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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.