SALT LAKE CITY — A federal judge in Utah on Jan. 13 remanded to the liquidation court an insolvent health insurer’s liquidator’s breach of fiduciary and negligence lawsuit against the insurer’s executives because the executives failed to establish that the case necessarily raises or involves a substantial issue of federal law for purposes of jurisdiction (Stillman Consulting Services, LLC v. Shaun Greene, et al., No. 19-668, D. Utah, 2020 U.S. Dist. LEXIS 6274).
WASHINGTON, D.C. — Rulings that found the Patient Protection and Affordable Care Act (ACA) individual mandate unconstitutional present no immediate impact and do not need to be addressed in an expedited fashion, a trio of Supreme Court respondents told the court Jan. 10 (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.).
LOS ANGELES — California law setting diagnosis-based payment rates applies to out-of-network care provided in an inpatient post-stabilization setting, a state appeals court held Jan. 9 (Dignity Health, et al. v. Local Initiative Health Care Authority of Los Angeles County, No. B288886, Calif. App., 2nd Dist.).
WASHINGTON, D.C. — A pair of Jan. 3 petitions for writ of certiorari seek U.S. Supreme Court review of a decision finding the Patient Protection and Affordable Care Act (ACA) individual mandate unconstitutional (The States of California, et al. v. The State of Texas, et al, No. 19-840, United States House of Representatives v. State of Texas, et al., No. 19-841, U.S. Sup.).
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.).
ALBUQUERQUE, N.M. — The government could not have acted in an arbitrary and capricious manner because it properly evaluated and investigated methods of imposing Patient Protection and Affordable Care Act (ACA) risk-adjustment charges, a 10th Circuit U.S. Court of Appeals panel held Dec. 31 (N.M. Health Connections v. United States HHS, No. 18-2186, 10th Cir., 2019 U.S. App. LEXIS 38739).
HARRISBURG, Pa. — A claim by a man with cancer that his health insurer misrepresented coverage lacks support and his claim that he didn’t know his health maintenance organization limited his coverage “is stunning,” a federal judge in Pennsylvania said in dismissing claims on Dec. 27 (Adam Brown v. Kaiser Foundation Health Plan of the Mid-Atlantic States Inc., No. 19-1190, M.D. Pa., 2019 U.S. Dist. LEXIS 221471).
WASHINGTON, D.C. — The liquidators for an insolvent insurer gave notice on Dec. 23 that they are appealing a U.S. Court of Federal Claims judge’s dismissal of their 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.).
WASHINGTON, D.C. — The U.S. government said on Dec. 19 that it is appealing to the Federal Circuit U.S. Court of Appeals a federal judge’s finding that Colorado insurance liquidation law bars its health agency from using money owed to an insolvent Colorado insurer to pay debts owed under the Patient Protection and Affordable Care Act’s (ACA) reinsurance and risk-adjustment programs (Michael Conway v. The United States, No. 18-1623, Fed. Clms., 2019 U.S. Claims LEXIS 1306).
NEW YORK — A federal judge in New York on Dec. 18 denied a motion for reconsideration, saying that a certified class did not include patients who assigned their Employee Retirement Income Security Act rights to health care providers and that the issue involved predominance more than commonality (The Medical Society of the State of New York, et al. v. UnitedHealth Group Inc., et al., No. 16-5265, S.D. N.Y.).
NEW ORLEANS — The Patient Protection and Affordable Care Act (ACA) individual mandate is unconstitutional with its payment set at zero, a majority of a Fifth Circuit U.S. Court of Appeals panel held Dec. 18, but it remanded the case for a closer inspection of whether the provision could be severed from the entire law (Texas, et al. v. United States, et al., No. 19-10011, 5th Cir.).
WASHINGTON, D.C. — In a Dec. 16 filing, the federal government indicated that it will appeal a nearly $1.6 billion judgment for its failure to make Patient Protection and Affordable Care Act (ACA) cost-sharing payments for 2017 and 2018 (Common Ground Healthcare Cooperative v. The United States, No. 17-877, Fed. Clms.).
SAN FRANCISCO — A woman adequately alleges that her insurer denies coverage for liposuction treatments for lipedema, despite covering surgeries needed to reduce pain and improve functionality in other settings, a federal judge in California said in declining to dismiss her case Dec. 10 (Michala Kazda v. Aetna Life Insurance Co., No. 19-2512, N.D. Calif.).
SALT LAKE CITY — A federal judge in Utah on Dec. 10 heard arguments about whether a family adequately pleaded that an insurer improperly denied coverage for wilderness therapy and withheld judgment on the insurer’s motion to dismiss the Mental Health Parity and Addiction Act claim (Candace B., et al. v. Blue Cross and Blue Shield of Rhode Island, No. 19-39, D. Utah).
WASHINGTON, D.C. — The U.S. Supreme Court heard arguments on Dec. 10 about whether the Patient Protection and Affordable Care Act (ACA)’s “shall pay” language created a financial obligation for the government or at all times remained contingent on later congressional funding (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.).
ALAMEDA, Calif. — A surgery provider’s preauthorization conversations with insurers led it to believe it that would be paid its usual and customary rates, a federal judge in California said Nov. 20 in denying a motion to dismiss (California Spine and Neurosurgery Institute v. Oxford Health Insurance Inc., et al., No. 19-3533, N.D. Calif., 2019 U.S. Dist. LEXIS 202556).
TRENTON, N.J. — The record is largely silent as to whether a medical provider has valid assignments from insureds, and even if it had standing under the Employee Retirement Income Security Act, its claims do not directly involve such a plan, a federal magistrate judge in New Jersey said Nov. 25 in recommending remand (North Jersey Brain & Spine Center v. United Healthcare Insurance Co., et al., No. 18-15631, D. N.J.).
CHICAGO — Only a health plan’s participating providers must obtain preauthorization for nonemergency transport, and absent evidence of a closer qualified provider, there exists no reason to conclude that air transport to the facility in question was not medically necessary, a federal judge in Illinois held Nov. 26 (Aviation West Charters LLC v. Health and Welfare Plan for Employees of Anjinomoto USA Inc., et al., No. 18-7431, N.D. Ill., 2019 U.S. Dist. LEXIS 204908).
SALT LAKE CITY — A health insurer and plan must produce documents related to an insured’s mental health treatments and how they determine medical necessity in that setting as well as surgical settings, a federal judge in Utah said Dec. 2 in reserving rulings on motions to dismiss and to amend a complaint (James C., et al. v. Anthem Blue Cross and Blue Shield, No. 19-38, D. Utah).
SALT LAKE CITY — Debts incurred when a health insurer denied coverage for a child’s treatments provide the parents with standing, but their attempts to recover the amount through the Mental Health Parity and Addiction Act rely on conclusory statements and are better addressed by the Employee Retirement Income Security Act, a federal judge in Utah said Nov. 21 (John R., et al. v. United Behavioral Health, et al., No. 18-35, D. Utah).