Mealey's Health Care / ACA : Mealey's : Legal News & Analysis

Mealey's Health Care / ACA

November 28, 2023
2nd Circuit: Hospital’s Use Of Daughter As Interpreter Didn’t Violate ACA

NEW YORK — A district court properly concluded that a hospital staff’s interactions with two individuals could be interpreted as a request that a deaf woman’s daughter serve as her interpreter and that the provider did not violate the Patient Protection and Affordable Care Act (ACA) in doing so, a panel of the Second Circuit U.S. Court of Appeals said.
November 28, 2023
Aging, Health Care Amici Throw Support Behind Medicare Drug Negotiation Law

WILMINGTON, Del. — In a trio of amicus curiae briefs, health care and aging experts and advocates told a federal judge in Delaware that a recently enacted Medicare drug negotiation program falls within well-established powers to regulate prices the program and others within the government pay and will help reign in the “unsustainable increase in prescription drug prices.”
November 28, 2023
10th Circuit Revives ERISA Claim For Violation Of Parity Act In Coverage Row

DENVER — Reversing and remanding dismissal of a Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA or Parity Act) claim in a case over residential mental health treatment, a 10th Circuit U.S. Court of Appeals panel ruled in part that the insureds “plausibly alleged a disparity between the treatment limitations applied to benefits for mental health or substance abuse care compared to those applied to benefits for medical or surgical care.”
November 27, 2023
Judge Orders Insurer To Fully Compensate Man For Proton Beam Therapy

ALEXANDRIA, La. — An insurer found liable for proton beam therapy (PBT) treatments a man paid for out of pocket after being denied coverage may not retroactively try to compensate him at in-network rates, a federal judge in Louisiana said in granting a motion to enforce judgment and ordering the insurer to fully compensate him after the Fifth Circuit U.S. Court of Appeals affirmed the award.
November 20, 2023
Judge Grants But Reduces By 70% Attorney Fees, Costs In ACA Discrimination Case

CENTRAL ISLIP, N.Y. — Because a hospital’s own offer of judgment in a Patient Protection and Affordable Care Act (ACA) discrimination case contemplates attorney fees and costs in a case where a woman recovered nominal damages, its “quarrel lies with their own drafting,” but a federal judge in New York said the problematic request for fees and costs required a 70% reduction.
November 16, 2023
2 Estates’ Class Suit Accuses UnitedHealth Of Care Denial By AI

MINNEAPOLIS — An insurer illegally employs artificial intelligence (AI) to deny elderly insureds medically necessary care based on a model that the insurer knows “has a 90% error rate,” two estates allege in a class complaint filed in a federal court in Minnesota.
November 15, 2023
HIV/AIDS Sufferers Defend ACA Discrimination, UCL Claims In Drug Case

SAN FRANCISCO — Defendants didn’t need a court ruling to know that restricting access to HIV/AIDS drugs would discriminate against those suffering from the disease in violation of the Patient Protection and Affordable Care Act (ACA), while the California unfair competition law (UCL) permits recovery of unlawful profits accrued through unfair means, plaintiffs tell a federal judge in California in a Nov. 14 memorandum opposing dismissal.
November 14, 2023
Class Suit: CVS Job Applicant AI Screening Tool Is Illegal Lie Detector Test

BOSTON — CVS Health Corp. and CVS Pharmacy Inc. use an artificial intelligence-based facial and vocal scanning program during the hiring process, drawing conclusions about applicants’ enthusiasm and potential culture fit in what amounts to a lie detector test given in violation of Massachusetts law, plaintiffs allege in a federal class action.
November 13, 2023
Lipedema Sufferers Keep Insurance Class, Can’t Secure Summary Judgment

SAN FRANCISCO — Recent precedent does not require decertifying an Employee Retirement Income Security Act class action seeking reprocessing of lipedema sufferers’ liposuction coverage claims, but because a dispute remains over whether the insurer categorically denied coverage, summary judgment for the insureds is also inappropriate, a federal judge in California said.
November 13, 2023
Government, Class Report Agreement To Settle 1 Appeal In ACA Reinsurance Row

WASHINGTON, D.C. — Parties in an appeal concerning a $185,230,024.42 judgment against the government have told the Federal Circuit U.S. Court of Appeals that they “have agreed to settle this matter,” with a settlement framework approved by both sides in the litigation over the Transitional Reinsurance Program (TRP) of the Patient Protection and Affordable Care Act (ACA).
November 10, 2023
Chambers: Medicare Pricing Law Dresses Up Unconstitutional Coercion As Voluntary

DAYTON, Ohio — The Medicare price-negotiation law dresses itself up as a voluntary scheme when in reality it imposes “unprecedented and unconstitutional” price controls and hands nearly unchecked powers to the federal government, four chambers of commerce plaintiffs argue in a motion for summary judgment in Ohio federal court.
November 09, 2023
Insurer Says Costa Rica Air Transport Wasn’t Medically Necessary

LOS ANGELES — Because there was no emergency and two insureds were transported from a hospital where they were in stable condition, the services were not medically necessary and the claims for payment properly denied, an insurer told a California appeals court.
November 09, 2023
Judge Dismisses Hospital’s ACA Cost-Sharing Case, Grants Leave To Amend

SACRAMENTO, Calif. — The Patient Protection and Affordable Care Act (ACA) does not appear to preclude a health plan from not contracting with any hospitals and thus the cap on in-network out-of-pocket costs does not apply to a hospital’s attempt to recover $400,000 in uncompensated care, a federal judge in California said while granting leave to amend.
November 09, 2023
2nd Circuit: Attorney Can Sue For Insureds, But Claims Ultimately Fail

NEW YORK — Attorney in fact status permits a lawsuit on behalf of a provider’s patients, but the breach of contract and other claims at the heart of the case alleging insufficient compensation for applied behavioral analysis therapy fail because the compensation complies with plan language and there is no evidence of conduct that would support an implied covenant of good faith and fair dealing claim, a panel of the Second Circuit U.S. Court of Appeals said in a Nov. 8 amended summary order affirming dismissal.
November 07, 2023
Air Transports Won’t Amend Complaints After No Surprises Act Dismissals

FORT MYERS, Fla. — Two emergency air transport companies said they believe in the sufficiency of their allegations and intend to stand on their complaints after a federal judge in Florida dismissed their actions alleging that two insurance plans misrepresented information during the No Surprises Act (NSA) arbitration process and naming the arbitrator as a defendant.
November 03, 2023
Final Settlement OK Sought Amid Attorney Fee Fight In ERISA Surgery Coverage Row

SAN FRANCISCO — With a separate and opposed attorney fee request pending, the plaintiff who sued a health plan and related entities over denial of coverage for a specialized form of liposuction to treat lipedema asked a California federal court for final approval of a class settlement that had a long road to preliminary approval.
November 02, 2023
California Supreme Court Grants Review In 3rd Suit Over Nondisclosure Of ER Fees

SAN FRANCISCO — The California Supreme Court on Nov. 1 granted an uninsured emergency room patient’s petition for review of his putative class suit accusing a group of medical service providers of violating California’s unfair competition law (UCL) by failing to directly disclose to him that he would be billed more than $10,000 for three emergency room visits.
October 26, 2023
Insurer’s Summary Judgment Motion Granted In Residential Treatment Case

NEW YORK — A federal judge in New York granted insurers’ motion for summary judgment on an Employee Retirement Income Security Act claim to recover benefits for residential treatment services and denied as moot a father and son’s cross-motion on the same claim, ruling that insurers provided substantial evidence to support their denials for coverage.
October 25, 2023
Fee Award Denied In Dismissed ‘Impossible To Adjudicate’ COVID-19 Testing Row

NEWARK, N.J. — Following dismissal with prejudice of a medical practice’s Employee Retirement Income Security Act suit over payment for COVID-19 tests, a New Jersey federal magistrate judge on Oct. 24 denied an insurer’s request for attorney fees and costs.
October 25, 2023
Judge: Bankruptcy Stays Attorney Fees Motion In Asbestos Diagnosis Case

MISSOULA, Mont. — Because a railway’s motion for attorney fees in the wake of its successful pursuit of a False Claims Act case came before the Patient Protection and Affordable Care Act (ACA) asbestos program provider’s bankruptcy, the request constitutes a claim against the debtor and falls under the U.S. Bankruptcy Code’s automatic stay, a federal judge in Montana said.
October 24, 2023
Partial Dismissal Recommended In Insurance Case For Mental Health Treatment

AUSTIN, Texas — A federal magistrate judge in Texas recommended partly granting a motion to dismiss filed by the parent company of an insurer on the ground that a high school student alleging that the insurer misrepresented policy provisions to deny covering her mental health treatment focused her complaint on facts that give rise to the need for coverage and not on alleged misrepresentation of the insurance policy itself.
October 24, 2023
Judge Stays Emergency Care Case Involving Claims Data File Production Dispute

TEXARKANA, Texas — A federal judge in Texas on Oct. 23 granted a joint motion to stay pending mediation, putting on hold a motion seeking reconsideration of a ruling ordering the production of data files created during the health care claims process, which the insurer warned would require 1.4 million man hours.
October 24, 2023
Texas Court Won’t Rehear Question On Health District’s Immunity From Suit

HOUSTON — A Texas appeals court on Oct. 24 declined rehearing en banc of its split decision finding that a statutorily created hospital district’s nonprofit health maintenance organization lacked the ability to claim immunity from a medical provider’s lawsuit as a unit of local government.
October 20, 2023
En Banc Review Denied To COVID-19 Test Provider Seeking Reimbursement From Insurer

SAN FRANCISCO — The Ninth Circuit U.S. Court of Appeals denied a petition for rehearing en banc sought by a COVID-19 test provider after a panel of the court 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.
October 20, 2023
Judge Denies Injunction In UCL Health Care Data Case Against Google

SAN JOSE, Calif. — Plaintiffs’ privacy and California unfair competition law (UCL) claims appear to turn on whether Google LLC simply acquires health information as a vendor or actually uses that data in some fashion, a federal judge said while concluding that the balance of hardships weighs against granting a motion for a preliminary injunction. In their complaint, the plaintiffs allege that Google’s own artificial intelligence suggested that Google’s collection of health data might run afoul of various laws.