DENVER - A Colorado federal judge on July 27 granted a preliminary injunction in favor of a for-profit secular employer that will prevent the federal government from enforcing a mandate contained in the Patient Protection and Affordable Care Act (PPACA), 111 P.L. 148, that requires most employers to provide birth control coverage as part of their employee health plans (William Newland, et al. v. Kathleen Sebelius, in her official capacity as Secretary of the United States Department of Health and Human Services, et al No. 12-12-1123, D. Colo.; 2012 U.S. Dist. LEXIS 104835).
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DALLAS - In ruling on a motion to dismiss in a reimbursement dispute between a health care provider and a health insurer, a Texas federal judge on July 25 held that the plaintiff had standing based on assignments of benefits to bring claims to recover medical benefits but not to assert violations of the Employee Retirement Income Security Act, 29 U.S.C.S. § 1001 et seq. (Encompass Office Solutions Inc. v. Connecticut General Life Insurance Co., et al., No. 11-2487, N.D. Texas; 2012 U.S. Dist. LEXIS 103479).
SAN FRANCISCO - A California appeals court in a July 20 unpublished opinion modified a judgment in a Medicare billing dispute to strike an award of attorney fees in favor of the plaintiff (Daughters of Charity Health Systems, et al. v. Robert A. Simoncini, No. A131947, Calif. App., 1st. Dis., Div. 5; 2012 Cal. App. Unpub. LEXIS 5356).
ANCHORAGE, Alaska - The Alaska Supreme Court on July 20 affirmed that it was an error for the state's Office of Rate Review to refuse to grant a hospital's request for a temporary Medicaid rate while waiting for an audited version of the most recent home office cost report to be completed (State of Alaska, Department of Health and Social Services v. North Star Hospital, No. 6696; Ala. Sup.; 2012 Alas. LEXIS 105).
WASHINGTON, D.C. - A District of Columbia federal judge on July 18 dismissed without prejudice a case brought by a Christian university that alleges that the Patient Protection and Affordable Care Act (PPACA), 111 P.L. 148 mandate requiring all health plans to provide "preventative services" for free, including those for birth control, violates the rights of religious organizations, saying that the plaintiff's injury is "too speculative" to confer standing and that the case is not ripe (Belmont Abbey College v. Kathleen Sebelius, et al., , No. 11-1989, D. D.C.).
NEWARK, N.J. - A New Jersey federal judge in a July 18 unpublished opinion partially granted a defendant's motion to dismiss a reimbursement suit, leaving two claims and dismissing three (Jersey Brain & Spine Center v. Anthem Blue Cross Blue Shield, No. 11-6379, D. N.J.; 2012 U.S. Dist. LEXIS 100267).
SAN FRANCISCO - The California Supreme Court on July 18 granted a request by the Ninth Circuit U.S. Court of Appeals to certify a question asking the state high court to address whether the distribution of studies related to drug costs violates free speech under the California Constitution (Jerry Beeman and Pharmacy Services Inc., et al. v. Anthem Prescription Management, et al., No. S203124, Calif. Sup.; 2012 Cal. LEXIS 7038).
NEW YORK - Several of a health plan participant's claims under the Employee Retirement Income Security Act, 29 U.S.C.S. § 1001 et seq., against the plan and the plan's claims administrator related to calculations of benefits for members who are eligible for Medicare were dismissed by a federal judge in New York on July 16 for being asserted against an improper defendant and for failure to state a claim (Marianne Gates v. United Health Group Inc., et al., No. 11 Civ. 3487, S.D. N.Y.).
PORT HURON, Mich. - A Michigan federal judge on July 17 declined to grant a preliminary injunction to a group of retirees of the City of Pontiac to prevent changes made to their health care benefits, saying the plaintiffs failed to show that it was likely that they would succeed on the merits of their claims (City of Pontiac Retired Employees, et al. v. City of Pontiac, et al., No. 12-12830, E.D. Mich.; 2012 U.S. Dis. LEXIS 98858).
LEXINGTON, Ky. - A Kentucky federal judge on July 16 held the Kentucky Cabinet for Health and Family Services in contempt for failing to properly process requests by patients to transfer from one managed care organization (MCO) to another in light of the MCO's impending termination of its provider contract with a health care provider that operates eight hospitals in the eastern part of the state (Appalachian Regional Healthcare, et al. v. Coventry Health and Life Insurance Co., et al., No. 12-114, E.D. Ky.; 2012 U.S. Dist. LEXIS 98168).
WHEELING, W. Va. - A West Virginia federal judge on July 11 remanded a wrongful denial of benefits case to state court, saying the defendants did not meet their burden in showing that the health plan at issue fell under the Employee Retirement Income Security Act (Christopher J. Regan, et al. v. Coventry Health & Life Insurance Co., et al., No. 12-25, N.D. W. Va.; 2012 U.S. Dist. LEXIS 96487).
PHILADELPHIA - A Pennsylvania federal judge on July 12 granted defendants' motion to dismiss a breach of contract and misappropriation of trade secrets dispute between a claims auditing company and health insurers, saying a contract between the parties required any dispute to be brought in state court (Medical Reimbursement Data Management v. Aetna Health Inc No. 12-1699, E.D. Pa.; 2012 U.S. Dist. LEXIS 97583).
CINCINNATI - The Sixth Circuit U.S. Court of Appeals on July 9 lifted a stay of a case challenging the Patient Protection and Affordable Care Act (PPACA), 111 P.L. 148 upon a motion by the federal government following the U.S. Supreme Court's decision in a similar case (U.S. Citizens Association, et al. v. Kathleen Sebelius, et al., Nos. 11-3327 &11-3798, 6th Cir.). Subscribers may view the order available within the full article.
HATTIESBURG, Miss. - Parties involved in a challenge to the Patient Protection and Affordable Care Act (PPACA), 111 P.L. 148, filed separate briefs on July 6 in a Mississippi federal court in opposition to each other's motions for summary judgment (Ryan S. Walters, et al. v. Eric H. Holder, et al., No. 10-76, S.D. Miss).
NEW YORK - In partially adopting a magistrate judge's recommendations, a New York federal judge on July 3 concluded that a defendant in a wrongful denial of benefits suit was not entitled to attorney fees, saying the company did not "obtain the minimum amount of success" on the merits (Nicholas Scarangella v. Group Health Inc., et al., No. 05-5298, S.D. N.Y.; 2012 U.S. Dist. LEXIS 92433).
NEWARK, N.J. - In an unpublished opinion, a federal New Jersey judge on July 5 granted a preliminary injunction and summary judgment in favor of community health care centers providing services to people in medically underserved communities, saying that recent changes to the state's Medicaid program violated state regulations and the federal Medicaid statute (New Jersey Primary Care Association v. State of New Jersey Department of Human Services, et al., No. 12-413, D. N.J.; 2012 U.S. Dist. LEXIS 92897).
WASHINGTON, D.C. - The U.S. Supreme Court on June 29 denied without comment petitions for certiorari in four cases challenging the Patient Protection and Affordable Care Act (PPACA), 111 P.L. 148 (PPACA) after holding in another challenge to the act that the individual mandate contained in the act is constitutional (Thomas More Law Center, et al. v. Barack Hussein Obama, et al., No. 11-117, U.S. Sup.; Commonwealth of Virginia v. Kathleen Sebelius, No. 110420, U.S. Sup.; Liberty University, et al. v. Timothy Geithner, et al., No 11-438, U.S. Sup.; Susan Seven-Sky, et al. v. Eric H. Holder Jr., et al., No. 11-679, U.S. Sup).
RICHMOND, Va. - A panel of the Fourth Circuit U.S. Court of Appeals on June 27 reversed the denial of a motion to dismiss reimbursement claims brought against a health plan by multiple hospitals pursuant to an arbitration agreement, saying that the lower court erred in finding that the defendant had defaulted on its right to arbitrate (Wheeling Hospital Inc. et al. v. The Health Plan of the Upper Ohio Valley Inc., et al., No. 11-1694; 4th Cir.; 2012 U.S. App. LEXIS 13154).
DALLAS - A Texas federal judge on June 27 denied a motion to remand a reimbursement dispute between health care providers and insurance companies, saying that federal law completely preempted one of the claims (Paragon Office Services, et al. v. Aetna Inc., et al., No. 11-1898, N.D. Texas; 2012 U.S. Dist. LEXIS 89044).
PHILADELPHIA - A Third Circuit U.S. Court of Appeals panel on June 27 affirmed in part and reversed in part an order declining to grant attorney fees in a reimbursement dispute, finding that the lower court erred in failing to determine whether the plaintiffs were entitled to interest on their claim for benefits even though the benefits were paid after the lawsuit was initiated (Christopher Templin, et al. v. Independence Blue Cross, et al., Nos. 11-2453, 11-3583, 3rd Cir.; 2012 U.S. App. LEXIS 13163).
PHILADELPHIA - Medicare Advantage provider Humana Medical Plan Inc. is allowed under Medicare law to seek reimbursement from GlaxoSmithKline PLC (GSK) for the costs of treating insurance customers who were injured by GSK's Avandia diabetes drug, a unanimous Third Circuit U.S. Court of Appeals panel said June 28 (In Re: Avandia Marketing, Sales Practices and Products Liability Litigation, No. 11-2664, 3rd Cir.; 2012 U.S. App. LEXIS 13230).
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WASHINGTON, D.C. - In a sweeping opinion covering four issues addressed over three days of oral argument, the U.S. Supreme Court today found that the Anti-Injunction Act (AIA) does not bar challenges to the Patient Protection and Affordable Care Act (PPACA), 111 P.L. 148, that the individual mandate contained in the act is constitutional and that the federal government can expand Medicaid but cannot withhold existing funding from the states for noncompliance with the expansion (Department of Health and Human Services, et al. v. State of Florida, et al., No. 11-398, U.S. Sup.; National Federation of Independent Business v. Kathleen Sebelius, et al. No. 11-393; State of Florida, et al. v. Department of Health and Human Services, et al., No. 11-400, U.S. Sup.).
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WASHINGTON, D.C. - The U.S. Supreme Court on June 25 agreed to decide whether the 180-day limit on appealing Medicare reimbursement decisions can be equitably tolled for 18 hospitals that want agency review of reimbursement decisions dating back as far as 1987 (Kathleen Sebelius, et al. v. Auburn Regional Medical Center, et al., No. 11-1231, U.S. Sup.).
WASHINGTON, D.C. - The U.S. Supreme Court on June 25 agreed to review a Third Circuit U.S. Court of Appeals ruling that a health plan administrator's claim for reimbursement against a plan participant is subject to equitable limitations, including unjust enrichment, under Employee Retirement Income Security Act (ERISA), 29 U.S.C.S. § 1001 Section 502(a)(3) (U.S. Airways, Inc. v. James McCutchen, et al., No. 11-1285, U.S. Sup.).
WASHINGTON, D.C. - The U.S. Supreme Court on June 25 granted the Federal Trade Commission's petition for a writ of certiorari seeking review of an 11th Circuit U.S. Court of Appeals ruling that although a merger between two Georgia hospitals would substantially lessen competition or tend to create a monopoly, the state-action doctrine immunized the conduct from a challenge by the FTC (Federal Trade Commission v. Phoebe Putney Health System, Inc., et al. No. 11-1160, U.S. Sup.).
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