Mealey's Health Law - Case Alleging Insurer Mislead Consumers About Health Plans Remanded

KANSAS CITY, Mo. - A Missouri federal judge on Sept. 9 granted a motion to remand a putative class action alleging that a health insurer misled consumers into obtaining an inferior health plan on the federal health care exchange pursuant to the Patient Protection and Affordable Care Act (ACA) (Debra...

Mealey's Health Law - U.S. House Extends Grandfathering Of Insurance For Small Businesses

WASHINGTON, D.C. - The U.S. House of Representatives on Sept. 11 passed legislation grandfathering more insurance plans from compliance with the Patient Protection and Affordable Care Act (ACA) minimum coverage standards

Mealey's Health Law - Court Halts Briefing After Government Moves For Remand In Birth Control Case

DETROIT - The Sixth Circuit U.S. Court of Appeals on Sept.12 held briefing of a Patient Protection and Affordable Care Act (ACA) contraceptive mandate challenge in abeyance until resolution of the government's unopposed motion to remand (Mersino Management Co., et al. v. Sylvia Burwell, et al., No...

Mealey's Health Law - ACA Changes Allow Renewal Of Black Lung Cases, 11th Circuit Holds

ATLANTA - The Patient Protection and Affordable Care Act (ACA)'s elimination of the causation requirement in Black Lung benefits cases permits pursuit of a denied claim originally made final in 2006, an 11th Circuit U.S. Court of Appeals panel held Sept. 12 (Jim Walter Resources Inc. v. Director...

Mealey's Health Law - Federal Claims In Prescription Drug Case Dismissed; Remaining Claims Remanded

BIRMINGHAM, Ala. - A federal judge in Alabama on Sept. 10 dismissed antitrust, Racketeer Influenced and Corrupt Organization Act and unjust enrichment claims against the third-party administrator of prescription medication and remanded the remaining state law claims to state court (Star Discount Pharmacy...

Mealey's Health Law - Appeals Court Affirms Judgment In Favor Of Insurer In Denial Of Benefits Suit

PHOENIX - In an unpublished opinion, an Arizona appeals panel on Sept. 11 affirmed summary judgment in favor of a health insurance company in a wrongful denial of health care benefits suit (Nicolai Tavilla, et al. v. Blue Cross and Blue Shield of Arizona Inc., No. CV-12-0843, Ariz. App., Div. 1; 2014...

Mealey's Health Law - Plaintiffs In Reimbursement MDL Oppose Dismissal Of Complaint, Support Amendment

NEWARK, N.J. - Plaintiffs involved in an antitrust and racketeering multidistrict litigation case accusing Aetna Inc. of underpaying out-of-network reimbursement claims asked a New Jersey federal court on Sept. 12 to deny the defendant's motion to dismiss the suit, which Aetna had filed just two...

Mealey's Health Law - 6th Circuit Denies Rehearing After Refusing To Enjoin Birth Control Mandate

GRAND RAPIDS, Mich. - The Sixth Circuit U.S. Court of Appeals on Sept. 16 denied en banc rehearing in a pair of cases challenging the Patient Protection and Affordable Care Act (ACA) contraceptive mandate opt-out, leaving stand a June decision affirming denial of injunctive relief (Michigan Catholic...

Mealey's Health Law - 7th Circuit Finds Lack Of Standing, Nixes ACA Tax Challenge

MILWAUKEE - The administration's decision to delay implementation of the Patient Protection and Affordable Care Act (ACA) employer mandate does not provide a cash-only physicians group with standing, a Seventh Circuit U.S. Court of Appeals panel held Sept. 19 (Association of American Physicians &...

Mealey's Health Law - District Of Columbia Federal Judge Dismisses Medicare Billing Suit

WASHINGTON, D.C. - A District of Washington federal judge on Sept. 17 dismissed a suit challenging limits to the billings of certain Medicare claims, saying the court lacked jurisdiction (The American Hospital Association, et al. v. Sylvia Matthews Burwell, No. 12-1770, D. D.C.; 2014 U.S. Dist. LEXIS...

Mealey's Health Law - Calif. Appeals Court Affirms Enforcement Of Billing Law Is Not A New Regulation

SACRAMENTO, Calif. - In an unpublished opinion, a California appeals panel on Sept. 18 affirmed that the California Department of Health Services' decision to begin enforcing a law requiring health providers to follow rigid billing procedures for Medi-Cal reimbursement claims or risk forfeiture is...

Mealey's Health Law - La. Federal Judge Affirms Decision Declining To Remand Balance Billing Suit

MONROE, La. - A Louisiana federal judge on Sept. 18 affirmed a magistrate judge's decision denying a motion to remand a class action dispute over balance billing, agreeing that a local exception rule did not apply (Bruce Stewart, et al. v. Ruston Louisiana Hospital Co., et al., No. 14-83, W.D. La...

Mealey's Health Law - Government Asks Judge To Stay Judgment Motion In ACA Challenge Case

WASHINGTON, D.C. - A District of Columbia federal judge should stay consideration of a summary judgment motion until resolution of jurisdictional questions in a case challenging the government's delayed implementation of portions of the Patient Protection and Affordable Care Act (ACA), the government...

Mealey's Health Law - Government To 11th Circuit: ACA Challengers Seek To Convert 'Shield Into A Sword'

MONTGOMERY, Ala. - The 11th Circuit U.S. Court of Appeals should reject plaintiffs' attempt to transform religious protections from a "shield into a sword" in a challenge to the Patient Protection and Affordable Care Act (ACA) contraceptive mandate, the government argued in a Sept. 26 brief...

Mealey's Health Law - Judge Allows Evidence Of Noneconomic Damages In Denial Of Benefits Trial

TRENTON, N.J. - In an unpublished opinion, a federal judge in New Jersey on Sept. 24 granted a plaintiff's motion in limine, which will allow her to introduce evidence of noneconomic damages at trial in her case alleging that a health insurer was negligent when it delayed approval of health benefits...

Mealey's Health Law - Federal Judge Dismisses RICO Claims In Drug Copay Case

CHICAGO - A federal judge in Illinois on Sept. 25 dismissed Racketeer Influenced and Corrupt Organizations Act claims against the manufacturer of Humira and AndroGel, saying the plaintiff failed to show the existence of a viable enterprise in the defendants' practice of offering savings cards that...

Mealey's Health Law - Judge Rejects IRS Rule, Finds ACA Tax Subsidies Apply Only In State Exchanges

MUSKOGEE, Okla. - Tax subsidies are available only to individuals who enroll through state exchanges under the language Congress chose to include in the Patient Protection and Affordable Care Act (ACA), and it is not a judge's place to revise those terms, an Oklahoma federal judge held Sept. 30 ...

Mealey's Health Law - Federal Judge Partially Grants Motion To Dismiss In Medicare Anti-Kickback Case

CAMDEN, N.J. - A federal judge in New Jersey on Sept. 29 dismissed federal False Claims Act (FCA) claims that predated March 4, 2005, as barred by the statute of limitations, but otherwise declined to dismiss the qui tam Medicare dispute (United States of America, ex rel. Marc Silver, et al. v. Omnicare...

Mealey's Health Law - Texas Federal Judge Allows Breach Claims To Continue In Reimbursement Suit

DALLAS - On Sept. 30, a federal judge in Texas granted in part and denied in part a health insurer's motion to dismiss reimbursement claims, finding that some of the claims were subject to arbitration or that the plaintiff failed to exhaust administrative remedies. Claims for breach of the patients...

Mealey's Health Law - ACA Changes To False Claims Act Disclosure Bar Apply Prospectively, Judge Says

SAVANNAH, Ga. - Changes the Patient Protection and Affordable Care Act (ACA) made to the False Claims Act public disclosure bar apply prospectively, a Georgia federal judge held Sept. 29 (United States of America and State of Georgia, ex rel. Chad Willis v. SouthernCare Inc., No. 10-124, S.D. Ga.; 2014...

Mealey's Health Law - Nevada Supreme Court Holds Lower Court Erred In Sua Sponte Granting Judgment

CARSON CITY, Nev. - The Nevada Supreme Court on Oct. 2 held that a lower court erred in granting summary judgment in favor of the plaintiff on two claims for relief in suit challenging a hospital's lien for payment that were not argued in the summary judgment briefing or at oral argument because...

Mealey's Health Law - Government Tells High Court ACA Language Supports Broad Tax Subsidy Availability

WASHINGTON, D.C. - No conflict among courts exists regarding the availability of tax credits for individuals obtaining insurance through federal exchanges, an outcome supported by the language and structure of the Patient Protection and Affordable Care Act (ACA), the government told the U.S. Supreme...

Mealey's Health Law - 8th Circuit Remands ACA Birth-Control Case For Injury Inquiry

ST. LOUIS - The Eighth Circuit U.S. Court of Appeals on Oct. 6 once again remanded an Patient Protection and Affordable Care Act (ACA) contraceptive mandate challenge brought by a closely held for-profit corporation for an inquiry into whether its inability to find insurance without such coverage arises...

Mealey's Health Law - D.C. Circuit Seeks Government Response In ACA 'Origination Clause' Attack

WASHINGTON, D.C. - The government must respond to a man's petition for rehearing en banc in a case challenging the origination of the Patient Protection and Affordable Care Act (ACA), the District of Columbia U.S. Circuit Court of Appeals said Oct. 9 (Matt Sissel v. United States Department of Health...

Mealey's Health Law - Washington High Court: Insurer Violates Mental Health Treatment Requirements

OLYMPIA, Wash. - The Washington Supreme Court on Oct. 9 held that health insurance blanket exclusions of neurodevelopmental therapies in plaintiffs' health plans are void and unenforceable under the state's Mental Health Parity Act and neurodevelopmental therapies (NDT) mandate (O.S.T., et al...