Mealey's Health Law - Nevada Dumps ACA Insurance Exchange, Will Rely On Federal Exchange

    CARSON CITY, Nev. - Citing "extensive and reoccurring errors" with Nevada's "underperforming" Patient Protection and Affordable Care Act (ACA) health insurance exchange, the board governing the exchange abandoned it on May 20 in favor of the federal one, sources told Mealey Publications.

    Mealey's Health Law - Illinois Federal Judge Sets Terms Of Injunction In Reimbursement Dispute

    CHICAGO - An Illinois federal judge on May 19 set the terms a permanent injunction should take against a Blue Cross Blue Shield entity found to have failed to provide adequate notice and appeal notices before recouping money from previously paid claims, saying the injunction would provide relief only to members of the chiropractic association involved and not all providers associated with the defendant and that the injunction would provide only prospective relief instead of the retroactive relief requested by the plaintiff (Pennsylvania Chiropractic Association, et al. v. Blue Cross Blue Shield Association, et al., No. 09-5619, N.D. Ill.).

    Mealey's Health Law - Final HHS Rule Imposes $250,000 Fine For False Info In ACA Exchanges

    WASHINGTON, D.C. - Individuals who knowingly provide false information to a Patient Protection and Affordable Care Act (ACA) health care exchange may be subject to $250,000 in civil penalties, according to a U.S. Department of Health and Human Services (HHS) final rule released May 16.

    Mealey's Health Law - Judge Rules On Dismissal Motion In Suit Over Foreign Prescription Drug Act

    BANGOR, Maine - A Maine federal judge on May 15 partially dismissed a lawsuit challenging state law regulating the importation of prescription drugs from foreign countries, dismissing one plaintiff but holding that the remaining plaintiffs have standing (Charles Ouellette, et al. v. Janet Mills, et al., No. 13-347, D. Maine; 2014 U.S. Dist. LEXIS 66880).

    Mealey's Health Law - Texas Federal Judge Says Plaintiff Adequately Pleaded Medicaid False Claims

    HOUSTON - A Texas federal judge on May 14 partially denied a defendant's request to dismiss a False Claims Act (FCA) case against it, saying that the plaintiff adequately provided factual content allowing the court to reasonably infer that the defendant knowingly submitted false claims for Medicaid reimbursement (United States of America and the State of Texas ex rel Patricia M. Carroll v. Planned Parenthood of Gulf Coast Inc., No. 12-3505, S.D. Texas; 2014 U.S. Dist. LEXIS 66385).

    Mealey's Health Law - Judge Denies Injunction, Finds No Substantial Burden From Birth-Control Mandate

    CHEYENNE, Wyo. - The Patient Protection and Affordable Care Act (ACA) contraceptive mandate does not substantially burden religious beliefs because the statute, and not the self-certification process, requires coverage by third-party administrators (TPAs), a Wyoming federal judge held May 13 (Diocese of Cheyenne, et al. v. Kathleen Sebelius, in her official capacity as Secretary of the U.S. Department of Health and Human Services, No. 14-21, D. Wyo.; 2014 U.S. Dist. LEXIS 65837).

    Mealey's Health Law - Judge Won't Clarify Insurer Subject To Birth-Control Injunction Ruling

    DETROIT - Imposing jurisdiction on a nonparty insurer allegedly affected by a ruling enjoining implementation of the Patient Protection and Affordable Care Act (ACA)'s contraceptive mandate requires impermissible speculation, a Michigan federal judge held May 11 in refusing to clarify his injunction (The Ave Marie Foundation, et al. v. Kathleen Sebelius, et al., No. 13-15198, E.D. Mich.).

    Mealey's Health Law - Universities Tell 10th Circuit Birth-Control Mandate Substantially Burdens Rights

    OKLAHOMA CITY - The government improperly asks a district judge to second-guess religious universities' beliefs, which the Patient Protection and Affordable Care Act (ACA)'s contraceptive mandate substantially burdens, plaintiffs told the 10th Circuit U.S. Court of Appeals on May 12 (Southern Nazarene University, et al. v. Kathleen Sebelius, et al., No. 14-6026, 10th Cir.).

    Mealey's Health Law - Surgeon Files Suit In New Jersey Federal Court Over Low Payment

    NEWARK, N.J. - A New Jersey orthopedic surgeon on May 9 sued a health insurer and plan administrator in federal court for allegedly underpaying for out-of-network services provided to a patient (Dr. Marc S. Menkowitz v. Blue Cross Blue Shield of Illinois, et al., No. 14-2946, D. N.J.).

    Mealey's Health Law - 1st Circuit Says Complete Preemption Does Not Exist Under FEHBA

    BOSTON - In what it called a matter of first impression, a First Circuit U.S. Court of Appeals panel on May 9 held that complete preemption does not exist under the Federal Employees Health Benefits Act (FEHBA) and ordered a district court to remand a denial of health benefits case to state court (Raquel Lopez-Munoz, et al. v. Triple-S Salud Inc., No. 13-1417, 1st Cir.; 2014 U.S. App. LEXIS 8796).

    Mealey's Health Law - Health Plan Properly Excluded Coverage Of Prosthetics, 9th Circuit Rules

    SAN FRANCISCO - A health insurer's categorical exclusion of myoelectric prosthetics from coverage under a health insurance plan governed by the Employee Retirement Income Security Act does not violate the California Health and Safety Code, the Ninth Circuit U.S. Court of Appeals affirmed May 8 (Martha Garcia v. PacifiCare of California, Inc., et al., No. 8:12-cv-02022, 9th Cir.; 2014 U.S. App. LEXIS 8659).

    Mealey's Health Law - Plaintiffs Argue ACA Was Revenue Bill, Improperly Originated In Senate

    HOUSTON - Supreme Court precedent and the "long history" of the origination clause of the U.S. Constitution render the Patient Protection and Affordable Care Act (ACA) and its individual mandate unconstitutional, plaintiffs told the Fifth Circuit U.S. Court of Appeals in a May 8 brief (Steven F. Hotze, M.D., et al. v. Kathleen Sebelius, et al., No. 14-20039, 5th Cir.).

    Mealey's Health Law - Federal Judge Denies Injunction In Suspension Of Medicaid Payment Suit

    WASHINGTON, D.C. - A District of Columbia judge on May 9 denied a motion by multiple licensed home health care providers for a preliminary injunction to halt the suspension of Medicaid payments for their services, saying that the plaintiffs were unlikely to succeed on the merits of their claim that they were terminated from the Medicaid program in violation of their due process rights and that they failed to exhaust administrative services (ABA Inc., et al. v. District of Columbia, No. 14-550, D. D.C.; 2014 U.S. Dist. LEXIS 64126).

    Mealey's Health Law - Judge Denies Temporary Restraining Order, Grants Plaintiff's Motion To Dismiss

    LOS ANGELES - A California federal judge on May 9 vacated an order to show cause issued May 8 after a plaintiff moved to voluntarily dismiss its case seeking a temporary restraining order to stop the U.S. Department of Health and Human Service (HHS) from terminating its privileges to provide ambulance services to Medicare patients (Royalty Ambulance Services Inc. v. Department of Health and Human Services, et al., No. 14-2936, C.D. Calif.; 2014 U.S. Dist. LEXIS 64000).

    Mealey's Health Law - Federal Appeals Court Hears Oral Arguments Over Contraceptive Mandate

    WASHINGTON, D.C. - A District of Columbia U.S. Circuit Court of Appeals panel on May 8 heard oral arguments over whether the Patient Protection and Affordable Care Act (ACA)'s contraceptive mandate substantially burdens Catholic groups' religious freedoms (Priests for Life, et al. v. U.S. Department of Health and Human Services, et al., No. 113-5368; Roman Catholic Archbishop of Washington, et al. v. Kathleen Sebelius, et al., No. 13-5371, D.C. Cir.).

    Mealey's Health Law - Catholic Groups, Government Debate Birth Control Mandate Before 6th Circuit

    GRAND RAPIDS, Mich. - The Sixth Circuit U.S. Court of Appeals on May 8 heard oral arguments from the federal government and Catholic organizations over whether the government provided proper notice of the Patient Protection and Affordable Care Act (ACA)'s contraceptive mandate and whether its application substantially burdens religious practices (Michigan Catholic Conference, et al. v. Kathleen Sebelius, et al., No. 13-2723, 6th Cir., The Catholic Diocese of Nashville, et al. v. Kathleen Sebelius, et al., No. 13-6640, 6th Cir.).

    Mealey's Health Law - Court Hears Arguments In Origination-Clause Challenge To Individual Mandate Tax

    WASHINGTON, D.C. - A District of Columbia Circuit U.S. Court of Appeals panel on May 8 heard arguments over whether the Patient Protection and Affordable Care Act (ACA)'s individual mandate tax constitutes a revenue measure and should properly have originated in the U.S. House of Representatives (Matt Sissel v. U.S. Department of Health and Human Services, et al., No. 13-5202, D.C. Cir.).

    Mealey's Health Law - Missouri Official: ACA Allows For State Licensing Of Exchange Navigators

    JEFFERSON CITY, Mo. - The Patient Protection and Affordable Care Act (ACA) specifically allows states to impose licensing and other regulatory requirements in areas typically falling under their jurisdiction, a Missouri official told the Eighth Circuit U.S. Court of Appeals on May 7 (St. Louis Effort for Aids, et al. v. John Huff, director of the Missouri Department of Insurance, Financial Institutions and Professional Registration, No. 14-1520, U.S. App., 8th Cir.).

    Mealey's Health Law - ACA Prevented 15,000 Hospital Deaths, Saved $4.1B, HHS Report Says

    WASHINGTON, D.C. - The Patient Protection and Affordable Care Act (ACA) prevented nearly 15,000 hospital deaths and 560,000 patient harms and saved $4.1 billion in costs in 2011 and 2012, according to a May 7 U.S. Department of Health and Human Services report.

    Mealey's Health Law - Health Plan Provides For Equitable Lien Over Settlement Funds, Judge Rules

    HOUSTON - A health benefits plan is entitled to an equitable lien over funds that a participant received in a third-party settlement pursuant to the plan's reimbursement/subrogation provision under the Employee Retirement Income Security Act, a federal judge in Texas ruled May 2 in granting the plan's motion for summary judgment (Humana Health Plan, Inc. v. Patrick Nguyen, et al., No. H-13-1793, S.D. Texas; 2014 U.S. Dist. LEXIS 61239).

    Mealey's Health Law - 2nd Circuit: Case Over Distribution Of Funds Properly Remanded To State Court

    NEW YORK - The Second Circuit U.S. Court of Appeals on May 6 affirmed that a lower court correctly remanded to state court a dispute over the failure to return surplus distributions to a not-for-profit corporation that provided comprehensive health services to individuals primarily made up of Medicaid patients, holding that the defendant failed to demonstrate that removal was proper (James J. Veneruso, as temporary receive for Community Choice Health Plan of Westchester Inc., v. Mount Vernon Neighborhood Health Center, No. 13-1572, 2nd Cir.; 2014 U.S. App. LEXIS 8449).

    Mealey's Health Law - 5th Circuit Affirms State Must Return Medicaid Funds To Federal Government

    NEW ORLEANS - In an unpublished opinion, the Fifth Circuit U.S. Court of Appeals on May 6 affirmed that the State of Louisiana must return to the federal government an excess of nearly $240 million it received in Medicaid funds for charity care (State of Louisiana Department of Health and Hospitals v. U.S. Department of Health and Human Services, et al., No. 13-30240, 5th Cir.; 2014 U.S. App. LEXIS 8520).

    Mealey's Health Law - 3rd Circuit Reverses Decision, Says Providers Do Not Need To Arbitrate Claims

    PHILADELPHIA - In reversing a lower court, a Third Circuit U.S. Court of Appeals panel on May 6 held that health care providers' direct and derivative claims fall outside the scope of an arbitration agreement with a health insurance provider and thus the claims at issue are not subject to arbitration (CardioNet Inc., et al. v. CIGNA Health Corp., No. 13-2496, 3rd Cir.; 2014 U.S. App. LEXIS 8468).

    Mealey's Health Law - Federal Judge Dismisses ERISA Claim Based On Denial Of Same-Sex Spousal Benefits

    NEW YORK - A health benefits plan that excludes benefits for same sex and domestic partners does not violate Employee Retirement Income Security Act Section 510's prohibition of interference with the attainment of benefits, a federal judge in New York ruled May 1 (Jane Roe, et al. v. Empire Blue Cross Blue Shield, et al., No. 12-cv-04788, S.D. N.Y.; 2014 U.S. Dist. LEXIS 61345).

    Mealey's Health Law - Massachusetts Explores 'Off-The-Shelf,' Federal Option After Abandoning Exchange

    BOSTON - Massachusetts will abandon its Patient Protection and Affordable Care Act (ACA) health insurance exchange and purchase an "off-the-shelf" exchange or default to the federal exchange, according to a May 5 press release.