Mealey's Health Care / ACA
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August 07, 2023
Magistrate Judge Finds Plaintiffs Can’t Link Premiums To ACA Network Size Claims
EL PASO, Texas — The plaintiffs’ own expert testified about the multitude of factors affecting health insurance premiums, and the plaintiffs never sufficiently explain how allegedly overinflated network provider lists would increase Patient Protection and Affordable Care Act marketplace plan premiums, a federal magistrate judge in Texas said Aug. 4 in recommending the court admit an expert on damages but deny a motion for class certification.
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August 04, 2023
Federal Judge Vacates No Surprises Act Fee, Batching Rules
TYLER, Texas — New rules increasing the No Suprises Act (NSA) fee and imposing restrictions on how independent dispute resolution (IDR) claims can be batched are substantive and required a notice and comment period, a federal judge in Texas said Aug. 3 in vacating the rules but declining to refund fees providers already paid.
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August 03, 2023
10th Circuit Won’t Rehear ERISA Residential Care Admission Opinion Case
DENVER — The 10th Circuit U.S. Court of Appeals declined rehearing and en banc rehearing, leaving in place a ruling finding that in denying coverage, an Employee Retirement Income Security Act health insurer failed to properly grapple with treating physicians’ opinions about a woman’s need for care at a long-term residential treatment facility.
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August 03, 2023
6th Circuit: ACA Shared Responsibility Payment Is A Tax For Bankruptcy Purposes
CINCINNATI — The Patient Protection and Affordable Care Act (ACA) shared responsibility payment acts as a tax and permits priority debtor status for the Internal Revenue Service under federal bankruptcy law, a Sixth Circuit U.S. Court of Appeals panel said in affirming a bankruptcy appellate panel’s ruling.
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August 02, 2023
Judge Won’t Reconsider ERISA Preemption Ruling In Medical Payment Case
NEW YORK — A federal judge in New York denied a medical provider reconsideration, saying there is no evidence that the original ruling finding the case preempted by the Employee Retirement Income Security Act overlooked any facts or law.
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August 01, 2023
Judge Denies Reconsideration In Light Of Amended No Surprises Act Complaint
BROOKLYN, N.Y. — A federal judge in New York denied as moot a motion for reconsideration in light of a provider’s amended complaint alleging that the government’s failure to employ sufficient arbitration entities and resulting delay in resolution violates the No Surprises Act (NSA).
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July 31, 2023
Judge Permits Amendment In ACA Discrimination Case Involving HIV Drug Shipping
SAN FRANCISCO — Because it does not appear that an effort to amend a class complaint would be overly prejudicial or futile, the plaintiffs can amend an action alleging that an insurer discriminated against those with AIDS by requiring HIV drugs to be purchased through mail order, a federal judge in California said July 28.
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July 28, 2023
California Appeals Court: Interactions Didn’t Create Provider-Insurer Contract
SAN DIEGO — There is no evidence that an insurer’s past payments or benefit discussions with a provider created a contract or promise to pay a specific level of reimbursement, a California appeals court said in affirming summary judgment on July 27.
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July 27, 2023
Court To Hear Arguments On Medical Reimbursement Claim Splitting Ruling
LOS ANGELES — A California appeals court set oral arguments for September in a case challenging rulings granting a demurrer, staying a case and imposing sanctions for improper claim splitting in a medical reimbursement action involving claims under the California unfair competition law (UCL).
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July 27, 2023
Proton Beam Cancer Treatment Class Receives Preliminary Class Settlement Approval
PHILADELPHIA — A federal judge in Pennsylvania granted an unopposed motion for preliminary approval of a settlement in a case alleging that an insurer breached its fiduciary duty under the Employee Retirement Income Security Act by denying coverage for proton beam therapy (PBT).
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July 27, 2023
ACA, Other Discrimination Claims Head To Trial After Surviving Summary Judgment
NEW YORK — Patient Protection and Affordable Care Act (ACA) and other discrimination claims are going to trial after a federal judge in New York on July 26 said questions remain as to whether a medical provider honored a deaf individual’s request for an interpreter and whether it provided an effective means of communication in the alternative.
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July 25, 2023
Cigna Denies Claims In Bulk Through Algorithm, California Class Action Alleges
SACRAMENTO, Calif. — Health insurer Cigna Corp.’s algorithm instantly rejects hundreds of thousands of claims without ever reviewing them and with the company’s knowledge that only a miniscule percentage of claimants will ever challenge the decisions, insureds allege in a July 24 class action filed in the U.S. District Court for the Eastern District of California alleging violation of California regulations and the state’s unfair competition law (UCL).
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July 24, 2023
Parties To Hearing Care ACA Discrimination Case Reach Tentative Settlement
SEATTLE — After being granted leave to file concurrent dispositive motions on whether covering cochlear implants to the exclusion of all other hearing loss care violates the Patient Protection and Affordable Care Act discrimination claims, the parties notified a federal judge in Washington on July 21 that they reached a tentative agreement.
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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.