LexisNexis® Legal Newsroom
    Mealey's Health Law - Maine Federal Judge Affirms Secretary's Decision In Medicare Billing Dispute

    PORTLAND, Maine - A Maine federal judge on March 25 granted the secretary of Health and Human Services' (HHS) motion for summary judgment in a Medicare reimbursement dispute, finding that the secretary's decision was supported by substantial evidence and not arbitrary or capricious (Maine Medical Center v. Kathleen Sebelius, Secretary of the U.S. Department of Health and Human Services, No. 13-118, D. Maine; 2014 U.S. Dist. LEXIS 39100).

    Mealey's Health Law - Parties Brief D.C. Circuit Over Premium Support In Federally Created Exchange

    WASHINGTON, D.C. - In a sometimes combative setting before a District of Columbia U.S. Circuit Court of Appeals panel, parties argued March 25 over whether premium assistance is available under the Patient Protection and Affordable Care Act (ACA) for individuals who purchase insurance through the federal exchange because their state has not enacted an exchange (Jacqueline Halbig, et al. v. Kathleen Sebelius, et al., No. 14-5018, D.C. Cir.).

    Mealey's Health Law - High Court Hears Arguments In Birth Control Mandate Cases

    WASHINGTON, D.C. - The U.S. Supreme Court on March 25 heard arguments in two cases that will decide whether for-profit, secular businesses have to provide contraceptive services as part of their health insurance packages to employees even if they oppose such measures on religious grounds (Kathleen Sebelius, et al. v. Hobby Lobby Stores Inc., et al., No. 13-354, U.S. Sup.; Conestoga Woods Specialties Corp., et al. v. Kathleen Sebelius, et al., No. 13-356, U.S. Sup.).

    Mealey's Health Law - Federal Court Finds Secretary Properly Determined Medicare Reimbursement Rates

    WASHINGTON, D.C. - A federal judge in the District of Columbia on March 21 held that the Health and Human Services (HHS) secretary's methodology for achieving budget neutrality for Medicare reimbursement rates is a rational interpretation of the Medicare Act (Adirondack Medical Center, et al. v. Kathleen Sebelius, No. 11-313, D. D.C.; 2014 U.S. Dist. LEXIS 27305).

    Mealey's Health Law - Louisiana Appeals Court Reverses Dismissal Of Breach Of Contract Case

    EAST BATON ROUGE, La. - A Louisiana appeals court on March 20 reversed the dismissal of a breach of health insurance contract, saying a state statute related to peremption periods did not extend to insurance companies (Laura E. Sibley v. Blue Cross Blue Shield of Louisiana, Nos. 2013 CA 0924, 2013 CA 0925, La. App., 1st Cir.; 2014 La. App. LEXIS 721).

    Mealey's Health Law - High Court Denies Petition In Health Care Reimbursement Disputes

    WASHINGTON, D.C. - The U.S. Supreme Court on March 24 denied a petition for writ of certiorari filed by multiple licensed ambulatory surgical centers, leaving in place the dismissal of their health care reimbursement suit against multiple health insurance companies (Sanctuary Surgical, et al. v. Aetna Health Inc., et al., No. 13-932, U.S. Sup.).

    Mealey's Health Law - Georgia Appeals Court Reverses Class Action Status In Hospital Lien Case

    ATLANTA - A Georgia appeals court on March 20 reversed class action status in a case challenging a hospital's lien practice against patients and remanded the case with instructions for the trial court to reconsider its summary judgment decision in light of an appeal's court decision in a similar case issued after the trial court rendered its opinion (MCG Health Inc. v. Donna Perry, et al., No. A13A1996, Ga. App., 4th Div.; 2014 Ga. App. LEXIS 190).

    Mealey's Health Law - New York Federal Judge Dismisses Dispute Over Payment Of Health Care Services

    NEW YORK - A New York federal judge on March 19 denied a plaintiff's motion to remand a breach of contract dispute over payment for home health care services and instead dismissed the suit, saying that the Employee Retirement Income Security Act preempted the plaintiff's claim, which really was for "right of payment" and not "amount of payment" (Star Multi Care Services Inc. v. Empire Blue Cross Blue Shield, et al., No. 13-1138, E.D. N.Y.; 2014 U.S. Dist. LEXIS 36287).

    Mealey's Health Law - Wisconsin Federal Judge Dismisses Health Care Reimbursement Suit For Lack Of Venue

    MADISON, Wis. - A Wisconsin federal judge on March 19 dismissed a health care reimbursement dispute between a health care provider and health insurance plan for lack of venue (University of Wisconsin Hospital and Clinics Authority, et al. v. RFMS Inc. Mutual Medical Plans, No. 13-610, W.D. Wis.; 2014 U.S. Dist. LEXIS 36075).

    Mealey's Health Law - Judge: Cash-Only Physicians' Alleged Injury Too Remote From ACA Mandate

    MILWAUKEE - The alleged reduction in clients physicians who accept only cash might face from the delayed implementation of the Patient Protection and Affordable Care Act (ACA)'s employer mandate is too attenuated to provide standing to sue the Internal Revenue Service, a Wisconsin federal judge held March 18 (Association of American Physicians & Surgeons Inc., and Robert T. McQueeney v. John Koskinen, commissioner of the Internal Revenue Service, in his official capacity, No. 13-1214, E.D. Wis.; 2014 U.S. Dist. LEXIS 34980).

    Mealey's Health Law - Health Insurer Seeks Dismissal Of Denial Of Benefits Suit

    SELMA, Ala. - A health insurance provider on March 14 removed a denial of health care benefits case to an Alabama federal court and moved to dismiss the case, saying the Employee Retirement Income Security Act preempted the plaintiffs' claims (Jane Wallace, et al. v. Blue Cross Blue Shield, No. 14-119, S.D. Ala.).

    Mealey's Health Law - HHS Issues Proposed Rule On Product Modifications, Risk Corridors, Civil Penalties

    WASHINGTON, D.C. - The U.S. Department of Health and Human Services on March 18 issued a proposed rule covering what changes to an existing policy constitute a discontinuation of that policy under the Patient Protection and Affordable Care Act (ACA), altering risk corridor regulations and governing civil penalties for fraud in the exchanges.

    Mealey's Health Law - HHS: ACA Plans Must Accept Specialty Support Programs

    WASHINGTON, D.C. - Patient Protection and Affordable Care Act (ACA) insurers must accept payment from federal and state programs that provide premium and cost-sharing support for specific individuals, the U.S. Department of Health and Human Services announced March 14.

    Mealey's Health Law - Ohio Appeals Court Affirms Arbitration Required In Payment Dispute

    DAYTON, Ohio - An Ohio appeals court on March 14 affirmed that a hospital provider and a Medicaid managed care payer were required to arbitrate all of their claims related to a payment dispute (Kettering Health Network v. CareSource, No. 25928, Ohio App., 2nd Dist.; 2014 Ohio App. LEXIS 895).

    Mealey's Health Law - California Federal Judge Affirms Denial Of Referral To Specialist In Medicare Case

    SAN FRANCISCO - A California federal judge on March 14 affirmed that the Medicare Appeals Council correctly denied a request by a claimant for a referral to a specialist, saying the claimant failed to exhaust the administrative appeals process (Theodore McElhone v. Kathleen Sebelius, No. 12-6090, N. D. Calif.; 2014 U.S. Dist. LEXIS 33944).

    Mealey's Health Law - ACA Insurance Plans To Offer Same-Sex Coverage In 2015, HHS Says

    WASHINGTON, D.C. - Patient Protection and Affordable Care Act (ACA) insurance plans offering same-sex coverage must also offer opposite-sex coverage starting in 2015, Health and Human Services official Matthew Heinz clarified in a March 14 blog post.

    Mealey's Health Law - Aetna Terminates Settlement In Reimbursement Class Action Suit

    NEWARK, N.J. - On March 13, just two days after plaintiffs filed a brief in a New Jersey federal court in support of a $120 million settlement agreement in a dispute over out-of-network reimbursement rates, defendant Aetna Inc. filed a notice of termination of the settlement, saying opt-outs from the settlement exceed allowed thresholds (In Re: Aetna UCR Litigation, Master File No. 07-3541, MDL 2020, D. N.J.).

    Mealey's Health Law - Federal Judge Affirms Decision To Deny Amended Complaint In COBRA Suit

    TRENTON, N.J. - In an unpublished opinion, a New Jersey federal judge on March 13 affirmed that a magistrate judge correctly denied a plaintiff's request to file a third amended complaint in a dispute over Consolidated Omnibus Budget Reconciliation Act (COBRA) benefits (Stephen J. Simoni v. Meridian Health Systems Inc., et al., No. 11-7528, D. N.J.; 2014 U.S. Dist. LEXIS 33145).

    Mealey's Health Law - U.S. House Passes ACA Individual, Employer Mandate Exemption Bills

    WASHINGTON, D.C. - The U.S. House on March 11 passed a trio of bills seeking to grant additional religious exemptions from the Patient Protection and Affordable Care Act (ACA)'s individual mandate and excluding military personnel and emergency services volunteers from the law's individual and employer mandates.

    Mealey's Health Law - Government: Bulletin Clarifies Enrollment In Exchange May Be Retroactive

    WASHINGTON, D.C. - The federal government on March 7 responded to a letter filed in the District of Columbia Circuit U.S. Court of Appeals by plaintiffs in a case challenging an Internal Revenue Service regulation imposed under the Patient Protection and Affordable Care Act (ACA) that extends eligibility for premium assistance subsidies to people who purchase health insurance through exchanges established by the ACA. The plaintiffs' letter addresses a bulletin issued by the Center for Medicare and Medicaid Services (CMS) discussing the tax credits available for individuals who purchase health care coverage through exchanges (Jacqueline Halbig, et al. v. Kathleen Sebelius, et al., No. 14-5018, D.C. Cir.).

    Mealey's Health Law - Government Asks Florida Federal Court To Nix Contraceptive Mandate Challenge

    MIAMI - The Patient Protection and Affordable Care Act (ACA) provides a simple opt-out procedure for employers with religious objections to the contraceptive mandate, and those with such objections should not be permitted to bar insurers from complying with the law, the government told a Florida federal judge in a March 10 motion to dismiss (Ave Maria School of Law v. Kathleen Sebelius, et al., No. 13-795, M.D. Fla.).

    Mealey's Health Law - Panel Partly Reverses Ruling In Coverage Suit Arising From Experimental Vaccine

    CHICAGO - An Illinois appeals panel on March 7 found that a lower court erred in finding that a directors and officers liability insurer had a duty to indemnify its insured for a $3 million settlement with former patients who sought compensation for the insured's decision to discontinue an experimental breast cancer vaccine program, concluding that only the primary and excess health care liability insurer has a duty to indemnify the insured (Rosalind Franklin University of Medicine and Science v. Lexington Insurance Co., et al., No. 06 CH 14486, Ill. App., 1st Dist., 5th Div.).

    Mealey's Health Law - Couple Sues In Mississippi Federal Court, Says Coverage Wrongfully Canceled

    HATTIESBURG, Miss. - A Mississippi couple on March 7 filed a lawsuit in federal court, alleging that they are wrongfully being held responsible for more than $50,000 in medical claims after the company responsible for making premium payments for their Pre-existing Condition Insurance Plan (PCIP) provided for under the Patient Protection and Affordable Care Act (ACA) failed to make the payments (Thomas and Wanda Carruth v. The Outsource Group, et al., No. 14-33, S.D. Miss.).

    Mealey's Health Law - Suit Filed In Texas Federal Court Alleges Coverage For Stroke Treatment Denied

    AUSTIN, Texas - A Texas woman on March 7 sued her health insurer in federal court for allegedly wrongfully denying coverage for treatment related to her husband's stroke (Eleanor Crose v. Humana Insurance Co., No. 14-205, W.D. Texas).

    Mealey's Health Law - Arkansas Federal Judge Dismisses Medicare Subrogation Case; Remedies Not Exhausted

    FORT SMITH, Ark. - An Arkansas federal judge on March 10 dismissed a subrogation dispute, saying the plaintiff failed to exhaust administrative remedies as required by the Medicare Act before filing the suit (Darrell Richard Cupp v. Dane F. Johns, et al., No. 14-2016, W.D. Ark.; 2014 U.S. Dist. LEXIS 30537).