Mealey's Health Care / ACA

  • April 12, 2024

    9th Circuit Discusses Parity Act Pleading Standard In Partly Reviving ERISA Case

    PASADENA, Calif. — Addressing “what pleading standard applies to cases alleging an improper internal process” under the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA or Parity Act), a Ninth Circuit U.S. Court of Appeals panel on April 11 partly reversed dismissal of a putative class case over mental health and substance use disorder (MH/SUD) treatment coverage.

  • April 11, 2024

    Insurer Accused Of Using AI Software To Deny Claims ‘En Masse’ In Class Suit

    OAKLAND, Calif. — An insured filed a putative class action in California state court accusing his insurer of violating California’s insurance regulations and its unfair competition law (UCL) by using artificial intelligence (AI) software to deny claims for coverage.

  • April 08, 2024

    Medical Coding, Damages Testimony Largely Admitted In Labs’ Compensation Case

    BRIDGEPORT, Conn. — Experts may largely testify about medical coding practices and the resulting damages labs incurred from an insurer’s denials of the labs’ claims because they go beyond a layperson’s knowledge and are based on solid calculations, a federal judge in Connecticut said in excluding only portions based on flawed data provided to the damages expert and the medical coder’s testimony about whether the labs attempted to collect from patients.

  • April 08, 2024

    Judge Allows Some Claims In ACA Hearing Loss Proxy Discrimination Case

    SEATTLE — Proxy discrimination and injunctive relief claims based on exclusions or limitations in health insurance coverage for hearing aids that allegedly targeted people with disabilities in violation of the Patient Protection and Affordable Care Act (ACA) may proceed, but other claims appear to be barred by state law, a federal judge in Washington said in partially granting a motion to dismiss.

  • April 08, 2024

    ACA Fertility Discrimination Claims Survive Dismissal, Federal Judge Says

    NEW HAVEN, Conn. — A woman who claims that an insurer’s policy on what constitutes infertility discriminates against non-heterosexual individuals assigned female at birth enjoys standing under the Patient Protection and Affordable Care Act, but since she no longer participates in the plan, she cannot proceed on a declaratory relief claim, a federal judge in Connecticut said in partly granting the insurer’s motion to dismiss.

  • April 02, 2024

    Judge Finds No Suprises Act Portal’s Reopening Moots Medical Provider’s Challenge

    BROOKLYN, N.Y. — The reopening of the No Suprises Act (NSA) arbitration portal moots a case challenging the process because it now appears fully capable of handling any problems that arise, and a medical provider may not proceed based on “an entirely speculative possibility that complained-of conduct may occur in the future,” a federal judge in New York said.

  • April 02, 2024

    Judge Sends Air Ambulances’ $5M Arbitration Award Cases To Connecticut

    AUSTIN, Texas — Because two actions alleging that insurers failed to make timely payments required by the No Surprises Act’s arbitration process involve alleged conduct by the insurers in Connecticut, a Texas court is not the proper venue, a federal judge in Texas said in granting motions to dismiss but transferring the actions.

  • April 02, 2024

    Judge ‘Appalled’ At AI’s Use In Research, Affirms Denial Of AD&D Claim

    CHICAGO  — A federal judge in Illinois said that despite an attorney’s clear violation of a court order prohibiting the use of artificial intelligence, she would assume that ChatGPT was not used to author the entire brief, while dismissing an Employee Retirement Income Security Act claim alleging that an insurer improperly denied an accidental death and dismemberment claim after a fatal car fire.

  • April 01, 2024

    Railway Says Montana Asbestos Screener Stuck ‘Head In Sand’

    MISSOULA, Mont. — Evidence introduced at trial showed a Libby, Mont., medical facility must have known the B-read-only and other claims it submitted to a special asbestos-related Patient Protection and Affordable Care Act (ACA) program were not a diagnosis and were fraudulent, and it cannot avoid liability by claiming it was simply doing its best when in reality it was sticking its head in the sand over the program’s requirements, a railway tells the Ninth Circuit U.S. Court of Appeals in a March 29 answering brief.

  • April 01, 2024

    California Court Affirms Insurer’s Summary Judgment In Medical Air Transport Case

    LOS ANGELES — Insureds seeking compensation for medical transport never produced evidence of disputed facts or sufficiently cited to the record, a California appellate court said March 29 in affirming summary judgment to the insurer.

  • March 26, 2024

    Preliminary Injunction Over Illinois Temp Worker Provision Draws Appeal

    CHICAGO — After an Illinois federal judge ruled that the Employee Retirement Income Security Act likely preempts an “equivalent benefits” amendment to the Illinois Day and Temporary Labor Services Act (DTLSA) and then issued a preliminary injunction prohibiting enforcement of that amendment, the leader of an Illinois regulatory department on March 25 filed notice of interlocutory appeal.

  • March 25, 2024

    6th Circuit Vacates Dismissal Of ERISA Preemption Case Against Tennessee Pharmacy

    CINCINNATI — In an unpublished opinion, a Sixth Circuit U.S. Court of Appeals panel vacated and remanded dismissal of a suit in which a bakery that wants to keep a pharmacy out of network for its self-funded health plan argued that the Employee Retirement Income Security Act preempts Tennessee’s “any willing pharmacy” laws.

  • March 22, 2024

    HHS Defends Rule Barring Health Providers’ Use Of Tracking Tech Under HIPAA

    FORT WORTH, Texas — Two U.S. Department of Health and Human Services officials on March 21 asked a Texas federal court to grant them summary judgment on four health care plaintiffs’ claims that a recently released bulletin violates the Health Insurance Portability and Accountability Act of 1996 (HIPAA) or the Administrative Procedure Act (APA), explaining that the bulletin properly served as a reminder to health care providers that the use of certain third-party website technologies violates HIPAA’s privacy protections by sharing users’ individually identifiable health information (IIHI).

  • March 22, 2024

    Parties Debate Reconsideration, Appeal In No Surprises Act Arbitration Case

    HOUSTON — A health insurer dismissed from a No Surprises Act (NSA) arbitration dispute opposed reconsideration on March 21, telling a federal judge in Texas that it is a necessary party for resolution of related claims against the arbitrator and that an interlocutory appeal will not materially advance the case.

  • March 19, 2024

    Judge Will Grant Preliminary Injunction For Illinois Temp Worker Provision

    CHICAGO — Ruling that trade associations and staffing agencies are likely to succeed on the merits of their argument that the Employee Retirement Income Security Act preempts one of three challenged amendments to the Illinois Day and Temporary Labor Services Act (DTLSA), an Illinois federal judge agreed to grant a preliminary injunction enjoining enforcement of that “equal pay” amendment.

  • March 19, 2024

    Untimely Cert Petition By COVID-19 Test Provider Denied By U.S. Supreme Court

    WASHINGTON, D.C. — The U.S. Supreme Court on March 18 denied a motion to direct the clerk to file a petition for a writ of certiorari out of time submitted by a COVID-19 test provider after a panel of the Ninth Circuit U.S. Court of Appeals affirmed the judgment of a California federal court dismissing five complaints brought by the provider seeking reimbursement from an insurer for COVID testing services under the Coronavirus Aid, Relief and Economic Security (CARES) Act.

  • March 15, 2024

    Respondents To High Court: Deny Review Of 4th Circuit ERISA Surcharge Ruling

    WASHINGTON, D.C. — Arguing that the case is a poor vehicle and that a purported circuit conflict is “illusory,” an employer and related respondents urge the U.S. Supreme Court to deny review and summary reversal in a suit concerning whether surcharge is available under an Employee Retirement Income Security Act provision that allows equitable relief.

  • March 14, 2024

    Labs Seek Reconsideration In ERISA Preemption, Florida Payment Laws Case

    NEW HAVEN, Conn. — Defendant laboratories in a battle over compensation for care provided to insureds filed a motion urging a federal judge in Connecticut to reconsider a finding that the Employee Retirement Income Security Act preempts certain claims, saying that Florida law creates a separate payment mandate that makes exploration of the plan language unnecessary.

  • March 13, 2024

    Arkansas Pharmacy Law Isn’t Preempted, Panel Says In Section 340B Drug Case

    ST. LOUIS — Arkansas law requiring Section 340B discount drug manufacturers to permit distribution through contract pharmacies does not conflict with the law, which is silent on distribution methods, or a second law governing highly regulated medications, the Eighth Circuit U.S. Court of Appeals said March 12 in affirming summary judgment for the state insurance commissioner and a pair of intervenors in the case.

  • March 12, 2024

    Judge Grants But Reduces Fees, Expenses In ACA Discrimination Case

    GREENSBORO, N.C. — Blind individuals and advocacy groups clearly constitute the prevailing party in a Patient Protection and Affordable Care Act (ACA) suit after receiving significant equitable relief from the court and are entitled to fees and expenses as a result, but they did not receive all the relief they sought and at least some of the complexity in the case arose from their own conduct, a federal judge in North Carolina said in granting but reducing a requested award.

  • March 08, 2024

    8th Circuit Sets Argument In ERISA Case Over Cross-Plan Offsetting

    ST. LOUIS — The Eighth Circuit U.S. Court of Appeals has set argument for March 14 in an Employee Retirement Income Security Act appeal where health plan participants challenging the practice known as “cross-plan offsetting” are seeking revival of their putative class suit, which was dismissed for failure to plead an injury in fact.

  • March 07, 2024

    Christian Employment Group, Members Have Standing In ACA Challenge, Judge Says

    BISMARCK, N.D. — Both the individual members of a Christian employers’ group and the association itself have standing in the face of imminent and concrete injury from a Patient Protection and Affordable Care Act (ACA) rule including gender identity under the definitions of discrimination, a federal judge in North Dakota said in granting the plaintiffs summary judgment on Religious Freedom Restoration Act (RFRA) claims.

  • March 07, 2024

    Briefing On Tolling In Opt-In Class Cases Ordered In Consolidated ACA Suits

    WASHINGTON, D.C. — Saying “issues important to the resolution of the [government’s dismissal] Motion remain unaddressed,” a U.S. Court of Federal Claims judge ordered supplemental briefing in consolidated cases of group health plans that allege that contributions were illegally exacted from them under the Transitional Reinsurance Program (TRP) of the Patient Protection and Affordable Care Act (ACA).

  • March 06, 2024

    11th Circuit Again Rules Against Dermatologist In ERISA Assignment Row

    ATLANTA — Saying in an unpublished per curiam opinion that a dermatologist’s “arguments are foreclosed by the prior panel precedent rule,” an 11th Circuit U.S. Court of Appeals panel issued the latest of many rulings against her over patients’ purported assignment of benefits.

  • March 05, 2024

    5th Circuit Hears Arguments Over Viability Of ACA Preventive Care

    NEW ORLEANS — Whether a task force’s members were properly empowered to issue preventive care recommendations under the Patient Protection and Affordable Care Act (ACA) and whether those recommendations or members can be accepted or appointed after the fact came before the Fifth Circuit U.S. Court of Appeals in March 4 oral arguments.