Mealey's Health Care / ACA

  • May 17, 2024

    Attorneys Get 25% Of $169M Exaction Class Settlement In ACA Reinsurance Row

    WASHINGTON, D.C. — A U.S. Court of Federal Claims judge on May 16 granted final approval of a class settlement under which the government will pay $169,022,397.28 to resolve part of a long-running lawsuit over the Transitional Reinsurance Program (TRP) of the Patient Protection and Affordable Care Act (ACA), also awarding 25% of that sum, net of expenses, for attorney fees.

  • May 15, 2024

    On Appeal, Parties Argue Property Interest In ACA Reinsurance Takings Case

    WASHINGTON, D.C. — Arguing primarily that the Transitional Reinsurance Program (TRP) of the Patient Protection and Affordable Care Act (ACA) “did not implicate a cognizable property interest,” the government filed an appellee brief urging the Federal Circuit U.S. Court of Appeals to affirm rulings against two self-insured group health plan trusts.

  • May 14, 2024

    AI Health Company Seeks Dismissal Of Counterclaims In Sci-Fi-Based Trademark Case

    NEW YORK — An artificial intelligence health care company named in honor of a word created by science fiction author Robert A. Heinlein asked a federal judge in New York to dismiss counterclaims against it, saying courts lack jurisdiction over trademark applications and that the lone exception to the rule does not apply.

  • May 06, 2024

    Under ERISA, Dermatologist Loses Yet Another 11th Circuit Appeal Over Assignments

    ATLANTA — In the latest of many similar Employee Retirement Income Security Act rulings concerning patients’ purported assignment of benefits, an 11th Circuit U.S. Court of Appeals panel said in an unpublished per curiam opinion that a pro se dermatologist lacks statutory standing to bring a claim for purported failure to provide insurance documents.

  • May 06, 2024

    Express Scripts Must Turn Over Some Financial Records In Blue Cross Contract Row

    DETROIT — Partly granting an insurance company’s motion to compel financial documents from its pharmacy benefit manager (PBM), a Michigan federal magistrate judge found that many of them were relevant to determining the PBM’s understanding of a 2019 agreement between the parties, including disputed rebates for medical supplies to which the insurer claims it was entitled.

  • May 03, 2024

    Amended Complaint Planned In Fiduciary Breach Case Against Health Plans’ Sponsor

    CAMDEN, N.J. — In a granted joint stipulation, parties in a high-profile putative class Employee Retirement Income Security Act fiduciary duty case over alleged “mismanagement of prescription-drug benefits” told a New Jersey federal court they agree that a pending dismissal motion will be mooted by a forthcoming amended complaint.

  • May 03, 2024

    Judge Lifts Limited Stay In Employment Group’s Suit After ACA Rule Reveal

    FARGO, N.D. — A federal judge in North Dakota lifted a limited stay after federal defendants in a lawsuit over Patient Protection and Affordable Care Act (ACA) Section 1557 filed notice that they issued a final rule governing the handling of the law’s provision prohibiting discrimination in health care.

  • May 02, 2024

    Federal Judge Finds Parts Of North Carolina’s Abortion Law Are Preempted

    GREENSBORO, N.C. — A North Carolina federal judge ruled that portions of a state law governing pregnancy termination that “frustrate the congressional goal of establishing a comprehensive regulatory framework under which the FDA determines conditions for safe drug distribution” are preempted but let stand parts of the law that focus on the practice of medicine and a patient’s informed consent.

  • May 01, 2024

    Gender-Affirming Care Exclusion Violates Law, 4th Circuit Affirms

    RICHMOND, Va. — State health plan exclusions on otherwise covered care as a treatment for gender dysphoria facially discriminate on the basis of sex, a majority of the Fourth Circuit U.S. Court of Appeals said in a split en banc decision, affirming summary judgment for the insureds but with some judges stating in dissent that the ruling “oversteps the bounds of the law.”

  • May 01, 2024

    Medicare Voluntary, Drug Price Law Survives Summary Judgment, Judge Says

    TRENTON, N.J. — Because participation in Medicare is wholly voluntary, the Inflation Reduction Act (IRA) requirement that drug manufacturers negotiate the prices of certain drugs is not an unconstitutional taking and does not compel speech in violation of First Amendment rights, a federal judge in New Jersey said in an unpublished opinion.

  • May 01, 2024

    Provider Tells Texas High Court Compensation Claim Is Dead, Appeal Is Moot

    AUSTIN, Texas — A ruling eliminating the possibility of liability under Texas law moots an appeal and warrants rejecting a petition for review, but the ruling below finding that a health maintenance organization did not enjoy governmental immunity from a suit seeking additional compensation for care was the correct one, a medical provider told the Texas Supreme Court.

  • May 01, 2024

    Government, Health Plans Brief Tolling Opt-In Class Cases In ACA Reinsurance Row

    WASHINGTON, D.C. — In supplemental briefing in the U.S. Court of Federal Claims in consolidated cases over allegedly illegal exactions made under the Transitional Reinsurance Program (TRP) of the Patient Protection and Affordable Care Act (ACA), group health plans and the government agree that there’s a dearth of case law on American Pipe & Construction Co. v. Utah tolling for opt-in classes.

  • May 01, 2024

    $42.1M Attorney Fees, Final Approval Sought In Class ACA Reinsurance Row

    WASHINGTON, D.C. — None of the 357 class members has objected to a $169,022,397.28 settlement that would resolve part of a lawsuit over the Transitional Reinsurance Program (TRP) of the Patient Protection and Affordable Care Act (ACA) or a request that class counsel get 25% of that amount for attorney fees, the class representative told the U.S. Court of Federal Claims in a reply brief.

  • April 29, 2024

    Multiplan Not Liable For Insurer’s Compensation, 3rd Circuit Affirms

    CAMDEN, N.J. — A contract between a plastic surgery center and Multiplan Inc. does not guarantee any specific rate of reimbursement, and the latter cannot be held liable for an insurer’s failure to properly compensate for medical care, a Third Circuit U.S. Court of Appeals panel said April 26.

  • April 29, 2024

    Special Master Won’t Reconsider Discovery Into Drug Savings Plan

    NEWARK, N.J. — The special master overseeing a dispute in federal court in New Jersey between two drug payment assistance programs declined to reconsider or clarify her early ruling limiting discovery into the plaintiffs’ program or how Johnson & Johnson Health Care Systems Inc. prices certain drugs.

  • April 23, 2024

    J&J Seeks Dismissal Of ERISA Fiduciary Breach Suit Over Drug Benefits

    CAMDEN, N.J. — Arguing in part that the sponsor of the self-funded health plans at issue “has every incentive to negotiate the best overall deal,” Johnson and Johnson (J&J) and related defendants asked a New Jersey federal court to dismiss the complaint and strike the jury demand in a putative class case asserting Employee Retirement Income Security Act claims over alleged “mismanagement of prescription-drug benefits.”

  • April 23, 2024

    Judge Dismisses Funds’ ERISA Suit Against Administrative Service Providers

    NEW HAVEN, Conn. — Ruling that the trustees of two multiemployer, self-funded welfare benefit funds had standing to sue administrative service providers but “do not plausibly allege that Defendants exercise or possess[] discretionary authority required to be” fiduciaries under the Employee Retirement Income Security Act, a Connecticut judge dismissed the case without prejudice on April 22.

  • April 23, 2024

    Intentional Discrimination Claims Survive In HIV/AIDS Medication Suit

    SAN FRANCISCO — Individuals required by their insurer to use mail or pharmacy pickup to receive their HIV/AIDS medications rather than their preferred community pharmacy have shown intentional discrimination under the Patient Protection and Affordable Care Act (ACA) but not proxy discrimination or violation of the California unfair competition law (UCL), a federal judge in the state said in partly denying a motion to dismiss.

  • April 19, 2024

    Judge Approves Settlement, Attorney Fees In ACA Hearing Discrimination Case

    SEATTLE — Class counsel’s “excellent result” in obtaining a settlement compensating claimants who paid out-of-pocket for hearing aids and hearing-loss related services regardless of whether they submitted a claim to the insurer warrants 33.3% in attorney fees, a federal judge in Washington said April 18 in granting final approval to the settlement in a case involving claims that the insurer’s exclusion of coverage for certain hearing loss products and care constituted discrimination under the Patient Protection and Affordable Care Act.

  • April 17, 2024

    Drug Pricing Suit Not Subject To Medicare Process, Appellants Tell 5th Circuit

    SAN ANTONIO — The government holds a “constitutionally dubious” position in a challenge to the Medicare drug price negotiation law, and a federal judge erred in dismissing on the grounds that the claim is subject to the Medicare Act channeling provision, appellants tell the Fifth Circuit U.S. Court of Appeals in an appellant brief.

  • April 17, 2024

    Judge Issues Limited Stay In Catholic Employment Groups’ Gender Transition Case

    FARGO, N.D. — Because a forthcoming final rule governing Patient Protection and Affordable Care Act Section 1557 could impact some portions of religious employers’ case, the action can be stayed until May 1, after which if the rule is not yet finalized the government defendants must answer the complaint, a federal judge in North Dakota said April 16.

  • April 15, 2024

    Blue Cross: Claim Denials Done With Plan In Mind, Not Discriminatory Intent

    PASADENA, Calif. — A third-party administrator tells the Ninth Circuit U.S. Court of Appeals in an April 12 opening brief that it was simply fulfilling its fiduciary duty under the Employee Retirement Income Security Act when it denied claims for transgender care and cannot be held liable under the Patient Protection and Affordable Care Act for any allegedly discriminatory plan details.

  • April 15, 2024

    U.S. Supreme Court Denies Review Bid Over 4th Circuit ERISA Surcharge Ruling

    WASHINGTON, D.C. — The U.S. Supreme Court on April 15 declined to review a case over a heart transplant denial, which concerns whether surcharge is available under an Employee Retirement Income Security Act provision that allows equitable relief.

  • 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.