Mealey's Health Care / ACA
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July 21, 2023
Judge: Under Thole, Plaintiffs Lack Standing In ERISA Row Over Drug Rebates
NEWARK, N.J. — An Employee Retirement Income Security Act complaint over approximately $65 million in drug rebates that plaintiffs argued should have benefitted health care plan participants has been dismissed, with a New Jersey federal judge citing Thole v. U.S. Bank N.A. in ruling that the plaintiffs lack standing.
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July 20, 2023
Judge Awards Low End Of Penalties In Libby, Mont., Asbestos Diagnosis Case
MISSOULA, Mont. — The federal judge in Montana overseeing the False Claims Act (FCA) dispute between a railroad and the provider of medical care under a special provision of the Patient Protection and Affordable Care Act (ACA) said $2,582,228 in statutory penalties, while at the low end of the permissible range, were sufficient to curtail “reckless disregard for proper medical procedure.”
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July 19, 2023
No Surprises Act Doesn’t Compel Government Action, Judge Says In Dismissing Case
BROOKLYN, N.Y. — A medical provider with “seemingly for good reason” for being unhappy with operation of the No Surprises Act (NSA) identifies no statutory provision requiring action by the government defendants, a federal judge in New York said in granting a motion to dismiss and denying a motion for preliminary injunction as moot.
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July 17, 2023
California High Court Resurrects Medical Group’s UCL Suit Against Insurer
SAN FRANCISCO — The California Supreme Court on July 17 reversed a state appellate court’s affirmance of summary judgment in an insurer’s favor and said a physicians’ association had created a triable issue of fact as to whether it had standing to sue the insurer under the state’s unfair competition law (UCL) based on resources it spent responding to an insurer’s policy restricting physicians from making out-of-network referrals.
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July 14, 2023
1st Prong Of Takings Analysis Dooms Takings Claim In ACA Reinsurance Row
WASHINGTON, D.C. — In an unsealed ruling filed July 13 in a lawsuit over the Transitional Reinsurance Program (TRP) of the Patient Protection and Affordable Care Act (ACA), a U.S. Court of Federal Claims judge granted the government partial summary judgment based on the first prong of the Federal Circuit’s takings analysis.
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July 13, 2023
7th Circuit: Patient Lacks Standing To Sue For Health Data Sharing With Google
CHICAGO — Affirming the dismissal of an Illinois man’s putative privacy and contractual class claims over a hospital’s health data-sharing agreement with Google LLC in conjunction with a joint artificial intelligence research venture, a Seventh Circuit U.S. Court of Appeals panel found that the one-time patient failed to plead any concrete harm to establish his standing to sue under Article III of the U.S. Constitution.
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July 10, 2023
Judge Denies Reconsideration In ACA Heath Care Discrimination Case
CENTRAL ISLIP, N.Y. — The primary consideration rule requires that medical providers give weight to a disabled individual’s choice of auxiliary aid but does not require summary judgment given the existence of genuine issues about whether effective communication occurred, a federal judge in New York said in denying reconsideration of a summary judgment ruling.
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July 10, 2023
California School District Pushes Immunity, Health Plan Language Arguments
FRESNO, Calif. — A health insurance plan “says what it says” about compensation levels, and public entities are immune to quasi-contract claims, a school district tells a California appeals court in a respondent’s brief to affirm demurrer in its favor.
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July 10, 2023
Parties In Appeal Of Judgment In ACA Reinsurance Row Note Settlement Negotiations
WASHINGTON, D.C. — Parties in an appeal concerning a $185,230,024.42 judgment against the government on July 7 asked the Federal Circuit U.S. Court of Appeals to stay proceedings until Oct. 9, saying they “have entered into settlement negotiations that may resolve this matter” in the litigation over the Transitional Reinsurance Program (TRP) of the Patient Protection and Affordable Care Act (ACA).
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July 10, 2023
Judge Issues Sealed Ruling For Government In Suit Over ACA Reinsurance
WASHINGTON, D.C. — A U.S. Court of Federal Claims judge on July 7 issued a sealed ruling granting the government partial summary judgment in a lawsuit over the Transitional Reinsurance Program (TRP) of the Patient Protection and Affordable Care Act (ACA).
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July 07, 2023
Recent Supreme Court Ruling Supports Pre-Enforcement Action, Medical Providers Say
NEW ORLEANS — A recent U.S. Supreme Court ruling supports a pre-enforcement challenge to the Patient Protection and Affordable Care Act’s discrimination provision, medical providers tell a Fifth Circuit U.S. Court of Appeals panel in a notice of supplemental authority.
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July 07, 2023
Insurer: Production Would Involve Millions Of Claims, Man Hours
TEXARKANA, Texas — A federal judge in Texas on July 6 gave a medical provider until July 21 to respond to an insurer’s motion for reconsideration challenging a ruling compelling production of records it said could potentially apply to all 21 million emergency reimbursement claims in Texas and require 1.4 million man hours.
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July 06, 2023
Supreme Court Vacates Medicare Private Right Of Action Ruling, Remands
WASHINGTON, D.C. — The U.S. Supreme Court granted a petition for review, vacated a ruling finding a private right of action in Medicare allowed a hospital to seek to enforce rules requiring timely payments and remanded for further consideration in light of its recent precedent.
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July 03, 2023
Texas High Court Passes On Health Insurance Arbitration Dispute
FORT WORTH, Texas — The Texas Supreme Court declined to weigh in on a dispute over the proper process for evaluating arbitration claims involving health insurers and out-of-network providers.
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June 30, 2023
Respondents Won’t Respond To Woman’s Proton Beam Coverage Petition
NEW ORLEANS — An insurer and a government employer on June 29 both waived their right to respond to a woman’s U.S. Supreme Court petition claiming that a court ruling defining “benefits” as requiring an unpaid bill improperly doomed her case seeking coverage for medically necessary proton beam therapy (PBT).
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June 30, 2023
Judge Certifies Questions Over Surprise Billing Law To Connecticut High Court
NEW HAVEN, Conn. — The lack of guidance from Connecticut appellate courts on how the state’s Surprise Billing Law works and whether it permits an unfair trade practices claim, combined with the fact that the answers to those important questions will likely resolve litigation, warrant certifying questions to the Connecticut Supreme Court, a federal judge said June 29.
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June 30, 2023
Pretrial Briefs Detail Paths Forward For Dissolving AI Radiology Company
WILMINGTON, Del. — The part owner of a health care company who saw promise in the use of artificial intelligence to automate the detection of abnormalities in radiology reports told a Delaware court in a pretrial brief that immediate sale of the dissolving company is in its best interests, not waiting for a hypothetical better offer or improvement in business conditions.
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June 29, 2023
Montana Jury Finds Against Screener In ACA-Asbestos Medicare Program Fight
MISSOULA, Mont. — A Montana jury on June 28 found that a medical screening company violated the False Claims Act (FCA) by knowingly submitting fraudulent asbestos-disease claims under a provision of the Patient Protection and Affordable Care Act (ACA) Medicare program designed for residents of Libby, Mont., and awarded $1,081,265.
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June 29, 2023
Government: Provider Lacks Standing In No Surprises Case Under Recent Precedent
NEW YORK — Recent U.S. Supreme Court precedent confirms that courts generally do not entertain challenges to an agency’s enforcement discretion policies and that a medical provider therefore lacks standing to pursue a claim that the government mismanages the No Surprises Act (NSA) arbitration process, the government told a federal judge in New York in a notice of supplemental authority.
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June 28, 2023
Amici Praise ACA Preventive Care Mandate In 5th Circuit Appeal
NEW ORLEANS — A medical insurer and two groups of health care advocates told the Fifth Circuit U.S. Court of Appeals on June 27 that the preventive care mandate of the Patient Protection and Affordable Care Act (ACA) saved lives and reduced costs and that a judge’s nationwide injunction undoing a decade’s worth of work was harmful and unnecessary.
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June 28, 2023
Judge Again Excludes Senator’s Testimony In ACA-Asbestos Program Trial
MISSOULA, Mont. — A federal judge in Montana affirmed her decision to exclude the testimony of a former senator instrumental in the crafting of Patient Protection and Affordable Care Act (ACA) Medicaid program designed for Libby, Mont., residents exposed to asbestos, saying his opinions are not relevant to whether a diagnosing center acted in good faith.
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June 27, 2023
Government Appeals $185.2M Judgment, Underlying Rulings In ACA Reinsurance Row
WASHINGTON, D.C. — The government filed a June 26 notice in a suit over the Transitional Reinsurance Program (TRP) of the Patient Protection and Affordable Care Act (ACA) that it is appealing a $185,230,024.42 judgment in favor of an opt-in class of 357 self-insured, self-administered employee health and welfare benefit plans (SISAs) and underlying U.S. Court of Federal Claims rulings.
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June 27, 2023
9th Circuit Won’t Assign Prior Panel To Mental Health, Substance Use Disorder Row
PASADENA, Calif. — The panel that partially upheld dismissal of a putative class case over coverage of mental health and substance use disorder claims in a prior appeal has declined to accept the latest challenge in the suit “as a comeback case,” the Ninth Circuit U.S. Court of Appeals said, denying a motion by UnitedHealth Group Inc. and related appellees.
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June 20, 2023
Judge Rules On Dismissal Motions In FCA Suit Alleging Fraudulent ACA Upcoding
SAN FRANCISCO — A federal judge in California denied an insurer’s motion to dismiss the federal government’s operative first amended complaint in intervention alleging federal False Claims Act (FCA) violations related to claims under the Patient Protection and Affordable Care Act (ACA) by upcoding, causing the government to overpay, finding that the government “sufficiently pled a factual falsity theory.”
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June 13, 2023
Court Told Standing, Ripeness Doom Pre-Enforcement ACA Section 1557 Case
CINCINNATI — Two associations representing medical providers have not shown that any of their members are likely to run afoul of the transgender discrimination rules under Patient Protection and Affordable Care Act Section 1557 and lack standing to bring their pre-enforcement action, the government says in an appellee brief in the Sixth Circuit U.S. Court of Appeals.