Mealey's Health Care / ACA

  • August 18, 2022

    Class Definitions Refined In LabCorp Kiosk Accessibility Case

    LOS ANGELES — A federal judge in California on Aug. 4 granted the plaintiffs’ motion to refine class definitions in a lawsuit brought by individuals who allege that Laboratory Corporation of America Holdings’ (LabCorp) self-service kiosks are not accessible for those who are visually impaired, but altered some of the wording to address concerns that the class was overinclusive or fail-safe in light of the Ninth Circuit U.S. Court of Appeals’ ruling in Olean Wholesale Grocery Cooperative, Inc. v. Bumble Bee Foods, LLC.

  • August 15, 2022

    Amici File Briefs In Calif. Supreme Court Row Over Medical Group’s UCL Standing

    SAN FRANCISCO — The California Supreme Court on July 6 gave an insurer and a physicians’ association until Aug. 22 to respond to amicus curiae briefs filed in June by municipal attorneys, unions, public interest groups and other parties, all weighing in on whether the association can claim standing under California’s unfair competition law (UCL) based on resources spent challenging the insurer’s policy restricting physicians from making out-of-network referrals in court.

  • August 12, 2022

    Most ERISA Claims Survive But Judge Dismisses ADA Claim In Transgender Coverage Row

    SPRINGFIELD, Mo. — A Missouri federal judge on July 27 denied dismissal regarding four counts asserted under the Employee Retirement Income Security Act in a suit over facial feminization surgery (FFS) for a transgender woman diagnosed with gender dysphoria but granted dismissal regarding a claim asserted under the Americans with Disabilities Act (ADA) and a statutory ERISA claim.

  • August 10, 2022

    New York Federal Judge Dismisses Autism Care Provider’s Suit Seeking Payment

    NEW YORK — Anti-assignment provisions and the standards for contract and quasi-contract claims require dismissal of an autism care provider’s suit, a federal judge in New York held Aug. 8.

  • August 10, 2022

    Pharmacy Managers’ Control Subjects Them To ACA-HIV Drug Claim, Judge Says

    SAN FRANCISCO — Pharmacy benefit managers’ control over subsidiary pharmacies receiving federal funds places them within the scope of Patient Protection and Affordable Care Act (ACA) Section 1557, a federal judge in California said Aug. 5 in denying a motion to dismiss discrimination claims involving provision of HIV/AIDS drugs.

  • August 09, 2022

    Court:  Provider’s Federal Funds Extend ACA Section 1557 To Insurance Plan

    CHICAGO — A subscriber to a health care provider’s insurance plan falls within the scope of interests protected by Patient Protection and Affordable Care Act Section 1557 because the provider receives federal assistance, the Seventh Circuit U.S. Court of Appeals said Aug. 5 in an interlocutory appeal ruling affirming a lower court.

  • August 08, 2022

    Drug Manufacturer Says Section 340B Doesn’t Require Contract Pharmacy Distribution

    PHILADELPHIA — In arguing that Public Health Service Act Section 340B requires manufacturers to distribute discount drugs to contract pharmacies without exception, the Department of Health and Human Services (HHS) now takes a position contrary to one it held for decades and without explaining the change or why it doesn’t violate federal law, a drug manufacturer tells the Third Circuit U.S. Court of Appeals in a July 14 reply.

  • August 08, 2022

    Kaiser Health Plan Disclaims Liability For Kaiser Providers’ Medical Decisions

    SAN FRANCISCO — Insureds have not shown that they were injured by their health plan when their medical providers denied access to care or that the insurer can be held liable for the subsidiary providers’ lack of staffing or scheduling, Kaiser Foundation Health Plan Inc. told a California appeals court July 1 in asking the court to uphold summary judgment on California unfair competition law (UCL) and state Parity Act claims.

  • August 05, 2022

    Receiver, Broker Submit Joint Status Report In Insolvent Health Plan Suit

    CHICAGO — An independent fiduciary receiver and insurance broker defendants on July 28 submitted a joint status report pursuant to a federal court’s June 1 order in a breach of duty of care suit against the insurance brokers, updating the court on the status of third-party subpoenas and settlements.

  • August 05, 2022

    Judge Finds Hearing Loss Treatment Exclusion Allegations Keep ACA Case Alive

    SEATTLE — Allegations that a health plan discriminates by covering cochlear implants to the exclusion of all other hearing loss treatments suffices for a breach of contract claim and a claim of discrimination under the Patient Protection and Affordable Care Act (ACA), a federal judge in Washington said Aug. 4 in denying a motion to dismiss.

  • August 05, 2022

    Company: Drug Discount Program Doesn’t Require Contract Pharmacy Deliveries

    CHICAGO — The text of Public Health Service Act Section 340B clearly permits pharmaceutical manufacturers to decline to deliver or sell drugs to contract pharmacies as long as they offer discounted prescription drugs to the covered entities, a conclusion the government has no answer for and simply breezes past in its brief, Eli Lilly and Co. and Lilly USA LLC argue in a July 25 Seventh Circuit U.S. Court of Appeals reply brief.

  • August 04, 2022

    West Virginia Medicaid Gender Surgery Exclusion Unlawful, Judge Says

    HUNTINGTON, W.Va. — The exclusion on surgical procedures for gender dysphoria in the West Virginia Medicaid program violates the U.S. Constitution and the Patient Protection and Affordable Care Act, a federal judge in the state said Aug. 2.

  • August 03, 2022

    8th Circuit Briefed On Proposed ACA Section 1557 Rule, Precedent

    ST. LOUIS — Parties in early July responded to the Eighth Circuit U.S. Court of Appeals’ request for briefing on how proposed rulemaking interpreting Patient Protection and Affordable Care Act (ACA) Section 1557 impacts their case, while on July 29 the appellee urged the court to reject the government’s contention that recent precedent shows that the rule’s challengers lack standing.

  • August 02, 2022

    Insurer: Texas Providers Can’t Meet Standard For Implied Right Of Action

    AUSTIN, Texas — Courts must use strict construction standards when asked to find an implied private right of action by imparting words into a statute, a task plaintiffs in an emergency care reimbursement case cannot surmount in light of regulatory enforcement provisions and available common-law remedies, an insurer says in an Aug. 1 reply brief on a certified question to the Texas Supreme Court.

  • July 28, 2022

    Judge Vacates ‘No Surprises’ Out-Of-Network Air Ambulance Arbitration Rule

    TYLER, Texas — By overweighting the qualifying payment amount over five other arbitration factors used to determine the proper reimbursement for out-of-network air ambulance providers the Department of Health and Human Services violated the statute, a federal judge in Texas said July 26 in denying a motion for transfer as a waste of judicial resources while vacating and remanding portions of the rule.

  • July 26, 2022

    Judge: Insurer’s Counterclaims Legal In Nature, Unavailable Under ERISA

    PHILADELPHIA — An insurer’s counterclaim seeking alleged overpayments it made on genetic testing claims seeks purely legal remedies and not the equitable remedies available under the Employee Retirement Income Security Act Section 502(a)(3), a federal judge in Pennsylvania said July 22 in dismissing the claim.

  • July 25, 2022

    ACA Discrimination Case Parties Brief Agency-Power Limiting Supreme Court Ruling

    NEW ORLEANS — Parties to a challenge to sex-discrimination rules issued under the Patient Protection and Affordable Care Act advised the Fifth Circuit U.S. Court of Appeals in July 21 and 22 filings about the impact of a recent U.S. Supreme Court ruling circumscribing agency power.

  • July 25, 2022

    N.J. Court:  Out-Of-Network Emergency Care Law Enforcement Lies Only With State

    NEWARK, N.J. — Enforcement of a recently enacted New Jersey law governing compensation for inadvertent out-of-network emergency care lies exclusively with the state and provides no authority for appealing, a New York appeals court said July 22.

  • July 22, 2022

    Emergency Care Provider May Largely Proceed In Connecticut Reimbursement Case

    NEW HAVEN, Conn. — While the statute governing surprise billing applies to provider groups, its enforcement is left entirely to the state and does not contain a private right of action; but the group’s remaining claims under insurance and trade practices laws may proceed, a federal judge in Connecticut said July 20.

  • July 19, 2022

    Judge:  Lack Of Detail Dooms ERISA Suit Over Substance Use Disorder Care

    SANTA ANA, Calif. — Ruling on remand that the plaintiff did not plausibly allege a violation of the Employee Retirement Income Security Act or the terms of the plan at issue, a California federal judge on July 14 granted dismissal of suit against a health insurer and related entities regarding substance use disorder care.