WASHINGTON, D.C. - The U.S. Supreme Court on Jan. 7 denied a petition for writ of certiorari brought by three Medicare beneficiaries challenging the dismissal of their suit seeking to formally disclaim their entitlement to Medicare Part A - hospital insurance (Brian Hall, et al. v. Kathleen Sebelius, Secretary of the U.S. Department of Health and Human Services, et al., No. 12-262, U.S. Sup.).
WASHINGTON, D.C. - A panel of the District of Columbia U.S. Circuit Court of Appeals on Jan. 4 affirmed that the secretary of defense reasonably interpreted a federal regulation aimed at curbing the cost of prescription drugs for military families to impose involuntary price caps on prescription drugs and to impose retroactive rebate liability on pharmaceutical manufacturers (Coalition for Common Sense in Government Procurement v. United States of America, et al., No. 11-5350, D.C. Cir.; 2013 U.S. App. LEXIS 216).
ATLANTA - The Employee Retirement Income Security Act preempts Georgia's statute requiring self-funded employer health insurance plans governed by ERISA to pay or deny benefit claims within a specified time frame, a federal judge in Georgia ruled Dec. 31 in granting a preliminary injunction prohibiting enforcement of the provision (American's Health Insurance Plans v. Hudgens, No. 1:12-cv-2978, N.D. Ga.; 2012 U.S. Dist. LEXIS 182922).
RICHMOND, Va. - A purchase option that was in effect for four months of the relevant calendar year did not require that the two companies be considered a single employer for purposes of continuation health care coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), the Fourth Circuit U.S. Court of Appeals ruled Dec. 28 in an unpublished opinion (Conn Feamster, et al. v. Mountain State Blue Cross & Blue Shield, Incorporated, et al., No. 11-2256, 4th Cir.; 2012 U.S. App. LEXIS 26628).
WASHINGTON, D.C. - A District of Columbia federal judge on Dec. 31 ordered the U.S. Department of Health and Human Services (HHS) to recalculate Medicare and Medicaid payments to disproportionate share hospitals (DSH) for services furnished to low-income patients and added that the agency must pay interest to the DSH providers if further reimbursement is forthcoming (Alegent Health -Immanual Medical Center et al. v. Kathleen Sebelius, et al., Nos. 11-139 and 11-1932, D. D.C.; 2012 U.S. Dist. LEXIS 182943).
DETROIT - A Michigan federal judge on Dec. 30 granted a temporary restraining order to halt the implementation of a mandate contained in the Patient Protection and Affordable Care Act (PPACA) related to the provision of birth control against the owner of a property management company and the company (Thomas Monaghan, et al. v. Kathleen Sebelius, et al., No. 12-15448, E.D. Mich.; 2012 U.S. Dist. LEXIS 182857).
HANNIBAL, Mo. - A Missouri federal judge on Dec. 31 granted plaintiffs a temporary restraining order and preliminary injunction to halt the implementation of a mandate contained in the Patient Protection and Affordable Care Act (PPACA) related to the provision of birth control (Sharpe Holdings Inc., et al. v. United States Department of Health and Human Services, et al., No. 12-92, E.D. Mo.; 2012 U.S. Dist. LEXIS 182942).
NEW ALBANY, Ind. - An Indiana federal judge on Dec. 27 denied the plaintiffs' motion for a preliminary injunction to halt the implementation of a mandate contained in the Patient Protection and Affordable Care Act (PPACA) related to the provision of birth control (Grote Industries, et al. v. Kathleen Sebelius, et al., No. 12-134, S.D. Ind.; 2012 U.S. Dist. LEXIS 181965).
WASHINGTON, D.C. - In an in-chambers order, the U.S. Supreme Court on Dec. 26 denied a request for an injunction pending appellate review of a lower court's decision rejecting a preliminary injunction to halt the implementation of a mandate contained in the Patient Protection and Affordable Care Act (PPACA) related to the provision of birth control (Hobby Lobby Stores Inc., et al. v. Kathleen Sebelius, et al., No. 12A644, U.S. Sup.; 2012 U.S. LEXIS 9594).
SAN FRANCISCO - A Ninth Circuit U.S. Court of Appeals panel on Dec. 13 reversed a district court's decisions and vacated preliminary injunctions prohibiting the implementation of Medicaid reimbursement reductions in California (Managed Pharmacy Care, et al. v. Kathleen Sebelius, et al., Nos. 12-55067, 12-55068, 12-55103, 12-55315, 12-55331, 12-55332, 12-55334, 12-55335, 12-55550, 12-55554, 9th Cir.; 2012 U.S. App. LEXIS 25478).
SAN FRANCISCO - A California federal judge on Dec. 12 found that the Employee Retirement Income Security Act did not preempt claims brought in a health insurance payment dispute and remanded the case to state court (Board of Trustees of Alameda County Medical Center v. Costco Employees Benefit Program, No. 12-4609, N.D. Calif.; 2012 U.S. Dist. LEXIS 176195).
EAST ST. LOUIS, Ill. - An Illinois federal judge on Dec. 14 denied a motion for preliminary injunction in a case brought by the owners of a secular, for-profit construction business who are seeking to stop the implementation of a "contraception mandate" contained in the Patient Protection and Affordable Care Act (PPACA) (Cyril B. Korte, et al. v. U.S. Department of Health and Human Services, et al., No. 12-1072, S.D. Ill.; 2012 U.S. Dist. LEXIS 177101).
WASHINGTON, D.C. - The U.S. Judicial Panel on Multidistrict Litigation on Dec. 12 centralized in the U.S. District Court for the Northern District of Alabama litigation alleging that the licensing agreements between Blue Cross Blue Shield Association (BCBSA) and its 38 licensees divide and allocate health insurance markets throughout the United States in violation of Sections 1 and 2 of the Sherman Act and various state laws (In re: Blue Cross Blue Shield Antitrust Litigation, MDL No. 2406, JPMDL).
NEWARK, N.J. - Parties involved in a multidistrict litigation case in which defendants are accused of manipulating the rates for which they reimburse out-of-network medical providers filed a joint motion on Dec. 7 asking a New Jersey federal judge to preliminarily approve a settlement valued up to $120 million (In re: Aetna UCR Litigation, MDL No. 2020, Master File No. 07-3541, D. N.J.).
PHOENIX - An Arizona federal court judge on Dec. 11 affirmed a health plan's denial of a prescription drug, agreeing that the drug is not covered under Medicare Part D (Penny Rickhoff v. United States Secretary for the Department of Health and Human Services, No. 11-2189, D. Ariz.; 2012 U.S. Dist. LEXIS 175206).
TRENTON, N.J. - A New Jersey federal judge on Dec. 5 partially granted motions to dismiss brought by a health insurance company and a peer review assessment company in a wrongful denial of benefits suit and allowed the plaintiff to amend a portion of her complaint (Linda S. Skelcy v UnitedHealth Group Inc., et al., No. 12-1014, D. N.J.; 2012 U.S. Dist. LEXIS 172922).
NEWARK, N.J. - A New Jersey federal judge on Dec. 6 dismissed claims against a claims administrator in a health care reimbursement suit, saying the defendant is not a fiduciary and, therefore, not a proper defendant (Montvale Surgical Center v. Horizon Blue Cross Blue Shield of New Jersey, et al., No. 12-2478, D. N.J.; 2012 U.S. Dist. LEXIS 173337).
NEW ORLEANS - The Fifth Circuit U.S. Court of Appeals on Dec. 6 affirmed a trial court order denying health care providers' challenge of how the U.S. Department of Health and Human Services (HHS) determines whether a hospital qualifies for, and the amount of, payment for serving a "disproportionate number of low-income patients." The court determined that the U.S. Congress specifically meant to leave out patients who qualify for Medicare Part A and Medicaid but do not qualify for Supplemental Security Income (SSI) when calculating the extra payments (Memorial Hospital at Gulfport, et al., v. Kathleen Sebelius, as Secretary of the United States Department of Health and Human Services, et al., No. 12-60333, 5th Cir.; 2012 U.S. App. LEXIS 25040).
KANSAS CITY, Mo. - The Western District Missouri Court of Appeals, Division Two, on Dec. 4 affirmed a trial court ruling denying Medicaid coverage for kidney dialysis treatment to a "legal alien." The appeals court concluded that while a legal alien may receive Medicaid benefits after living in the country for five years or more, or for seeking emergency treatment, the plaintiff had resided in the United States for only three years and her condition was not considered an emergency under state and federal law (Bertha Cruz v. Mo. Department of Social Services, No. WD74667, Mo. App., Western Dist., Div. 2; 2012 Mo. App. LEXIS 1537).
CHICAGO - Citing the previously unsettled state of case law regarding the production of insurers' internal documents and a lack of bad faith in an insurer's handling requests for such documents, a Seventh Circuit U.S. Court of Appeals panel on Nov. 28 upheld a lower court's ruling that had limited an insured's damages against her health plan provider (Sharon Mondry v. American Family Mutual Insurance Co, et al., No. 10-3490 and 11-1750, 7th Cir.; 2012 U.S. App. LEXIS 24476).
DETROIT - A Michigan federal judge on Nov. 30 declined to dismiss a class action lawsuit alleging that a health insurance company's conduct of incorporating "most favored nation" (MFN) clauses into its contracts with hospitals results in antitrust violations; the judge said the plaintiffs sufficiently stated plausible claims of injury under an antitrust case (The Shane Group Inc., et al. v. Blue Cross Blue Shield of Michigan, No.10-14360, E.D. Mich.; 2012 U.S. Dist. LEXIS 170201).
SALT LAKE CITY - A medical benefits plan is entitled to summary judgment on a hospital's claim for reimbursement under the Employee Retirement Income Security Act because the hospital's letters to the plan did not constitute an appeal of an adverse benefits determination and because the hospital's failure to exhaust its administrative remedies before filing suit was not excused, a federal judge in Utah ruled Nov. 27 (IHC Health Services, Inc. v. FCH1 LLC, No. 2:11-cv-00657, D. Utah).
BURLINGTON, Vt. - A federal magistrate judge on Nov. 28 affirmed a decision by the U.S. Department of Health and Human Services (HHS) and Secretary Kathleen Sebelius regarding coverage of a prescription antibiotic via an intravenous (IV) external infusion pump. The magistrate judge concluded that neither Medicare Part A nor Part B cover the administration of daptomycin through an IV, adding that the drug can be injected instead (Kathryn Ottinger v. Kathleen Sebelius, Secretary of the U.S. Department of Health and Human Services, No. 2:12cv2, D. Vt.; 2012 U.S. Dist. LEXIS 168498).
PITTSBURGH - A federal judge in Pennsylvania on Nov. 27 dismissed a challenge to the contraception mandate contained in the Patient Protection and Affordable Care Act (PPACA), 111 P.L. 148, brought by a group of Catholic organizations, saying the claims are not ripe for judicial review (Most Reverend David A. Zubik, et al. v. Kathleen Sebelius, No. 12-676, W.D. Pa.; 1012 U.S. Dist. LEXIS 167737).
WASHINGTON, D.C. - A federal judge on Nov. 26 rejected 29 health care organizations' challenge of U.S. Department of Health and Human Services (HHS) rules and regulations for reviewing Medicare payment determinations by its fiscal intermediaries. The judge found that because the plaintiff hospitals have yet to ask HHS to reopen any of their Medicare payment determinations for review, the challenge must be dismissed (Banner Health f/b/o Banner Good Samaritan Medical Center, et al., v. Kathleen Sebelius, Secretary of the U.S. Department of Health and Human Services, No. 10-01638, D. D.C.; 2012 U.S. Dist. LEXIS 167266).