Mealey's Health Law - Court Finds Method Of Determining Medicare Reimbursements Reasonable

WASHINGTON, D.C. - A federal judge in the District of Columbia on Oct 31 granted summary judgment in favor of the secretary of Health and Human Services (HHS) in a suit challenging the method used by the secretary to calculate the plaintiff hospital's reimbursement rates for services provided to...

Mealey's Health Law - Pennsylvania High Court Finds Lower Court Permitted To Determine Benefits Claim

HARRISBURG, Pa. - The Pennsylvania Supreme Court on Oct. 31 reversed an appeals court decision and held that a lower court was permitted to reach the substantive claim made by a plaintiff challenging a health care insurer's decision to use its policy's place-of-service exclusion to deny autism...

Mealey's Health Law - Government Tells En Banc D.C. Circuit ACA Language Supports Broad Subsidies

WASHINGTON, D.C. - Reading the Patient Protection and Affordable Care Act (ACA)'s language in context clearly indicates Congress' intent to offer states a choice, not to threaten them and the viability of the statute through disastrous language, the government told the en banc District of Columbia...

Mealey's Health Law - Colleges Tell 8th Circuit Government Hasn't Met Burden In ACA Mandate Challenge

CEDAR RAPIDS, Iowa - The government has not shown that the accommodation it offers religious employers with objections to the Patient Protection and Affordable Care Act (ACA)'s contraceptive mandate is the least restrictive means of accomplishing its goals, two colleges told the Eighth Circuit U...

Mealey's Health Law - No Wrongful Denial Of Benefits In Coordination-Of- Benefits Case, 5th Circuit Rules

NEW ORLEANS - A federal judge properly dismissed a health plan participant's putative class action claim that the plan's claim administrator violated the Employee Retirement Income Security Act by denying claims until it is provided evidence regarding whether there is a collateral source for...

Mealey's Health Law - U.S. High Court Agrees To Decide Availability Of Subsidies In State Exchanges

WASHINGTON, D.C. - The U.S. Supreme Court on Nov. 7 agreed to decide whether the Patient Protection and Affordable Care Act (ACA) authorizes tax subsidies for individuals who enroll in insurance through state exchanges (David King, et al. v. Sylvia Mathew Burwell, et al., No. 14-114, U.S. Sup.).

Mealey's Health Law - Appeals Court Affirms Class Status, Deletes Subclasses In Unlawful Billing Case

LAKE CHARLES, La. - A Louisiana appeals court on Nov. 5 affirmed class action status in an unlawful health care billing case but deleted two subclasses, agreeing that the plaintiff representative was not a member of the subclasses (Gloria Vallare v. Ville Platte Medical Center, et al., No. 14-261, La...

Mealey's Health Law - Oklahoma Federal Judge Dismisses Medicare False Billing Claim Case

TULSA, Okla. - A federal judge in Oklahoma on Nov. 5 dismissed a Medicare false claims case, saying the plaintiff failed to identify any false certification premised upon the requirements of a particular statute, regulation or contract by the defendants (United States of America, ex rel. Mark Troxler...

Mealey's Health Law - Magistrate Judge Orders Health Care Company To Produce Data For Sampling

RENO, Nev. - A federal magistrate judge in Nevada on Nov. 5 ordered a health care company accused by a former employee of fraudulently billing Medicare to produce data from 28 diagnosis-related groups (DRGs) dating back to June 2006 so the plaintiff can develop a statistical sampling plan (United States...

Mealey's Health Law - 9th Circuit: Health Care Provider Has Standing To Sue Plan Administrator

SAN FRANCISCO - A health care provider has constitutional standing as an assignee of health plan beneficiaries to bring claims for payment of benefits against the plan administrator under the Employee Retirement Income Security Act, the Ninth Circuit U.S. Court of Appeals held Nov. 5 (Spinedex Physical...

Mealey's Health Law - ACA Subsidy Challengers Seek Stay Of D.C. Circuit Court's En Banc Review

WASHINGTON, D.C. - The Supreme Court's grant of certiorari in King v. Burwell (No. 14-114, U.S. Sup.) warrants staying en banc review of a Patient Protection and Affordable Care Act (ACA) case challenging the availability of tax subsidies, plaintiffs told the District of Columbia Circuit U.S. Court...

Mealey's Health Law - D.C. Circuit Stays Argument, En Banc Review In ACA Subsidy Challenge

WASHINGTON, D.C. - The District of Columbia Circuit U.S. Court of Appeals on Nov. 12 stayed oral arguments and en banc review of a ruling that the Patient Protection and Affordable Care Act (ACA) bars subsidies for individuals enrolling in insurance through the federal exchange. The action followed the...

Mealey's Health Law - Federal D.C. Appeals Panel Finds ACA Opt Out Protects Religious Beliefs

WASHINGTON, D.C. - The de minimus "bit of paperwork" required to opt out of contraceptive coverage under the Patient Protection and Affordable Care Act (ACA)'s contraceptive mandate does not substantially burden religious exercise and is the least restrictive means of ensuring universal...

Mealey's Health Law - Injunction Enjoins Law Aimed At Prohibiting Health Benefits For Same-Sex Couples

DETROIT - A federal judge in Michigan on Nov. 12 granted summary judgment in favor of plaintiffs challenging a state law that prohibits local governments from continuing to furnish health care and other fringe benefits to the domestic partners of their employees and entered a permanent injunction prohibiting...

Mealey's Health Law - 7th Circuit Affirms Dismissal Of Medicaid False Claims Case

CHICAGO - A panel of the Seventh Circuit U.S. Court of Appeals on Nov. 12 affirmed the dismissal of a qui tam action brought against the owner and operator of a chain of retail pharmacies for Medicaid fraud, agreeing that the claims were premised on an untenable legal theory (Carl E. Thulin v. Shopko...

Mealey's Health Law - Judge Rejects Trade Group's Suit Challenging Fees On Non-Exchange Insurers

WASHINGTON, D.C. - The District of Columbia's assessment of Patient Protection and Affordable Care Act (ACA) exchange fees on insurance products offered outside the exchange resulted from reasonable analysis within the normal political channels, a District of Columbia federal judge ruled Nov. 13...

Mealey's Health Law - ACA 'Maintenance Of Effort' Requirement Constitutional, 1st Circuit Finds

BOSTON - The Patient Protection and Affordable Care Act (ACA) regulation requiring that states maintain existing Medicaid services is not unconstitutional under two recent Supreme Court precedents, a First Circuit U.S. Court of Appeals panel held Nov. 17 (Mary C. Mayhew, in her capacity as Secretary...

Mealey's Health Law - Equitable Relief Not Available To Fund For Overpayment, Magistrate Judge Says

GREENBELT, Md. - A federal magistrate judge in Maryland recommended Nov. 13 that no default judgment be awarded to a multiemployer health fund in its action seeking to recover overpayments under the Employee Retirement Income Security Act under the equitable theories of unjust enrichment and restitution...

Mealey's Health Law - Iowa Appeals Court Affirms Denial Of Health Benefits As Excluded Under Policy

DES MOINES, Iowa - A panel of the Iowa Court of Appeals on Nov. 13 affirmed that a health care insurer properly denied coverage for sensory integration therapy and hyperbaric oxygen therapy used in the treatment of cerebral palsy as not covered under the policy (Ryan Gjerde, et al. v. UnitedHealthcare...

Mealey's Health Law - Reimbursement Action Seeks Legal, Not Equitable Relief, 2nd Circuit Rules

NEW YORK - A multiemployer welfare fund was not entitled to reimbursement from another insurer for benefits paid on behalf of a plan beneficiary who was covered by both insurers because the claims were not "appropriate equitable relief" under the Employee Retirement Income Security Act, the...

Mealey's Health Law - Health Insurer: Endo Paid Impax $112M To Delay Selling Generic Opana ER

BATON ROUGE, La. - Blue Cross Blue Shield of Louisiana on Nov. 17 filed a class action complaint in federal court, alleging that Endo Health Solutions Inc. paid a competitor at least $112 million to delay a generic drug until Endo could market a new, crush-resistant formula (Louisiana Health Service...

Mealey's Health Law - Federal Judge Grants Injunction To Privately Held For-Profit After Hobby Lobby

DETROIT - The government may not enforce the Patient Protection and Affordable Care Act (ACA) contraceptive mandate against a privately held for-profit company, a Michigan federal judge held Nov. 17 (M & N Plastics Inc., et al. v. Sylvia Burwell, et al., No. 13-14754, E.D. Mich.).

Mealey's Health Law - Judge Enjoins ACA Birth Control Mandate, Excludes Future Regulations

OKLAHOMA CITY - An Oklahoma federal judge on Nov. 19 enjoined application of the Patient Protection and Affordable Care Act (ACA) contraceptive mandate against Hobby Lobby Stores Inc. but limited his judgment to the regulation as it existed at the time of the Supreme Court's ruling on the issue ...

Mealey's Health Law - Government Tells 8th Circuit That Hobby Lobby Endorsed Accommodation

CEDAR RAPIDS, Iowa - The government on Nov. 18 responded to two religious schools' argument that Hobby Lobby was not an implicit endorsement of the Patient Protection and Affordable Care Act (ACA) accommodation allowing religious objectors to avoid paying for contraceptive insurance coverage as a...

Mealey's Health Law - U.S. House Files Suit Over Implementation Of ACA Employer Mandate, Funding

WASHINGTON, D.C. - The U.S. House of Representatives on Nov. 21 filed suit in the District of Columbia federal court against Sylvia Burwell, the U.S. Department of Health and Human Services (HHS) and others over implementation of the Patient Protection and Affordable Care Act (ACA) (United States House...