Mealey's Health Care / ACA

  • November 21, 2019

    Contracted Rate Allegations Escape ERISA Removal, Federal Judge Finds

    NEW ORLEANS — A medical provider’s suit seeking compensation for what it claims are the rates an insurer agreed to pay for insured’s treatments alleges the type of independent obligation separate from the Employee Retirement Income Security Act plan, a federal judge in Louisiana said Nov. 18 (Crescent City Surgical Center v. United Healthcare of Louisiana, et al., No. 19-12586, E.D. La., 2019 U.S. Dist. LEXIS 199009).

  • November 21, 2019

    Disparate Mental Treatment Allegations Satisfy Parity Act Standard, Judge Says

    SALT LAKE CITY — Allegations that a health insurer applied different standards for medical necessity in the mental health realm compared to traditional surgical and medical procedures adequately allege a violation of federal law, a federal judge in Utah said Nov. 18 (Peter E., et al. v. United Healthcare Services Inc., et al., No. 17-435, D. Utah, 2019 U.S. Dist. LEXIS 200603).

  • November 21, 2019

    Judge:  Entering Partial Final Judgment Avoids Injustice In ACA Cost-Sharing Case

    WASHINGTON, D.C. — Seeking to prevent the injustice that would arise from preventing an insurer from collecting post-judgment interest on nearly $18 million to which a court found it was entitled under the Patient Protection and Affordable Care Act (ACA) cost-sharing program for years 2017 and 2018, a federal judge on Nov. 18 granted partial final judgment (Local Initiative Health Authority for L.A. Co, et al. v. The United States, No. 17-1542C, Fed. Clms., 2019 U.S. Claims LEXIS 1779).

  • November 18, 2019

    Parties Settle Health Insurance Payment Spat After Case Survives Dismissal Motion

    PORTLAND, Ore. — A federal judge on Nov. 13 granted in part a motion to stay and extend case deadlines pending a settlement in a case challenging compensation from a health insurer (Dwayne Brandon v. Health Net Health Plan of Oregon Inc., No. 19-356, D. Ore.).

  • November 13, 2019

    HHS Secretary: No Protected Interest For Class Over Medicare Hospital Designation

    HARTFORD, Conn. — The secretary of Health and Human Services in an Oct. 31 post-trial brief tells a Connecticut federal court that a class of Medicare recipients have no protected property interest and no “state action” concerning the classification of their hospital services under Medicare rules (Christina Alexander, et al. v. Alex M. Azar II, No. 11-1703, D. Conn.).

  • November 12, 2019

    Lack Of Contract Between Insurer, Provider Dooms Health Care Action, Judge Says

    HONOLULU — An out-of-network provider’s letter indicating that it would bill patients if an insured does not pay its rates did not create a contract between the parties, and the lack of any contract dooms the insurer’s action, a federal judge in Hawaii said in dismissing the case with prejudice on Oct. 31 (Kaiser Foundation Health Plan Inc. v. The Queen’s Medical Center Inc., et al., No. 19-301, D. Hawaii, 2019 U.S. Dist. LEXIS 189386).

  • November 07, 2019

    Autism Therapy Coverage Class Seeks Preliminary Approval Of Settlement

    SEATTLE — Catholic health plan defendants will cover autism behavior therapy without exclusion or limitation and create an $800,000 fund reimbursing class members for out-of-pocket expenses under the terms of a settlement for which plaintiffs sought preliminary approval on Nov. 4 (J.R., et al. v. Blue Cross and Blue Shield of Illinois, et al., No. 18-01191, W.D. Wash.).

  • November 06, 2019

    Amicus Parties Urge Supreme Court Review Of ACA Mandate Case

    WASHINGTON, D.C. — A handful of amicus curiae parties on Nov. 1 urged the U.S. Supreme Court to take up the Patient Protection and Affordable Care Act (ACA) contraceptive mandate case (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.).

  • November 05, 2019

    Health Insurance Switch Claims Must Go Before Arbitration, California Court Says

    LOS ANGELES — California Patient Protection and Affordable Care Act (ACA) exchange plans fall outside state law governing arbitration clauses, and individuals who enrolled in health plans outside the exchange have not shown that the arbitration agreement violated the law, a California appeals court held Nov. 1 (Paul Simon, et al. v. Blue Cross of California, No. B292118, Calif. App., 2nd Dist., 2019 Cal. App. Unpub. LEXIS 7324).

  • November 04, 2019

    Part Of Liquidator’s Claims Over Offset Under ACA Reinsurance Program Dismissed

    WASHINGTON, D.C. — A U.S. Court of Federal Claims judge on Oct. 31 dismissed for lack of jurisdiction insolvent insurer liquidators’ state law claims against the U.S. government over violation of South Carolina insurance law following the government’s 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., 2019 U.S. Claims LEXIS 1584).

  • October 31, 2019

    Florida Proton Beam Coverage Case Heads North Under First-Filed Rule

    MIAMI — A proton beam coverage class action’s differences from one filed a month prior in Massachusetts involving cervical rather than prostate cancer are not so great that transfer is not warranted, a federal judge in Florida said Oct. 28 (Richard Cole, et al. v. United HealthCare Insurance Co., No. 19-21258, S.D. Fla.. 2019 U.S. Dist. LEXIS 187358).

  • October 28, 2019

    Federal Judge Rejects State Law Analysis, Clips Air Transport Suit Claims

    DALLAS — Texas laws governing payment for emergency care lack a private right of action and doom an air transport company’s suit, a federal magistrate judge in Texas held Oct. 4 in overriding a magistrate judge’s recommendations (Apollo MedFlight LLC v. BlueCross BlueShield of Texas, No. 18-166, N.D. Texas, 2019 U.S. Dist. LEXIS 172927).

  • October 28, 2019

    Dialysis Provider Portrays Assignment As Broad In ERISA, Medicare Claims Suit

    SAN FRANCISCO — A health care plan violated the Employee Retirement Income Security Act when it failed to notify insureds that the plan no longer offered in-network dialysis providers, a move that violated Medicare rules when prohibiting discrimination, and the assignment of “any cause of action” provides legal standing to pursue the claims, a provider tells the Ninth Circuit U.S. Court of Appeals in an Oct. 23 opening brief (DaVita Inc., et al. v. Amy’s Kitchen Inc., et al., No. 19-15963, 9th Cir.).

  • October 28, 2019

    Government, Amicus Say ACA Never Mandated Risk-Corridor Payments

    WASHINGTON, D.C. — The Patient Protection and Affordable Care Act (ACA) never appropriated funds for the risk corridor, and congressional action later limited how the program would function, dooming insurers’ suit seeking billions of dollars from the government, an amicus curiae told the U.S. Supreme Court on Oct. 25 on the heels of the government’s Oct. 21 respondent brief (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.).

  • October 25, 2019

    11th Circuit Affirms Judgment In ERISA Spine Surgery Benefit Case

    ATLANTA — An insurer with discretionary authority did not err when it denied coverage for two-level spinal fusion surgery under the plan’s exclusion on experimental procedures, an 11th Circuit U.S. Court of Appeals panel held Oct. 24 in rejecting an Employee Retirement Income Security Act claim (Sharon Pierce v. Wyndham Worldwide Operations Inc., et al., No. 19-11079, 11th Cir., 2019 U.S. App. LEXIS 31746).

  • October 25, 2019

    Judge Awards ACA Cost-Sharing Insurer Class $1.58B

    WASHINGTON, D.C. — A federal claims judge on Oct. 22 awarded a class of health insurers nearly $1.6 billion in Patient Protection and Affordable Care Act (ACA) cost-sharing reduction payments for 2017 and 2018 (Common Ground Healthcare Cooperative v. The United States, No. 17-877, Fed. Clms.).

  • October 24, 2019

    Judge Says Air Transport Provider, Insurer Never Agreed To Settlement

    GRAND RAPIDS, Mich. — Because a health insurer’s agent never signed a proposed settlement with an emergency air transport company, no formal agreement exists, the provider cannot claim to have relied on later statements in providing the service and the Employee Retirement Income Security Act preempts the lone other claim, a federal judge in Michigan held Oct. 2 (Air Trek Inc. v. Capital Steel & Wire Inc., et al., No. 17-1145, W.D. Mich., 2019 U.S. Dist. LEXIS 171716).

  • October 24, 2019

    Judge Adopts Report Denying Judgment, Remanding Health Care Case

    CENTRAL ISLIP, N.Y. — An action challenging the amount of a payment does not invoke the Employee Retirement Income Security Act, and without that claim, no reason exists to keep the case in federal court, a federal judge in New York said Oct. 9 in adopting a magistrate judge’s report and recommendation (Long Island Thoracic Surgery, et al. v. Building Service 32BJ Health Fund, No. 17-163, E.D. N.Y., 2019 U.S. Dist. LEXIS 150761).

  • October 24, 2019

    States Want More Time To Respond To Petition In ACA Birth Control Rules Case

    WASHINGTON, D.C. — Seeking to simultaneously respond to two petitions for writ of certiorari challenging a nationwide injunction on rules expanding moral and religious exemptions from the Patient Protection and Affordable Care Act (ACA) contraceptive mandate, the states of Pennsylvania and New Jersey on Oct. 22 asked the U.S. Supreme Court for additional time to file a response (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.).

  • October 23, 2019

    9th Circuit Keeps ACA Contraceptive Rules Injunction In Place

    SAN FRANCISCO — Rules expanding religious and moral exemptions to the Patient Protection and Affordable Care Act (ACA) contraceptive mandate overstep the law’s reach, and a federal judge properly granted a preliminary injunction, a majority of the Ninth Circuit U.S. Court of Appeals held Oct. 22 (State of California, et al. v. U.S. Department of Health & Human Services, et al., No. 19-15072, 9th Cir., 2019 U.S. App. LEXIS 31389).