Michigan Appeals Court Modifies Class Definitions In Reimbursement Dispute

DETROIT - A Michigan appeals panel on April 18 partially affirmed and partially reversed class certification of five classes in a suit alleging that a health insurer failed to properly reimburse chiropractors (Michigan Association of Chiropractors, et al. v. Blue Care Network of Michigan Inc., No. 304783...

Mich. Appeals Court Affirms, Reverses Class Order In Reimbursement Suit

DETROIT - A Michigan appeals panel on April 18 partially affirmed and partially reversed class certification in a suit alleging that a health insurer failed to properly reimburse chiropractors (Michigan Association of Chiropractors, et al. v. Blue Cross Blue Shield, No. 304763, Mich. App.; 2013 Mich...

New York Federal Judge Dismisses Copay Dispute For Lack Of Standing

NEW YORK - A New York federal judge on April 19 dismissed a health care copayment dispute, finding that the plaintiff lacked standing to bring her claims (Marianne Gates v. United Healthcare Insurance Co., et al., No. 11-3487, S.D. N.Y.; 2013 U.S. Dist. LEXIS 56619).

Fla. Federal Judge Dismisses Suit Alleging Insurer Schemed To Avoid Paying Rebates

FORT LAUDERDALE, Fla. - A Florida federal judge on May 7 dismissed a putative class action case against a health insurer and a third-party administrator accused of inflating medical loss ratios to avoid paying rebates for excessive premiums to subscribers as mandated by the Patient Protection and Affordable...

Health Insurance Purchasers May Drop $4.8M Settlement Of Antitrust Litigation

PITTSBURGH - A federal judge in Pennsylvania on May 7 permitted purchasers of health insurance from Highmark Inc. to withdraw their motion for preliminary approval of their settlement with Highmark of their antitrust claims, where the purchasers argued that Highmark failed to disclose information that...

California Appeals Court Affirms Hospital Has No Duty To Prevent Balance Billing

SAN JOSE, Calif. - A California appeals court panel held in a May 9 unpublished opinion that a hospital has no duty to inform patients admitted to the emergency room that emergency room physicians do not accept a particular health care plan and to take action to prevent emergency room physicians from...

Supreme Court Affirms Decision In Health Care Class Arbitration Dispute

WASHINGTON, D.C. - In a unanimous opinion, the U.S. Supreme Court on June 10 affirmed that an arbitrator acted within his powers under the Federal Arbitration Act (FAA) in determining that parties affirmatively "agreed to authorize class arbitration" in a case involving a dispute over a health...

Plan Administrator That Didn't Supervise TPAs Is Hit With $1.8M COBRA Penalty

INDIANAPOLIS - A class of 741 former Visteon Corp. employees is entitled to more than $1.8 million in penalties based on the company's failure to provide them with timely notices of their rights to continued health care coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA), a...

7th Circuit Affirms Dismissal Of Prescription Drug Headline Fraud Case

CHICAGO - A panel of the Seventh Circuit U.S. Court of Appeals on July 8 affirmed the dismissal of a class action complaint alleging that a prescription drug manufacturer and pharmacy engaged in a scheme to defraud insurers (United Food and Commercial Unions and Employers Midwest Health Benefits Fund...

Antitrust, Some ERISA Claims Dismissed From Wellpoint Reimbursement MDL

LOS ANGELES - A federal judge in California on July 19 dismissed antitrust and other claims alleging that WellPoint Inc. and other companies conspired to use a flawed database to set the rates for which out-of-network medical services (ONS) are reimbursed (In re: WellPoint Inc. Out-Of-Network "UCR"...

California Federal Judge Partially Grants Arbitration In Drug Trade Secret Suit

SAN FRANCISCO - A California federal judge on July 22 granted in part and denied in part a motion to compel arbitration in a class action lawsuit, alleging that a pharmacy benefit management company (PBM) and its related entities made unauthorized disclosures of customer information (Uptown Drug Company...

7th Circuit Affirms Dismissal Of Lawsuit Challenging Copayments

CHICAGO - A panel of the Seventh Circuit U.S. Court of Appeals on July 26 affirmed the dismissal of a proposed class action lawsuit alleging that six health insurance companies violated Wisconsin state law by requiring copayments for chiropractic care, saying that although the insurance companies were...

1 Claim Remains In Breach Of Health Insurance Contract Dispute

OKLAHOMA CITY - An Oklahoma federal judge on July 29 partially granted summary judgment in favor of a health care provider in a breach of contract dispute, leaving only the plaintiff's claim that she is a third-party beneficiary seeking to enforce restrictions on permitted billing of members for...

Chiropractors Sufficiently Alleged Breach, Bad Faith Under ERISA, Judge Rules

NEWARK, N.J. - Three chiropractors pursuing class claims against a health insurer's "bundling" of purportedly distinct claims survived dismissal on July 31, with a New Jersey federal judge finding that they had satisfied standing and pleading requirements under the Employee Retirement Income...

Federal Judge Grants Health Insurers Summary Judgment In Reimbursement Dispute

NEWARK, N.J. - A New Jersey federal judge on Aug. 1 granted summary judgment in favor of health insurers in a reimbursement dispute and denied the plaintiffs' motion for class certification (Premier Health Center, et al. v. UnitedHealth Group, et al., No. 11-425, D. N.J.; 2013 U.S. Dist. LEXIS 108041...

3rd Circuit Reverses Dismissal Of Dispute Against Health Insurer; Analysis Wrong

PHILADELPHIA - A Third Circuit U.S. Court of Appeals panel on Aug. 16 reversed a putative class action reimbursement dispute against a health insurer, saying the lower court improperly relied on the defendant's competing account of events when dismissing the claim (TRi3 Enterprises v. Aetna Inc....

Puerto Rico Federal Judge Retains Jurisdiction In Dentists' Reimbursement Suit

SAN JUAN, Puerto Rico - A Puerto Rico federal judge on Sept. 6 held that federal jurisdiction remains in a reimbursement suit brought by dentists and their employers against multiple health insurers following the denial of class certification under the Class Action Fairness Act (CAFA) (College of Dental...

Federal Judge Declines To Dismiss Fraudulent Advertising Of Health Policy Claim

MADISON, Wis. - A Wisconsin federal judge on Sept. 20 declined to dismiss a complaint alleging that a health insurer and companies hired to advertise its policies on television committed fraud and bad faith in their advertising practices, allowed the plaintiffs to amend their complaint and declined to...

Maine Federal Judge Dismisses Challenge To Medicaid Amendment

PORTLAND, Maine - A Maine federal judge on Sept. 30 dismissed without prejudice a potential class action suit against the secretary of Health and Human Services, which alleges that a recent amendment to Maine's Medicaid plan that reduced or terminated Medicaid benefits does not comply with the "maintenance...

Class Certification Denied In ERISA Coordination-Of-Benefits Action

CAMDEN, N.J. - A federal judge in New Jersey on Sept. 26 denied class certification of claims that United Healthcare, as the claims administrator for thousands of health insurance plans, violated the Employee Retirement Income Security Act by using a method for estimating what Medicare would have paid...

Ohio Federal Judge Grants In Part Motions To Compel Against Non-Party

DAYTON, Ohio - Non-party Community Insurance Co., doing business as Anthem Blue Cross and Blue Shield (Anthem), must produce certain documents regarding its deliberations not to contract with a medical center in the medical center's lawsuit claiming that it was denied contracts with managed care...

Federal Judge Rules On Expert Testimony, Access In Merger Trial

BOISE, Idaho - The federal judge in Idaho overseeing the trial involving an antitrust challenge to a consummated merger between a hospital system and a physician group on Oct. 18 refused to exclude certain expert testimony regarding the impact of unwinding the merger and ruled that the Associated Press'...

Federal Judge Certifies Class Of Health Care Purchasers In Hospital Merger Case

CHICAGO - End payers who purchased inpatient and outpatient health care services directly from NorthShore University HealthSystem and alleged that NorthShore illegally monopolized the market for such services following the merger of hospitals demonstrated that class adjudication of the antitrust claims...

Split Montana High Court Reverses Certification Of Class Question In Benefits Suit

HELENA, Mont. - A split Montana Supreme Court on Dec. 13 upheld a state court's order defining the class in a suit challenging the denial of a preauthorization request for a medical procedure but reversed and remanded with respect to the court's certification of the plaintiffs' claim as to...

9th Circuit Vacates Injunctions In Medicare Secondary Payer Class Action Suit

SAN FRANCISCO - A Ninth Circuit U.S. Court of Appeals panel on Jan. 2 filed an amended opinion vacating injunctions entered by a lower court prohibiting the secretary of the U.S. Department of Health and Human Services (DHHS) from demanding "up front" reimbursement for secondary payments from...