Mealey's Health Care / ACA

  • December 8, 2017

    Court: Standing Lacking In Taxpayer’s Congressional Health Benefits Challenge

    WASHINGTON, D.C. — A taxpayer has not shown that his tax dollars were used to fund allegedly illegal congressional participation in an Patient Protection and Affordable Care Act (ACA) insurance exchange, and he has not shown that precedent permits him to sue absent such an injury, a District of Columbia appeals panel held Dec. 7 (Kirby Vining v. Executive Board of the District of Columbia, et al., No. 15-CV-242, D.C. App., 2017 D.C. App. LEXIS 397).

  • December 7, 2017

    Anti-Assignment Clause Ends ERISA Suit Against Health Insurer, Judge Says

    TRENTON, N.J.  — An anti-assignment provision bars a medical provider’s Employee Retirement Income Security Act suit alleging breach of fiduciary duty and the failure to make full payment, a New Jersey judge held Nov. 16 (University Spine Center v. Blue Shield of California, No. 17-8673, D. N.J., 2017 U.S. Dist. LEXIS 190684).

  • December 6, 2017

    District Of Columbia Passes Bill Codifying Women’s Health Care Coverage

    WASHINGTON, D.C. — Health care insurers would be required to cover preventive women’s health services — including contraceptives and breast-cancer screenings — without imposing cost-sharing measures for those services under legislation unanimously approved by the District of Columbia Council Committee of the Whole on Dec. 5.

  • December 6, 2017

    Judge Permits ACA, ERISA Claims Challenging Insurer’s Lactation Services Coverage

    CHICAGO — Three women may largely proceed with their class action claiming that their health insurance company erected insurmountable barriers rendering it impossible to procure in-network lactation services and imposed illegal cost-sharing on out-of-network services in violation of the Patient Protection and Affordable Care Act (ACA) and Employee Retirement Income Security Act (ERISA), a federal judge in Illinois held Dec. 4 (Laura Briscoe, et al. v. Health Care Service Corp., et al., No. 16-10294, N.D. Ill., 2017 U.S. Dist. LEXIS 198452).

  • December 6, 2017

    Dave & Buster’s $7.4M ERISA Settlement Denied By New York Federal Judge

    NEW YORK — A New York federal judge, in an order filed Dec. 1, declined preliminary approval of a class settlement worth up to $7,425,000 offered by Dave & Buster’s Inc. to end claims that the nationwide restaurant/entertainment chain violated the Employee Retirement Income Security Act by reducing the hours of its work force in 2013 to avoid the costs associated with providing health insurance to its full-time employees in compliance with the Patient Protection and Affordable Care Act (ACA) (Maria De Lourdes Parra Marin v. Dave & Buster’s, Inc., et al., No. 15-3608, S.D. N.Y.).

  • December 4, 2017

    New York Justice Finds State Law Bars Providers’ Underpayment Suit Against Insurer

    NEW YORK — A New York emergency medicine provider group’s claims that an insurer under-payed it are inseparably tied to, and based on, a state law lacking a private right of action, a justice said Nov. 30 in granting a motion to dismiss the action (Buffalo Emergency Assoc. LLP v. Aetna Health Inc., No. 651937/2017, N.Y. Sup., New York Co.).

  • December 4, 2017

    Magistrate Judge Recommends Dismissing Back Surgery Health Care Coverage Action

    DENVER — A woman’s ERISA suit seeking $377,233.50 for multilevel fusion surgery fails, first because the doctor who performed the procedure failed to exhaust administrative remedies and because the insured has not shown that her insurer erred in denying coverage sought by other doctors, a federal magistrate judge in Colorado held Nov. 30 in recommending dismissal of the suit (Rebecca Concilio v. Cigna Health and Life Insurance Co., No. 16-1863, D. Colo.).

  • November 30, 2017

    Judge Dismisses Title VII ACA Discrimination Claim Against Insurer

    MADISON, Wis. — The Civil Rights Act of 1964 applies to employers and their agents, making it an inappropriate vehicle for the pursuit of claims that an insurer allegedly discriminated against transgender individuals when it denied coverage for gender dysphoria and related procedures, a federal judge in Wisconsin held Nov. 20 (Alina Boyden and Shannon Andrews v. State of Wisconsin Department of Employee Trust Funds, et al., No. 17-264, W.D. Wis., 2017 U.S. Dist. LEXIS 191306).

  • November 30, 2017

    Pa.: ACA Birth-Control Mandate Exemptions Provide Injury, Standing For Suit

    HARRISBURG, Pa. — New rules expanding moral and religious exemptions from the Patient Protection and Affordable Care Act (ACA) contraceptive mandate threaten the health of Pennsylvania women and the commonwealth itself, the state argues in a Nov. 27 brief in support of a preliminary injunction barring the regulations (Commonwealth of Pennsylvania, et al. v. Donald J. Trump, et al., No. 17-4540, E.D. Pa.).

  • November 30, 2017

    8th Circuit Upholds Dismissal Of Dispute Seeking To Recover ACA Reinsurance Fee

    ST. LOUIS — Finding sovereign immunity was not waived, the Eighth Circuit U.S. Court of Appeals on Nov. 27 affirmed the dismissal of a lawsuit filed by trustees of a self-insured group health plan seeking to recoup from the U.S. government a fee paid under the Affordable Care Act’s transitional reinsurance program (Paul Batsche, et al. v. Thomas E. Price, No. 16-4305, 8th Cir., 2017 U.S. App. LEXIS 23844).

  • November 29, 2017

    COMMENTARY: When Strategies Go Awry: Part 2 in a Series on Cognitive Biases and Their Impact

    By Laura A. Frase

  • November 28, 2017

    ACA Forecloses On Review Of HHS Hospital Expansion Decision, Court Says

    WASHINGTON, D.C. — The Patient Protection and Affordable Care Act (ACA) precludes judicial review of agency decisions granting or denying hospital expansion requests, the District of Columbia Circuit U.S. Court of Appeals said Nov. 21 (Knapp Medical Center, et al. v. Eric D. Hargan, et al., No. 16-5234, D.C. Cir., 2017 U.S. App. LEXIS 23452).

  • November 28, 2017

    Catholic Group Seeks To Intervene In States’ Contraceptive Mandate Suit

    SAN FRANCISCO — The Little Sisters of the Poor on Nov. 21 asked a court to allow it to intervene in a lawsuit aiming to enjoin the newly issued expansion of religious and moral exemptions to the Patient Protection and Affordable Care Act (ACA) contraceptive mandate (State of California, et al. v. Don J. Wright, et al., No. 17-5783, N.D. Calif.).

  • November 22, 2017

    Judge Says Vague Evidence Keeps Claims Against Health Insurer Alive

    INDIANAPOLIS — Documents submitted in support of dismissal are sufficiently vague about the parties to a contract to deny a health insurer’s motion seeking to dismiss claims that it failed to properly pay $1,959,000 for a woman’s medical transport from Tanzania, a federal judge in Indiana held Nov. 17 (Teresa Kersey v. Anthem Insurance  Companies Inc., et al., No. 16-3335, S.D. Ind., 2017 U.S. Dist. LEXIS 190179).

  • November 22, 2017

    Judge: Arbitration Clause Doesn’t Cover Health Insurance Breach Of Contract Claims

    HOUSTON — A Texas hospital and health insurer agreed to arbitrate certain claims, but not the type of breach of contract claims stemming from the insurer’s alleged failure to pay the provider for services rendered to those covered under a Patient Protection and Affordable Care Act (ACA) exchange policy, a federal judge in Texas held Nov. 17 (Memorial Hermann Health System v. Blue Cross Blue Shield of Texas, No. 17-2661, S.D. Texas, 2017 U.S. Dist. LEXIS 190412).

  • November 15, 2017

    Class Action Challenges ACA Contraceptive Mandate Exemption Rules

    SOUTH BEND, Ind. — Newly issued rules implementing broad exemptions from the Patient Protection and Affordable Care Act (ACA) mandated contraceptive coverage imperils women’s health and violates federal law, a group of women allege in an Oct. 31 complaint (Mary Shiraef, et al. v. Eric Hargan, et al., No. 17-817, N.D. Ind.).

  • November 15, 2017

    Judge Relates Cases Challenging New ACA Contraceptive Rules

    SAN FRANCISCO — A federal judge on Nov. 6 granted the American Civil Liberties Union’s request to relate its case challenging newly issued federal regulations granting broad exemptions from the Patient Protection and Affordable Care Act (ACA) contraceptive mandate with a second case brought by the State of California (American Civil Liberties Union, et al. v. Don Wright, et al., No. 17-5772, N.D. Calif.).

  • November 15, 2017

    Judge: Tribe’s Health Care Plan Doesn’t Improperly Shift Costs To Government

    WASHINGTON, D.C. — An Indian tribe’s self-insured health plan excluding coverage for services where government benefits provide for lower costs does not violate the payer of last resort provision enacted by the Patient Protection and Affordable Care Act (ACA), a federal judge in the District of Columbia held Nov. 7 in remanding a case to an agency for reconsideration (Redding Rancheria v. Eric D. Hargan, et al., No. 14-2035, D. D.C., 2017 U.S. Dist. LEXIS 184061).

  • November 15, 2017

    Insurer Files Suit Seeking $21M In ACA Risk-Corridor Funds

    WASHINGTON, D.C. — Yet another insurer on Nov. 9 sued the United States, saying the government owes it more than $21 million under the Patient Protection and Affordable Care Act (ACA) risk-corridor program for 2016 (Health Alliance Medical Plans, et al. v. The United States of America, No. 17-1759, Fed. Clms.).

  • November 15, 2017

    Louisiana Court Affirms Certification Of Balance Billing Class Action

    LAKE CHARLES, La. — The fact that an insurer compensated an insured for some out-of-pocket expenses allegedly caused by a hospital’s illegal balance billing practice does not defeat class typicality requirements, a Louisiana appeals court held Nov. 2 in affirming certification of the class (Aaron Emigh, et al. v. West Calcasieu Cameron Hospital, et al., No. 17-292, La. App., 3rd Cir.).