WASHINGTON, D.C. — The U.S. Supreme Court on Dec. 13 invited the solicitor general to file a brief expressing the United States’ views on a petition by health plans and individual subscribers for review of a ruling that a health benefits provider and a pharmacy benefits manager (PBM) were not acting as fiduciaries under the Employee Retirement Income Security Act when they set prescription drug prices.
WASHINGTON, D.C. — A federal judge on Nov. 30 held that the U.S. government cannot use an administrative offset to make an “end-run around” a state liquidation process, “particularly not where the government elected to participate in that process and had its claim decided,” finding that the Nevada commissioner of Insurance as receiver for the Nevada Health CO-OP (NHC) is entitled to judgment on all claims in her lawsuit alleging that the government improperly withheld payments under the Patient Protection and Affordable Care Act (ACA).
KANSAS CITY, Kan. — An insurer that recently assumed an insolvent excess insurer’s responsibility for claims and defenses in an antitrust coverage dispute filed an opposition on Nov. 23 to Blue Cross Blue Shield of Kansas Inc.’s objection to a Kansas federal magistrate judge’s discovery order.
WASHINGTON, D.C. — The U.S. Supreme Court on Dec. 3 granted an 45-day extension of time to respond to a petition over the objections of the state employees’ health plan, which argued that such a delay forces it to face summary judgment motions and potentially a trial before resolution of whether it is entitled to sovereign immunity from Patient Protection and Affordable Care Act discrimination claims.
WASHINGTON, D.C. — After plaintiffs filed a pair of summary judgment motions in a case alleging that a state employee health plan’s exclusion on transgender procedures violates the Patient Protection and Affordable Care Act prohibition on discrimination, defendants asked the court on Dec. 6 to strike them and for expedited consideration, saying the more than 12,000 combined words fail to comply with local rules and court rulings.
LOS ANGELES — A California appellate court Nov. 30 declined to publish its opinion finding that a judge properly excluded an injunctive relief claim under California’s unfair competition law (UCL) while also affirming the exclusion of certain evidence and expert testimony and dismissal of tort claims arising from alleged underpayment for emergency services.
WASHINGTON, D.C. — Whether the Patient Protection and Affordable Care Act (ACA) and the underlying anti-discrimination statutes from which it borrows put a federal funding recipient on notice of the potential for emotional distress damages or whether such damages are more akin to punitive damages and must be clearly imposed by Congress came before the U.S. Supreme Court during oral arguments on Nov. 30.
WASHINGTON, D.C. — The District of Columbia U.S. Circuit Court of Appeal on Nov. 23 rejected efforts by an appellant to obtain coverage under his Employee Retirement Income Security Act-governed benefits plan for mental health treatment sought by a dependent, leaving intact findings by a District of Columbia federal judge that the denial of benefits was supported by substantial evidence.
BRIDGEPORT, Conn. — An insurer’s claims that laboratories fraudulently billed it are subject to the presumption of laches but not barred by the doctrine, but it states a claim against only two of the six defendants, a federal judge in Connecticut said Nov. 22 in partially granting a motion to dismiss.
ST. LOUIS — Plaintiffs’ Employee Retirement Income Security Act fiduciary claims impermissibly seek damages, and the statute preempts state law parity act claims in a residential treatment case against a self-funded plan, a federal judge in Missouri said Nov. 19 in dismissing claims.
CHARLOTTE, N.C. — Even if the Patient Protection and Affordable Care Act covers health care recipients’ companions, discrimination claims under the law still rise and fall with the Rehabilitation Act, and a man lacks evidence that isolated failures during a single visit to a hospital for the birth of his child constitute intentional discrimination, a federal judge in North Carolina said Nov. 16 in dismissing the man’s suit.
AKRON, Ohio — Members of health insurance plans filed a class complaint in a federal Ohio court on Oct. 21, seeking a declaration that the plans “were and are illegal contracts” and a ruling that Liberty HealthShare Inc.’s CEOs or directors are personally liable upon finding Liberty an unauthorized and insolvent insurer under Virginia Code Annotated Section 38.2-215.
COLUMBUS, Ohio — The secretary of Labor lacks authority to challenge out-of-network reimbursement methodology under the Employee Retirement Income Security Act because there are no alleged plan losses, but some of the claims stemming from a self-insured wellness plan’s failure to provide tobacco users an alternative means of meeting a health-related reward may proceed, a federal judge in Ohio said Nov. 17 in a mixed ruling on motions to dismiss.
GREENSBORO, N.C. — The Patient Protection and Affordable Care Act’s incorporation of discrimination statutes did not constitute a waiver of sovereign immunity by the states, a health plan covering North Carolina university employees tell the U.S. Supreme Court in a Nov. 2 petition urging it to accept review and end the “deep uncertainty” states face in the wake of a ruling allowing transgender discrimination claims to proceed.
WASHINGTON, D.C. — Precedent supports awards of compensatory damages such as those for emotional distress in a case alleging discrimination in the provision of health care in violation of the Patient Protection and Affordable Care Act (ACA), a deaf and blind woman told the U.S. Supreme Court Nov. 2.
NEW ORLEANS — The Fifth Circuit U.S. Court of Appeals in an Oct. 25 order denied panel rehearing and rehearing en banc regarding a decision that upheld a health plan benefit denial under the Employee Retirement Income Security Act, declining an appellee’s request to reevaluate its “substantial evidence” standard for reviewing such denials.
SAN FRANCISCO — The U.S. Supreme Court on Nov. 12 granted a joint motion dismissing a case involving the interplay between federal discrimination law and the Patient Protection and Affordable Care Act and whether together they recognize disparate impact cases.
AUSTIN, Texas — The Texas Supreme Court should affirm that the state’s emergency care laws require payment for out-of-network emergency at the usual and customary rate, that providing care to insureds can form the basis of a quantum meruit claim and that providers have standing to pursue their case, emergency care providers tell the court in a Nov. 8 brief on the merits.
WASHINGTON, D.C. — Congress and federal agencies are permitted to create standards governing the dispersing of federal funds and even rely on private entities for guidance on highly technical issues, the federal government told the U.S. Supreme Court on Nov. 8 in urging it to deny review of a challenge to a ruling upholding the ACA-Medicaid actuarial soundness rule.
SAN FRANCISCO — A California appeals court on Nov. 8 declined to rehear a case in which it found that even under the most generous standard, a man never establishes that a hospital’s failure to disclose that it imposes an emergency room fee separate from its listed charges constitutes unfair conduct under the California unfair competition law (UCL) or the California Consumers Legal Remedies Act (CLRA).