Mealey's Health Law - Medical Device Provider Failed To Demonstrate ERISA Standing, 11th Circuit Rules

ATLANTA - The provider of medical devices to health plan participants lacks standing to bring a reimbursement action against the plan insurer under the Employee Retirement Income Security Act because the provider did not demonstrate that it possessed valid written assignments of benefits from the participants...

Mealey's Health Law - Montana Top Court Rejects Challenge To ACA Defunding Legislation

HELENA, Mont. - The Montana Supreme Court on April 2 denied a petition challenging the constitutionality and legal sufficiency of a proposed ballot measure barring the use of state resources to administer the Patient Protection and Affordable Care Act (ACA) (Travis Hoffman, Melissa Smylie and Kim Abbott...

Mealey's Health Law - U.S. House Passes Bill Redefining Full-Time Employees Under ACA

WASHINGTON, D.C. - The U.S. House of Representative on April 3 passed legislation redefining a full-time employee for purposes of the Patient Protection and Affordable Care Act (ACA)'s employer mandate as an individual who works on average 40 hours per week.

Mealey's Health Law - Participant Has Standing To Assert Claims In Coordination Of Benefits Dispute

NEW YORK - A federal district court erred in ruling that a health plan participant did not have standing under the Employee Retirement Income Security Act to challenge calculations of benefits for members who are eligible for Medicare, the Second Circuit U.S. Court of Appeals ruled April 4 in an unpublished...

Mealey's Health Law - 3rd Circuit Reverses Decision In Medicare Reimbursement Dispute

PHILADELPHIA - In holding that the Health and Human Services secretary had a rational basis for distinguishing between two types of patient days in determining Medicare reimbursement rates, a panel of the Third Circuit U.S. Court of Appeals on April 1 reversed a lower court's decision (Nazareth Hospital...

Mealey's Health Law - Pennsylvania Court Says Change To Medicaid Payment System Appropriate

HARRISBURG, Pa. - In an unpublished April 3 opinion, a panel of the Commonwealth Court of Pennsylvania affirmed a decision denying a hospital's challenge to the implementation of a new Medicaid payment system (Monongahela Valley Hospital Inc. v. Department of Public Welfare, No. 1110 C.D. 2013, Pa...

Mealey's Health Law - Judge Grants Unopposed Injunction Against ACA's Employer Mandate

WASHINGTON, D.C. - A District of Columbia federal judge on April 3 granted an unopposed motion enjoining the government from applying the Patient Protection and Affordable Care Act (ACA) employer mandate (John F. Stewart, et al. v. Kathleen Sebelius, et al., No. 13-1879, D. D.C.).

Barnes & Thornburg LLP: Another Round Of HIPAA Audits

By Stacy Cook The Office for Civil Rights (OCR) recently announced that it will be sending surveys to approximately 1,200 organizations in preparation for conducting HIPAA audits. The HIPAA audits are mandated by the HITECH Act. According to the OCR, the surveys will be sent to about 800 covered...

Barnes & Thornburg LLP: President Obama Signs Bill Extending Physician Medicare Rates And Delaying ICD-10 And RAC Audits Under The 2-Midnights Rule

By Nita Garg On April 1, President Obama signed the Protecting Access to Medicare Act of 2014. This legislation extends current Medicare physician reimbursement rates and delays implementation of the ICD-10 code for a full year. Previously, hospitals were to be ICD-10 compliant by October 1, 2014;...

Mealey's Health Law - 7th Circuit: Provider Not Entitled To Hearings To Challenge Deficiencies

CHICAGO - A Seventh Circuit U.S. Court of Appeals panel on Nov. 8 affirmed that a Medicaid nursing home provider was not entitled to a hearing to challenge deficiency findings under state and federal Medicaid regulations (Bryn Mawr Care Inc. v. Kathleen Sebelius, No. 12-3687, 7th Cir.; 2014 U.S. App...

Mealey's Health Law - 9th Circuit Grants Injunction In Case Over Use Of Drugs For Abortion

SAN FRANCISCO - Noting that the issue was a matter of first impression in the circuit, the Ninth Circuit U.S. Court of Appeals on April 8 granted an emergency injunction pending appeal to halt the implementation of an Arizona law prohibiting the use of certain drugs to induce abortions (Planned Parenthood...

DLA Piper Alert: Federal Agencies Propose Health IT Regulatory Framework, Seek Stakeholder Input and Participation In New Initiatives

By Mary B. Langowski and Kristen E. Ratcliff A little more than five years after the passage of the Health Information Technology Economic and Clinical Health (HITECH) Act, the Food and Drug Administration, Federal Communications Commission and the Office of the National Coordinator for Health IT have...

Mealey's Health Law - Ohio Appeals Court Reverses Defense Judgment In Subrogation Case

CLEVELAND - An Ohio appeals court on April 10 reversed a summary judgment decision in favor of the defendant in a health insurance subrogation case, saying that the contract at issue was ambiguous and that the defendant did not show that its interpretation of the policy was the only reasonable interpretation...

Mealey's Health Law - D.C. Circuit Affirms Denial Of Medicare Payment For Depreciation After Merger

WASHINGTON, D.C. - A District of Columbia Circuit U.S. Court of Appeals panel on April 11 affirmed a district court's decision affirming an administrative ruling by the U.S. Department of Health and Human Services (HHS) denying depreciation reimbursement under the Medicare program to a Catholic health...

Mealey's Health Law - CBO: ACA Will Cost $36B Less In 2014 Than Previously Estimated

WASHINGTON, D.C. - Patient Protection and Affordable Care Act (ACA) insurance provisions will cost $36 billion in 2014 and $1,383 billion for the period of 2015 through 2024, reductions of almost $5 billion less this year $104 billion long term, according to an April 14 analysis by the Congressional...

Mealey's Health Law - HHS Secretary Sebelius Resigns; Budget Director Burwell Nominated For Post

WASHINGTON, D.C. - U.S. Secretary of Health and Human Services Kathleen Sebelius formally resigned April 11, and President Obama nominated Sylvia Matthew Burwell, now director of the Office of Management and Budget, to succeed her, according to the White House.

Mealey's Health Law - New Jersey Federal Judge Declines Class Certification In Reimbursement Dispute

NEWARK, N.J. - A New Jersey federal judge on April 14 denied a renewed motion to certify two classes in a reimbursement lawsuit filed against a health care insurer, a database company and the database's parent company (Darlery Franco v. Connecticut General Life Insurance Co., et al., No. 07-6039...

Mealey's Health Law - Physician Sues Insurer In Federal Court For Underpaying Claims

SAN DIEGO - A California physician on April 15 sued his health care provider in federal court for allegedly under-reimbursing his neurosurgeon for two surgeries he underwent for back and leg pain (Michael Keller v. Aetna Health and Life Insurance Co., No. 14-895, S.D. Calif.).

Mealey's Health Law - Plaintiffs Tell D.C. Court Contraceptive Mandate Imposes Substantial Burden

WASHINGTON, D.C. - While the government tries to downplay its impact, the contraceptive mandate imposes a substantial burden on religious organizations that cannot be avoided through the self-certification process, plaintiffs told the District of Columbia Circuit U.S. Court of Appeals on April 11 (Priests...

Mealey's Health Law - District Of Columbia Federal Judge Rules On Medicare Reimbursement Dispute

WASHINGTON, D.C. - A District of Columbia federal judge on April 17 remanded one hospital's Medicare payment dispute to a review board, but granted the defendant's summary judgment motion as to a second hospital's dispute, saying the review board did not have jurisdiction to hear the challenge...

Mealey's Health Law - Doctor Sues Insurer In Federal Court For Underpaying Claim

NEWARK, N.J. - A New Jersey board-certified orthopedic surgeon and the company he owns on April 16 sued a patient's health insurer and employer in federal court for allegedly paying the wrong amount for out-of-network services provided to the patient (Professional Orthopedic Associates, et al. v...

Mealey's Health Law - Official: Less Than Half Of Georgia ACA Enrollees Paid Premiums

ATLANTA - Less than half of the 221,604 Georgia residents who signed up for insurance through the Patient Protection and Affordable Care Act (ACA)'s federal exchange paid their premium by the close of enrollment, Georgia Insurance Commissioner Ralph Hudgens announced April 17.

Mealey's Health Law - Families File Class Action Over Denial Of Coverage For Treatment Of Autism

SEATTLE - Two families who have had coverage for applied behavioral analysis (ABA) therapy to treat their children's autism spectrum disorders (ASD) denied filed a class action lawsuit in a Washington federal court against the plan and plan administrator on April 17 (C.S., et al. v. The Boeing Company...

Mealey's Health Law - Louisiana Federal Judge Dismisses Reimbursement Dispute; Exhaustion Required

ALEXANDRIA, La. - A Louisiana federal judge on April 21 concurred with a magistrate judge's finding that a reimbursement dispute over the payment of health care benefits should be dismissed for failure of the plaintiff to exhaust administrative remedies (Sanat V. Sanghani, M.D. v. Aetna Life Insurance...

Mealey's Health Law - Colorado Federal Judge Grants Injunction In Birth-Control Mandate Challenge

DENVER - A Colorado federal judge on April 17 enjoined Patient Protection and Affordable Care Act (ACA) regulations mandating that a group health plan provide post-fertilization contraceptive coverage (Dr. James C. Dobson and Family Talk v. Kathleen Sebelius, et al., No. 13-3326, D. Colo.; 2014 U.S....