Mealey's Health Care / ACA

  • June 25, 2020

    Government Prevails In ACA Hospital Pricing Rule Challenge

    WASHINGTON, D.C. — Hospital price disclosure rules crafted in furtherance of the Patient Protection and Affordable Care Act (ACA) and transparency are legal, as are enforcement measures, a federal judge in the District of Columbia said June 23 (The American Hospital Association, et al. v. Alex M. Azar II, et al., No. 19-3619, D. D.C., 2020 U.S. Dist. LEXIS 110130).

  • June 23, 2020

    Parity Act Discovery Exceeds That Of ERISA, Federal Judge Says

    SALT LAKE CITY — While Employee Retirement Income Security Act cases strictly limit discovery, plaintiffs are entitled to more when alleging distinct Parity Act claims, a federal judge in Utah said June 19 (Michael W., et al. v. United Behavioral Health, et al., No. 18-818, D. Utah, 2020 U.S. Dist. LEXIS 108103).

  • June 22, 2020

    Parity Act Permits Discovery; Claim Survives Dismissal, Federal Judge Says

    SALT LAKE CITY — The existence of an Employee Retirement Income Security Act claim does not preclude discovery into a Parity Act claim, and nothing prevents plaintiffs from pleading the latter as an alternative to the former, a federal judge in Utah said June 18 (Denise M., et al. v. Cigna Health and Life Insurance Co., et al., No. 19-975, D. Utah, 2020 U.S. Dist. LEXIS 108097).

  • June 22, 2020

    High Court Denies Cert Over Denial Of Attorney Fees After ‘Procedural’ Win

    WASHINGTON, D.C. — The U.S. Supreme Court revealed in a June 22 orders list that it will not weigh in on claims that the Fifth U.S. Circuit Court of Appeals wrongly denied an attorney fees award to a plan participant who, in an earlier appeal, won a “procedural” victory over health benefits governed by the Employee Retirement Income Security Act (Ariana M. v. Humana Health Plan of Texas, Inc., No. 19-980, U.S. Sup.).

  • June 22, 2020

    Judge Denies Man’s Request To Transfer Criminal Health Care Fraud Suit

    HARTFORD, Conn.  — A federal judge in Connecticut on June 18 denied a motion to transfer filed by a former substance abuse clinic owner who is accused of conspiracy to commit health care fraud, health care fraud and wire fraud, finding that California is not a better venue for the action and that the novel coronavirus pandemic does not weigh in favor of transfer (United States v. R. Jeffrey Yates, No. 19-cr-266, D. Conn., 2020 U.S. Dist. LEXIS 107339).

  • June 19, 2020

    ACA Dispute Between Insolvent Insurer, U.S. Government Remanded

    WASHINGTON, D.C. — The Federal Circuit U.S. Court of Appeals on June 18 remanded an insolvent insurer’s case against the government over Patient Protection and Affordable Care Act (ACA) risk-corridor funds after a high court ruling allowing the pursuit of billions of dollars in lost payment (Land of Lincoln Mutual Health Insurance Co. v. United States, No. 17-1224, Fed. Cir.).

  • June 19, 2020

    Class Certified In Suit Over Surgery Denied Under Gender Reassignment Exclusion

    TUCSON, Ariz. — A federal judge in Arizona on June 15 accepted and adopted in full a magistrate judge’s recommendation to grant class certification in a lawsuit by a University of Arizona professor who alleges that the denial of his request for a surgery to treat gender dysphoria violated the U.S. Constitution and constituted sex discrimination (Russell B. Toomey v. Arizona, et al., No. 19-35, D. Ariz., 2020 U.S. Dist. LEXIS 104303).

  • June 18, 2020

    Hospital Secures Judgment In Deaf Man’s ACA Discrimination Case

    NEW ORLEANS — A deaf individual has not shown that a hospital discriminated against him by failing to secure a live interpreter during his hourlong stay, a federal judge in Louisiana said in granting summary judgment June 15 (Joseph Lockwood v. Our Lady of the Lake Hospital Inc., No. 17-509, M.D. La., 2020 U.S. Dist. LEXIS 103979).

  • June 18, 2020

    Judge Stays Liquidators’ Case Over Offset Under ACA Reinsurance Program

    WASHINGTON, D.C. — In light of a recent U.S. Supreme Court ruling, a U.S. Court of Federal Claims judge on June 12 further stayed a dispute between an insolvent insurer’s liquidators and the U.S. government over an alleged violation of South Carolina insurance law after an offset of $36 million under the reinsurance program of the Patient Protection and Affordable Care Act (ACA) (Raymond G. Farmer, et al. v. The United States, No. 18-1484, Fed. Clms.).

  • June 16, 2020

    Top Court Urged To Find Mandate Constitutional, Keep ACA Intact

    WASHINGTON, D.C. — Having heard from petitioners that the respondents lack standing or a meritorious challenge to the Patient Protection and Affordable Care Act (ACA) individual mandate, the U.S. Supreme Court on May 13 heard from groups as diverse as Indian tribes, a pair of states and various medical experts that the court should at the very least sever the provision from the rest of the law (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.).

  • June 15, 2020

    Commonality Problems Doom Wilderness Therapy Class, Federal Judge Says

    SALT LAKE CITY — Contrary to the plaintiffs’ claim that their insurer uniformly denies coverage for wilderness therapy as experimental, the evidence shows various outcomes for such claims, a federal judge in Utah held June 9 in denying class certification (Amy G., et al. v. United Healthcare, et al., No. 17-413, D. Utah, 2020 U.S. Dist. LEXIS 101752).

  • June 15, 2020

    Allegations Don’t Support Speech Therapy Coverage Claims Federal Judge Says

    BOSTON — A class has not shown that denial of insurance coverage for nonrestorative speech therapy violates the plan, nor that the insurer applies the exclusion only in the mental health setting, a federal judge in Massachusetts said June 9 in dismissing claims (N.R., et al. v. Raytheon Co., et al., No. 20-10153, D. Mass., 2020 U.S. Dist. LEXIS 101197).

  • June 15, 2020

    Appeal Launched In Residential Treatment Center Coverage Case

    SAN FRANCISCO — A man on May 28 appealed an adverse ruling by a California federal judge to the Ninth Circuit U.S. Court of Appeals, asking it to weigh in on an Employee Retirement Income Security Act case challenging a denial of medical benefits for 14 months of care at a residential treatment center (Martin P., et al. v. Premera Blue Cross, et al., No. 20-16071, 9th Cir.)

  • June 15, 2020

    Health Care Provider Loses State Law Claims, But ERISA Claims Survive

    TYLER, Texas — A health care provider’s Employee Retirement Income Security Act claim survives, but the balance of its suit seeking more than $43 million in unpaid bills from an insurer largely fails, a federal judge in Texas said May 29 in partially dismissing an action (Neil Gilmour, et al. v. Blue Cross and Blue Shield of Alabama, et al., No. 19-160, E.D. Texas, 2020 U.S. Dist. LEXIS 93771).

  • June 12, 2020

    ERISA Benefits Claim’s Survival Dooms Equity Claim, Judge Says

    ORLANDO, Fla. — A magistrate judge’s conclusion that a woman adequately alleges a claim seeking benefits for her daughter’s anorexia nervosa under the Employee Retirement Income Security Act precludes her from pleading an equitable relief claim based on the same allegations in the alternative, a federal judge in Florida said in adopting a report and recommendation on June 1 (Susan Hering v. New Directions Behavioral Health, et al., No. 19-1727, M.D. Fla.).

  • June 12, 2020

    Colorado Lawmakers Push For Premium Fee On Health Insurers

    DENVER — Colorado lawmakers introduced a bill on June 9 that would impose a premium fee on health insurers to support the state’s reinsurance program and extend access to more affordable health insurance for residents who are unable to get coverage under the Affordable Care Act.

  • June 11, 2020

    Colorado Insolvency Law Bars Offset Under ACA Program, Liquidator Says

    WASHINGTON, D.C. — An insolvent insurer’s liquidator argues in a June 8 appellee brief to the Federal Circuit U.S. Court of Appeals that Colorado’s insolvency law prohibits the U.S. government’s offset of payment under the Patient Protection and Affordable Care Act’s (ACA) risk adjustment program against the liquidator’s demand for payment under the ACA’s reinsurance program (Michael Conway v. The United States, No. 20-1292, Fed. Cir.).

  • June 10, 2020

    Pair Of Cases Survive Health Insurers’ Challenges To Assignment, Recovery

    MILWAUKEE — It makes no legal sense to conclude that a patient can assign rights to health insurance benefits but not the right to sue to enforce those benefits, a federal judge in Wisconsin said June 8 in a pair of cases (Jason Morris, et al. v. Aurora Network Plan, et al., No. 19-1210, 2020 U.S. Dist. LEXIS 99826, Emil Meucci, et al. v. Aurora Network Plan, et al., No. 19-1188, 2020 U.S. Dist. LEXIS 99833, E.D. Wis.).

  • June 10, 2020

    Insurer, Woman Battle Over Need For Bench Trial In ERISA Mental Health Case

    BOSTON — Appellees told a First Circuit U.S. Court of Appeals panel that having lost on summary judgment, an appellant cannot now seek a bench trial in an Employee Retirement Income Security Act case, but the woman fired back on June 8, saying that the insurer applied the wrong standard in denying care and that a bench trial is the lone way forward (Jane Doe v. Harvard Pilgrim Health Care Inc., et al., No. 19-1879, 1st Cir.).

  • June 08, 2020

    Class Allegations Struck From Proton Beam Treatment Case

    CHICAGO — An insured whose proton beam radiation therapy (PBRT) treatment for brain cancer was rejected by her Employee Retirement Income Security Act plan and the plan administrator may proceed with claims for benefits and attorney fees and costs against both defendants and a breach of fiduciary duty claim against the administrator only, a federal judge in Illinois ruled June 1, dismissing the breach claim against the plan and striking the complaint’s class claims partially based on the “fail-safe” definition (Brittany Day, et al. v. Humana Insurance Company, et al., No. 19-3141, N.D. Ill., 2020 U.S. Dist. LEXIS 95211).

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