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Mealey's Health Care / ACA

October 19, 2023
9th Circuit Affirms Ruling For Fair Housing Advocate In Suit Against Nursing Home

SAN FRANCISCO — The Ninth Circuit U.S. Court of Appeals affirmed a district court’s ruling in favor of a nonprofit that advocates to stop housing discrimination under the federal Fair Housing Act (FHA) and Arizona Fair Housing Act, finding that the nonprofit had standing to sue and seek injunctive relief against a nursing home that allegedly refused to provide an American Sign Language (ASL) interpreter to a fictitious prospective resident and that “[t]he punitive damages award was not constitutionally excessive.”
October 18, 2023
Plaintiffs File Notice Of Appeal Regarding Rulings In ACA Reinsurance Row

WASHINGTON, D.C. — Two plaintiffs in a lawsuit over the Transitional Reinsurance Program (TRP) of the Patient Protection and Affordable Care Act (ACA) have filed a notice that they are appealing rulings against them that were issued in the U.S. Court of Federal Claims.
October 16, 2023
Supreme Court Grants Certiorari In 2nd Challenge To Chevron Deference

WASHINGTON, D.C. — The U.S. Supreme Court on Oct. 13 granted a petition for a writ of certiorari in a second case challenging the doctrine of Chevron deference and ordered that it be briefed on a schedule allowing argument “in tandem” with a pending case pertaining to the same issue, both of which involve challenges to regulations that require fishing vessels to pay federal monitors.
October 16, 2023
Hospitals Must Disclose ER Fees To Patients, California Supreme Court Told

SAN FRANCISCO — A patient tells the California Supreme Court in an opening brief on the merits that it should find that California’s unfair competition law (UCL) and Consumers Legal Remedies Act (CLRA) require a hospital to disclose emergency room visitation fees to patients, an issue on which a “split of authority” exists among California appellate courts.
October 13, 2023
Amici, Government Defend ACA Preventive Care Mandate To 5th Circuit

NEW ORLEANS — A women’s advocacy group warns in an amicus curiae brief about the impact of removing insurance coverage for preventive care while federal defendants tell the Fifth Circuit U.S. Court of Appeals that the individuals responsible for formulating what constitutes preventive care under the Patient Protection and Affordable Care Act (ACA) are inferior officers subject to sufficient control by the Department of Health and Human Services (HHS) to survive a constitutional challenge.
October 13, 2023
Providers: Insurer Avoids NSA Arbitration Through ‘Absurd’ Claim Processing

FLAGSTAFF, Ariz. — Arizona’s largest commercial health insurance company uses the No Surprises Act as both “a sword and a shield” by processing out-of-network claims as in-network claims based on decades-old contracts with individual physicians rather than the medical practice doing the billing in an effort to short circuit the law’s arbitration process, medical providers allege in an Oct. 12 federal lawsuit.
October 13, 2023
FDA Forms Committee With Eye On Digital Health, AI Technologies

WASHINGTON, D.C. — The Food and Drug Administration on Oct. 11 announced the formation of an advisory committee investigating digital health technologies such as artificial intelligence (AI) and related advancements.
October 12, 2023
Connecticut High Court Accepts Surprise Billing Certified Questions

HARTFORD, Conn. — The Connecticut Supreme Court accepted three certified questions, agreeing to resolve issues involving the interplay of the state’s Surprise Billing Law and insurance statutes.
October 12, 2023
Judge: Insurer’s Website Plan Details Can’t Support Hospitals’ Compensation Case

TRENTON, N.J. — References to how an insurer’s website portrays its plans’ out-of-network compensation do not sufficiently allege that hospitals were entitled to additional compensation under the Employee Retirement Income Security Act, and nothing in Patient Protection and Affordable Care Act (ACA) regulations precludes balance billing, a federal judge in New Jersey said in dismissing a case.
October 11, 2023
10th Circuit Won’t Rehear ERISA Case Where Panel Ordered Claim Reprocessing

DENVER — A ruling directing remand for claim reprocessing in an Employee Retirement Income Security Act case involving coverage of residential treatment for mental health and substance use will stand, with a 10th Circuit U.S. Court of Appeals panel issuing an Oct. 10 order denying insureds’ petition for panel or en banc rehearing.
October 10, 2023
4th Circuit Denies Rehearing In ERISA Case Involving Equitable Remedy Question

RICHMOND, Va. — The Fourth Circuit U.S. Court of Appeals has denied a petition for panel or en banc rehearing of an Employee Retirement Income Security Act case over denial of a heart transplant in which a panel partly vacated dismissal, focusing on the question of when monetary relief is equitable and splitting on an issue involving interpretation of a 2016 U.S. Supreme Court decision.
October 10, 2023
9th Circuit Panel Won’t Revive $75M ERISA Suit Against Insurers Under Bristol

PASADENA, Calif. — In an unpublished memorandum disposition rejecting the appellant’s reliance on Bristol SL Holdings, Inc. v. Cigna Health & Life Ins. Co., a Ninth Circuit U.S. Court of Appeals panel ruled in part that a debt collector “lacks derivative authority to bring [Employee Retirement Income Security Act] claims as a second assignee.”
October 09, 2023
DOL Announces Settlement Regarding Cross-Plan Offsetting For ERISA Plans

NEW YORK — Under a settlement agreement with the acting secretary of Labor regarding a practice known as cross-plan offsetting, EmblemHealth Inc. has agreed to provide prospective and retrospective relief regarding its administration of health plans covered by the Employee Retirement Income Security Act.
October 06, 2023
Oklahoma Judge Approves Receiver’s $1.8M Request In Liquidation Of Friday Health

OKLAHOMA CITY — An Oklahoma judge approved a fee and costs request filed by the receiver of Friday Health Plans of Oklahoma (FHPOK), seeking $1,868,131.46 for legal and administrative fees and fees for prescription and medical claims, finding the amounts requested to be “justified.”
October 06, 2023
9th Circuit Sets Argument In 2nd Appeal Of ERISA Parity Case Over Coverage

PASADENA, Calif. — Oral argument in the Ninth Circuit U.S. Court of Appeals is scheduled for Oct. 19 in an insured’s appeal challenging dismissal of his putative class case over coverage of mental health and substance use disorder claims, the docket shows.
October 04, 2023
AI Health Care Company’s ‘Patient Stories’ Handling Led To Data Breach, Suit Says

BOSTON — An artificial intelligence (AI) company specializing in health care “patient stories” failed to adequately secure the private health information it obtained, resulting in a data breach releasing patient medical records and other related information, a woman claims in a putative class action in Massachusetts federal court.
October 03, 2023
Provider: Plan Sponsor Ignoring No Surprises Act Arbitration Ruling

CAMDEN, N.J. — Almost a year past the 30-day window for making payment, a health care plan sponsor has yet to make good on a more than $10,000 No Surprises Act (NSA) arbitration award against it, a medical provider claims in an Oct. 2 complaint in New Jersey federal court.
October 02, 2023
Big TPA Seeks Dismissal Of Backward-Looking Claims In DOL’s ERISA Case

MADISON, Wis. — Arguing in part that Acting U.S. Department of Labor Secretary Julie A. Su “invokes two inapposite causes of action,” the third-party administrator (TPA) of hundreds of self-funded employee welfare benefit plans in a Sept. 29 motion asked a Wisconsin federal court to dismiss backward-looking claims in the suit over hospital emergency services claims and urinary drug screening claims.
October 02, 2023
Judge Vacates Notice Allowing Copayment Accumulator Drug Program

WASHINGTON, D.C. — A federal judge in the District of Columbia on Sept. 29 vacated a notice allowing insurers to exclude manufacturers’ copay assistance programs from deductible and out-of-pocket calculations, finding that the notice conflicted with the Patient Protection and Affordable Care Act’s (ACA) definition of cost sharing and that remand was necessary to correct the defects.
October 02, 2023
Supreme Court Won’t Review Ruling Equating Health Care ‘Benefit’ With Bill

NEW ORLEANS — The U.S. Supreme Cout on Oct. 2 denied a petition for certiorari in which a woman claimed that by defining health care “benefits” as requiring an unpaid bill the court below improperly doomed her case seeking coverage for medically necessary proton beam therapy (PBT) and ignored that many insureds who are denied coverage lack the resources required to pay out of pocket.
October 02, 2023
Rehearing Opposed In ERISA Case Where 10th Circuit Ordered Claim Reprocessing

DENVER —Contending in part that an “extreme argument” against remand for claim reprocessing was raised too late to be considered and “has no legal or logical basis,” United Health Insurance Co. and related entities urge the 10th Circuit U.S. Court of Appeals not to rehear a case involving residential treatment claims for mental health and substance use.
September 29, 2023
Judge: Vague Health Plan References Can’t Save Bariatric Surgery Case

LOS ANGELES — Allegations that bariatric surgery providers obtained assignment of rights suffice for standing under the Employee Retirement Income Security Act, but the failure to identify the plans or terms in question require dismissal, a federal judge in California said while granting leave to amend.
September 28, 2023
Parties Stipulate To Dismissal Of ERISA Drug Prices Suit Against Insurer

NEW HAVEN, Conn. — Parties in an Employee Retirement Income Security Act suit over allegations that Cigna Health and Life Insurance Co. “had no right under its prescription drug plans to charge ‘spread’ and then ‘claw back’ the member copayment or deductible ‘overpayments’” have filed a joint stipulation in Connecticut federal court to dismissal with prejudice.
September 27, 2023
Provider Urges Review In Connecticut Surprise Billing Certified Questions Case

HARTFORD, Conn. — A medical provider told the Connecticut Supreme Court that certified questions ask the court only to resolve an area of unsettled law involving the interplay of the state’s Surprise Billing Law and insurance statutes and do not seek an advisory opinion or ask the justice to act as a trial court.
September 27, 2023
Air Ambulance: Insurer Must Make No Surprises Act Arbitration Payments

PHOENIX — An insurer refuses to make payments on 21 claims for which it is liable under the No Surprises Act independent dispute resolution process, even where the arbitrator selected the insurer’s own submission, an air ambulance company alleges in a complaint filed in an Arizona federal court.