Mealey's Health Law - 8th Circuit Affirms Dismissal Of Challenge To Medicare Bidding Program

ST. LOUIS - An Eighth Circuit U.S. Court of Appeals panel on Aug. 25 affirmed the dismissal of a Medicare dispute, agreeing that the Medicare Prescription Drug Improvement Act's bar on judicial review precluded jurisdiction (Key Medical Supply Inc. v. Sylvia Matthews Burwell, et al., No. 13-2084...

Mealey's Health Law - Divided N.M. High Court: Payment Law Not Applicable To Managed Care Organizations

SANTA FE, N.M. - In a divided opinion, the New Mexico Supreme Court on Aug. 25 held that state law regulating the payment of pharmacists who dispense prescription drugs to Medicaid recipients applies only in the fee-for-services context and not in the managed care system (Starko Inc., et al. v. New Mexico...

Mealey's Health Law - Government Report Shows 30 Percent Of ACA Contracts Exceed Budget

WASHINGTON, D.C. - One in three government contracts related to the development and operation of the Patient Protection and Affordable Care Act's (ACA) federal exchange exceeded the total estimated value of the entire contract by February 2014, according to an Aug. 26 report.

Mealey's Health Law - N.J. Federal Judge Finds 1 Plaintiff Lacks Standing, Grants Class Status

NEWARK, N.J. - In granting a motion to reconsider, a New Jersey federal judge on Aug. 28 held that a health care provider lacked standing to contest an insurer's methods of recouping benefit overpayments under the Employee Retirement Income Security Act for payments previously submitted because his...

Mealey's Health Law - California Hospice Agrees To Multimillion Settlement For Medicare Fraud

SAN DIEGO - A California business that provides hospice care agreed to a multimillion-dollar settlement to resolve allegations that it was fraudulently admitting and retaining hospice patients who did not meet requirements for hospice care, according to a Sept. 2 release issued by the U.S. Department...

Mealey's Health Law - 8th Circuit Partially Reverses Medicaid False Claims Suit

ST. LOUIS - A panel of the Eighth Circuit U.S. Court of Appeals on Aug. 29 partially reversed a false claims suit, saying the plaintiff provided sufficient support for some of her allegations that a Planned Parenthood organization submitted false claims to Medicaid (United States of America, ex rel....

Mealey's Health Law - Illinois Federal Judge Remands Prescription Drug Negligence Claim To State Court

CHICAGO - An Illinois federal judge on Aug. 29 remanded a negligence claim arising from the untimely filling of a prescription drug to state court, finding that removal to federal court was not proper (Barbara Woodruff v. Humana Pharmacy Inc., No. 14-2311, N.D. Ill.; 2014 U.S. Dist. LEXIS 120516).

Mealey's Health Law - Full D.C. Appeals Court Takes Up ACA Tax Credit Case

WASHINGTON, D.C. - The District of Columbia Circuit U.S. Court of Appeals granted en banc review on Sept. 4 of a decision finding that the Patient Protection and Affordable Care Act (ACA) provides tax credits only for individuals who enrolled through state-created exchanges (Jacqueline Halbig, et al...

Mealey's Health Law - 8th Circuit Remands ACA Contraceptive Challenge For Jurisdictional Inquiry

ST. LOUIS - On remand, a judge must determine whether government conduct gave birth to Patient Protection and Affordable Care Act (ACA) challengers' inability to obtain insurance without the contraceptive coverage, the Eighth Circuit U.S. Court of Appeals held Sept. 5 (Annex Medical Inc., et al....

Mealey's Health Law - N.Y. Federal Judge Grants Health Insurer Judgment In Denial Of Benefits Case

BUFFALO, N.Y. - A New York federal judge on Sept. 3 granted a health insurer's motion for summary judgment in a wrongful denial of benefits suit, saying mental health coverage provided at the residential treatment facility at issue was not covered under the plan because the facility did not have...

Mealey's Health Law - 2 Michigan Companies Sue Blue Cross In Federal Court For Hidden Fee Scheme

DETROIT - In two separate complaints filed Sept. 3 and 4 in federal court, two Michigan companies and their health benefits plan sued Blue Cross Blue Shield of Michigan for allegedly engaging in self-dealing in violation of the Employee Retirement Income Security Act by charging self-insured welfare...

Mealey's Health Law - Girl Sues Health Insurer In California Federal Court For Denial Of Benefits

SAN JOSE, Calif. - A California resident on Sept. 8 sued her health insurer in federal court for allegedly wrongfully denying benefits (A.D. v. Blue Cross of California, No. 14-4069, N.D. Calif.).

Mealey's Health Law - Study Finds States With Expanded Medicaid Experiencing Bump In ER Volume

GREENWOOD VILLAGE, Colo. - States with expanded Medicaid under the Patient Protection and Affordable Care Act (ACA) saw a threefold increase in emergency-department visits over nonexpansion states in the second quarter of 2014, according to a Sept. 8 study.

Mealey's Health Law - Case Alleging Insurer Mislead Consumers About Health Plans Remanded

KANSAS CITY, Mo. - A Missouri federal judge on Sept. 9 granted a motion to remand a putative class action alleging that a health insurer misled consumers into obtaining an inferior health plan on the federal health care exchange pursuant to the Patient Protection and Affordable Care Act (ACA) (Debra...

Mealey's Health Law - U.S. House Extends Grandfathering Of Insurance For Small Businesses

WASHINGTON, D.C. - The U.S. House of Representatives on Sept. 11 passed legislation grandfathering more insurance plans from compliance with the Patient Protection and Affordable Care Act (ACA) minimum coverage standards

Mealey's Health Law - Court Halts Briefing After Government Moves For Remand In Birth Control Case

DETROIT - The Sixth Circuit U.S. Court of Appeals on Sept.12 held briefing of a Patient Protection and Affordable Care Act (ACA) contraceptive mandate challenge in abeyance until resolution of the government's unopposed motion to remand (Mersino Management Co., et al. v. Sylvia Burwell, et al., No...

Mealey's Health Law - HHS Expands Primary Care Access With $295 Million In ACA Funds

WASHINGTON, D.C. - More than $295 million in Patient Protection and Affordable Care Act (ACA) funds have been awarded in an effort to help health centers expand access to primary care services, according to a Sept. 12 release by the U.S. Department of Health and Human Services (HHS).

Mealey's Health Law - ACA Changes Allow Renewal Of Black Lung Cases, 11th Circuit Holds

ATLANTA - The Patient Protection and Affordable Care Act (ACA)'s elimination of the causation requirement in Black Lung benefits cases permits pursuit of a denied claim originally made final in 2006, an 11th Circuit U.S. Court of Appeals panel held Sept. 12 (Jim Walter Resources Inc. v. Director...

Mealey's Health Law - Federal Claims In Prescription Drug Case Dismissed; Remaining Claims Remanded

BIRMINGHAM, Ala. - A federal judge in Alabama on Sept. 10 dismissed antitrust, Racketeer Influenced and Corrupt Organization Act and unjust enrichment claims against the third-party administrator of prescription medication and remanded the remaining state law claims to state court (Star Discount Pharmacy...

Mealey's Health Law - Appeals Court Affirms Judgment In Favor Of Insurer In Denial Of Benefits Suit

PHOENIX - In an unpublished opinion, an Arizona appeals panel on Sept. 11 affirmed summary judgment in favor of a health insurance company in a wrongful denial of health care benefits suit (Nicolai Tavilla, et al. v. Blue Cross and Blue Shield of Arizona Inc., No. CV-12-0843, Ariz. App., Div. 1; 2014...

Mealey's Health Law - California Judge Allows Limited Discovery In Denial Of Health Benefits Suit

SAN DIEGO - A federal judge in California on Sept. 12 granted a plaintiff's motion for limited discovery beyond the administrative record in his wrongful denial of benefits case (Christopher Brown v. United Healthcare Insurance Co., et al., No. 14-661, S.D. Calif.; 2014 U.S. Dist. LEXIS 128219).

Mealey's Health Law - Plaintiffs In Reimbursement MDL Oppose Dismissal Of Complaint, Support Amendment

NEWARK, N.J. - Plaintiffs involved in an antitrust and racketeering multidistrict litigation case accusing Aetna Inc. of underpaying out-of-network reimbursement claims asked a New Jersey federal court on Sept. 12 to deny the defendant's motion to dismiss the suit, which Aetna had filed just two...

Mealey's Health Law - Health Insurers Ask Pradaxa MDL Judge To Vacate His 'Amnesty' Order For Liens

EAST ST. LOUIS, Ill. - Fifteen health insurers on Sept. 15 asked an Illinois federal judge to dissolve or vacate his order ordering private lien holders to notify plaintiffs' counsel of their claims or risk having them foreclosed (In Re: Pradaxa [Dabigatran Etexilate] Products Liability Litigation...

Mealey's Health Law - 6th Circuit Denies Rehearing After Refusing To Enjoin Birth Control Mandate

GRAND RAPIDS, Mich. - The Sixth Circuit U.S. Court of Appeals on Sept. 16 denied en banc rehearing in a pair of cases challenging the Patient Protection and Affordable Care Act (ACA) contraceptive mandate opt-out, leaving stand a June decision affirming denial of injunctive relief (Michigan Catholic...

Mealey's Health Law - Physician Group Defends Standing In ACA Tax Case From Seemingly Skeptical Panel

MILWAUKEE - A cash-only physicians group challenging the Internal Revenue Service's implementation of the Patient Protection and Affordable Care Act (ACA) faced repeated questioning during Sept. 16 oral arguments from a Seventh Circuit U.S. Court of Appeals panel seemingly skeptical of its standing...