court of Appeals on March 24 denied a petition for en banc rehearing without poll, leaving stand a panel ruling that the Patient Protection and Affordable Care Act (ACA) is spending clause legislation that acts as a contract and cannot support emotional distress damages (Jane Cummings v. Premier Rehab Keller PLLC, et al., No. 19-10169, 5th Cir.).

  • April 27, 2020

    ACA Mandates Billions In Risk-Corridor Payments, Supreme Court Says

    WASHINGTON, D.C. — The Patient Protection and Affordable Care Act (ACA) risk-corridor program mandated payments that subsequent appropriations riders did not eliminate, and an insolvent insurer and its fellow petitioners may pursue the billions of dollars in lost payments in federal court, a majority of the U.S. Supreme Court said April 27 (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.).

  • April 22, 2020

    Hospital Wants Reconsideration Of Order Allowing Expert In ACA Discrimination Case

    BATON ROUGE, La. — A judge found an expert qualified to testify on hospital policies, but her opinion is unreliable because it is based on a site visit she performed in a different case in an entirely different context, a hospital told a federal judge in Louisiana April 17  (Katrina Rivers LaBouliere, et al. v. Our Lady of the Lake Hospital Inc., No. 16-785, M.D. La.).

  • April 21, 2020

    Amicus States:  Court Erred In Enjoining Title X Abortion Rules

    BALTIMORE — A district court erroneously established medical providers’ ethical concerns about a Title X rule as the governing law and ignored the proper standard of review and existing precedent in concluding that abortion rules violated the Patient Protection and Affordable Care Act (ACA), federal defendants and various states tells the Fourth Circuit U.S. Court of Appeals in April 17 supplemental briefing before the en banc court (Mayor and City Council of Baltimore v. Alex M. Azar II, et al., Nos. 19-1614, 20-1215, 4th Cir.).

  • April 20, 2020

    Judge: Acute-Subacute Disparity Allegations Save Parity Act Claim

    SALT LAKE CITY — Allegations that an insurer imposed acute level criteria on subacute care in the mental health setting but not in other medical and surgical settings successfully allege a Parity Act violation, and the claim is not duplicative of the Employee Retirement Income Security Act claim seeking benefits, a federal judge in Utah said April 7 (M.S., et al. v. Premera Blue Cross, et al., No. 19-199, D. Utah).

  • April 20, 2020

    Supreme Court Resets, Grants Divided Argument In ACA Case

    WASHINGTON, D.C. — The U.S. Supreme Court on April 20 granted a request by the solicitor general for divided arguments in a pair of cases involving whether the Patient Protection and Affordable Care Act (ACA) and Religious Freedom Restoration Act (RFRA) permit expanded religious and moral exemptions to the contraceptive mandate.  Originally scheduled for late April, oral arguments were postponed due to the coronavirus, and the cases are now set for telephonic arguments on May 6 (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.).

  • April 16, 2020

    Health Insurer Appeals ERISA Preemption, Federal Officer Jurisdiction Rulings

    GREENSBORO, N.C. — An insurer on April 15 appealed a decision by a federal judge in North Carolina finding that the Employee Retirement Income Security Act did not preempt a dispute over reimbursement because neither party enjoyed standing under the law and that a private contract with the provider did not give rise to federal officer removal simply because some beneficiaries were federal employees or covered by Medicare (LifeBrite Hospital Group of Stokes LLC v. Blue Cross and Blue Shield of North Carolina, No. 18-293, M.D. N.C.).

  • April 09, 2020

    Judge:  Texas Payment Law No Remedy For Out-Of-Network Providers

    CHICAGO — Medical providers misconstrue insurers’ arguments in seeking reconsideration of an order finding derivative standing under the Employee Retirement Income Security Act (ERISA) and have not shown that Texas law would provide them with damages, a federal judge in Illinois said April 6 (Emerus Hospital, et al. v. Health Care Service Corp., et al.,  No. 13-8906, N.D. Ill., 2020 U.S. Dist. LEXIS 60269).

  • April 07, 2020

    ACA Doesn’t Preempt California Charity Care Regulation, 9th Circuit Says

    SACRAMENTO, Calif. — The Patient Protection and Affordable Care Act (ACA) does not preempt California’s charity care regulation requiring a hospital to provide a certain amount of indigent care or donate the equivalent amount of that care to entities that do, a Ninth Circuit U.S. Court of Appeals panel held April 2 (Deanco Healthcare LLC, et al. v. Xavier Becerra, et al., No. 19-55155, 9th Cir., 2020 U.S. App. LEXIS 10407).

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