http://www.lexisnexis.com/mealeys/news.aspx Headline Managed Care Liability Legal News from LexisNexis® en-us http://www.lexisnexis.com/mealeys/images/lexismealeyslogo.gif 130 29 http://www.lexisnexis.com/mealeys/news.aspx Copyright 2012 http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%201%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank OMAHA, Neb. - The federal government on April 30 asked a Nebraska federal court to dismiss a suit challenging a provision contained in the Patient Protection and Affordable Care Act (PPACA) that requires all health plans to provide preventive health services for free, including those for birth control, saying the court lacks jurisdiction to hear the case (State of Nebraska, et al. v. U.S. Department of Health and Human Services, et al., No. 12-3035, D. Neb.; See 3/7/12, Page 9). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%202%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank DENVER - A Christian university on May 3 filed a brief in Colorado federal court opposing dismissal of its first amended complaint in a case that alleges that the mandate contained in the Patient Protection and Affordable Care Act (PPACA) requiring that all health plans provide "preventative services" for free, including those for birth control, violates the rights of religious organizations (Colorado Christian University v. Kathleen Sebelius, No. 11-3350, D. Colo., See 4/4/12, Page 10). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%203%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank WASHINGTON, D.C. - The U.S. Supreme Court is being asked to review a Ninth Circuit U.S. Court of Appeals ruling that Section 702 of the Employee Retirement Income Security Act, enacted by the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), preempts Montana's version of the law but that ERISA does not preempt a claim for relief under separate state laws governing unfair insurance practices regulating the setting of health insurance premiums (Blue Cross and Blue Shield of Montana, Inc. v. Dale Fossen, et al., No. 11-1155, U.S. Sup.; Dale Fossen, et al. v. Blue Cross and Blue Shield of Montana, Inc., No. 11-1280, U.S. Sup.; See 11/2/11, Page 17). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%204%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank PHILADELPHIA - A hospital lacked standing as a participant or a beneficiary to bring a claim for benefits under Employee Retirement Income Security Act Section 502(a); therefore, the hospital's breach of contract claim against the sponsor and third-party claims administrator of a medical plan for failure to pay for medical services rendered on behalf of a plan participant were not completely preempted, a federal judge in Pennsylvania ruled May 2 in remanding the case to state court (Tenet Health System Philadelphia, Inc. v. Diversified Administration Corporation, et al., No. 07-4948, E.D. Pa.; 2012 U.S. Dist. LEXIS 61395). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%205%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank NEWARK, N.J. - A Florida federal judge on May 8 declined to dismiss counterclaims brought by an insurance company against chiropractors in a billing dispute and also affirmed a magistrate judge's decision to deny the plaintiffs' request to file a second amended complaint to address their post-auditing practice claims (Association of New Jersey Chiropractors, et al. v. Aetna Inc., No. 09-3761, D. N.J.; See 10/19/11, Page 22). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%206%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank DALLAS - A Texas federal judge on May 7 declined to dismiss a reimbursement suit brought by a provider of mobile cardiopulmonary diagnostic tests against a health insurer, saying the plaintiff pleaded sufficient allegations to support its causes of action (Team Healthcare/Diagnostic Corp. v. BlueCross and Blue Shield, No. 10-1441, N.D. Texas; 2012 U.S. Dist. LEXIS 63760). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%207%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank SAN JUAN, Puerto Rico - A Puerto Rico federal judge on May 2 declined to set aside an earlier opinion that left only a breach of contract claim in a class action reimbursement suit, saying that the plaintiffs provided no evidence in support of the relief requested (College of Dental Surgeons of Puerto Rico v. Triple S Management Inc., No. 09-1209, D. Puerto Rico; 2012 U.S. Dist. LEXIS 61462; See 9/7/11, Page 18). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%208%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank ATLANTA - A panel of the 11th Circuit U.S. Court of Appeals on May 1 affirmed the dismissal of a health insurance reimbursement suit, saying a lower court did not err in finding that the case was barred because the plaintiff previously filed two suits and dismissed them (Hooman Melamed, M.D., et al. v. Blue Cross of California, et al., No. 11-14643, 11th Cir.; 2012 U.S. App. LEXIS 8820; See 2/1/12, Page 12). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%209%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank NEWARK, N.J. - A health insurer accused of making wrongful reimbursements for out-of-network medical services filed a brief on May 3 in New Jersey federal court, opposing class certification for the case (Cathleen McDonough v. Horizon Blue Cross Blue Shield of New Jersey, No. 09-571, D. N.J.; See 10/5/11, Page 12). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2010%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank WASHINGTON, D.C. - A health plan administrator on April 25 asked the U.S. Supreme Court to review a Third Circuit U.S. Court of Appeals ruling that a plan participant may assert the equitable principle of unjust enrichment on the plan's reimbursement claim brought under Employee Retirement Income Security Act Section 502(a)(1) (U.S. Airways, Inc. v. James McCutchen, et al., No. 11-1285, U.S. Sup.). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2011%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank SCRANTON, Pa. - Participants in their employer's health plan failed to demonstrate that the insurer violated the Employee Retirement Income Security Act by terminating the insurance contract because the employer breached the contract's underwriting requirements, a federal judge ruled May 3 in granting the insurer summary judgment (New Life Homecare, Inc., et al. v. Blue Cross of Northeastern Pennsylvania, et al., No. 3:06-2485, M.D. Pa.; 2012 U.S. Dist. LEXIS 61959). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2012%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank COLUMBUS, Ga. - Following a bench trial, a Georgia federal magistrate judge held May 4 that a plaintiff's breach of fiduciary duty claim in a suit alleging violations of the Consolidated Omnibus Budget Reconciliation Act (COBRA) was time-barred and that even if the claim was not time-barred, the plaintiff had failed to show that the defendants were fiduciaries who owed him any duties (Homer Ira Lockhart v. Southern Health Plan Inc., et al., No. 04-0006, M.D. Ga.; 2012 U.S. Dist. LEXIS 63265). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2013%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank HONOLULU - A divided Hawaii Supreme Court on May 11 held that a health maintenance organization cannot appeal the denial of a Medicaid contract awarded by the Department of Human Services (DHS) for the State of Hawaii under a state statute pertaining to procurement contracts but can obtain judicial review of the administrative denial of such matters under the declaratory judgment statute (AlohaCare v. Department Of Human Services, State of Hawaii, No. SCWC-29630, Hawaii Sup.; 2012 Haw. LEXIS 152). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2014%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank BALTIMORE - A federal judge in the U.S. District Court for the District of Maryland on May 9 granted a U.S. Department of Health and Human Services (HHS) motion to dismiss a physicians' group's challenge to the way the department and the Centers for Medicare and Medicaid Services (CMS) calculate the physician fee schedule (PFS). The judge concluded that the U.S. Congress has barred administrative and judicial review of the fee schedule under 42 U.S. Code Section 1395w-4(i)(1)(B) (Paul Fischer, M.D., et al. v. Donald Berwick, M.D., et al., No. WMN-11-2191, D. Md.; 2012 U.S. Dist. LEXIS 65034). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-10%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2015%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank President Obama signed the Patient Protection and Affordable Care Act (PPACA), as amended by the Health Care and Education Reconciliation Act, on March 23, 2010. One of the main requirements of the act is that most Americans without insurance obtain coverage or face a penalty. Other provisions will stop insurance companies from dropping or denying care to people with pre-existing conditions and expand the federal-state Medicaid insurance program for the poor to cover people with incomes up to 133 percent of the federal poverty level and to cover childless adults for the first time, starting in 2014. http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%201%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank WASHINGTON, D.C. - A Christian university on April 23 opposed dismissal in a District of Columbia federal court of its case, which alleges that the mandate contained in the Patient Protection and Affordable Care Act (PPACA) requiring all health plans to provide "preventative services" for free, including those for birth control, violates the rights of religious organizations (Belmont Abbey College v. Kathleen Sebelius, et al., No. 11-1989, D. D.C.; See 3/7/12, Page 12). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%202%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank DETROIT - A Michigan federal judge on April 18 dismissed a claim for breach of settlement agreement from a wrongful denial of benefits suit, saying that the Employee Retirement Income Security Act preempted the claim (Paul Goldman v. BCBSM Foundation, No. 11-14043, E.D. Mich.; 2012 U.S. Dist. LEXIS 54469; See 2/1/12, Page 17). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%203%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank OXFORD, Miss. - In reconsidering a previous decision denying a motion to dismiss in a wrongful denial of benefits case, a Mississippi federal judge on March 20 held that a plaintiff failed to support her claims under the Employee Retirement Income Security Act and that the case should be dismissed. On April 19, the plaintiff filed a notice in the district court that she intends to appeal the decision to the Fifth Circuit U.S. Court of Appeals (Theresa Hall v. Newmarket Corp., et al., No. 09-41, S.D. Miss.; See 10/6/10, Page 12). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%204%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank NEWARK, N.J. - In an unpublished opinion, a New Jersey federal judge on April 24 dismissed a putative class action case against a health insurer, saying the plaintiff failed to state a cause of action because the actions taken by the defendant in seeking repayment of money for services provided failed to implicate the Employee Retirement Income Security Act (TR13 Enterprises v. Aetna Inc., et al., No. 11-3021, D. N.J.; 2012 U.S. Dist. LEXIS 57158). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%205%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank CHICAGO - A divided Seventh Circuit U.S. Court of Appeals panel on April 19 affirmed in part and remanded in part a wrongful denial of benefits case, holding that a lower court correctly granted the defendants summary judgment on the denial of benefits and breach of fiduciary duty claims but incorrectly calculated the plaintiffs' statutory damages award (James E. Killian v. Concert Health Plan, et al., No. 11-1112, 7th Cir.; 2012 U.S. App. Lexis 7880; See 1/5/11, Page 17). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%206%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank MILWAUKEE - A Wisconsin federal judge on April 19 dismissed a wrongful denial of benefits case against a third-party administrator, saying that the administrator did not breach its fiduciary duty in denying a claim for gastric bypass surgery because the plan clearly excluded the procedure (Jeffrey Smith v. Medical Benefit Administrators, No. 09-538, E.D. Wis.; 2012 U.S. Dist. LEXIS 54913; See 4/6/11, Page 21). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%207%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank SAN DIEGO - A California federal judge on April 24 denied summary judgment to both parties in a reimbursement dispute between a health benefit plan and a hospital, saying remand to the plan administrator for review of the denial of benefits was warranted (Scripps Health v. Food Employers & Bakery & Confectionery Workers Benefit Fund of Southern California, et al., No. 10-2484, S. D. Calif.; 2012 U.S. Dist. LEXIS 58012). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%208%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank ATLANTA - In an unpublished opinion, the 11th Circuit U.S. Court of Appeals on March 26 affirmed the dismissal of a suit seeking declaratory judgment that a reimbursement dispute against multiple insurers was not barred by an injunction in the managed care multidistrict litigation, saying the plaintiffs did not follow the proper procedure for testing injunctions (Derrick E. Antell, et al. v. Aetna Inc., et al., No. 11-11209 and Stephen Henry, et al. V. WellPoint Inc., No. 11-11211, 11th Cir.; See 7/6/11, Page 17). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%209%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank LOS ANGELES - A California appeals court on April 26 in an unpublished opinion affirmed that plaintiffs suing a hospital for breach of contract involving health insurance payments failed to allege any factual basis for recoverable damages (Clinton B. Eull III, et al. v. Providence Little Company of Mary, No. B227903, Calif. App., 2nd Dist., Div. 3; 2012 Cal. App. Unpub. LEXIS 3161). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2010%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank ST. LOUIS - A Missouri federal judge on April 17 granted a health plan administrator's request for expedited discovery in a contract dispute over the access of client information, saying the information would help the plaintiff prepare for a preliminary injunction hearing (Meritain Health Inc., et al. v. Express Scripts Inc., No. 12-266, E.D. Mo.; 2012 U.S. Dist. LEXIS 53827). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2011%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank PITTSBURGH - A federal judge in Pennsylvania on April 25 ruled that pharmacies and pharmacy trade groups challenging the consummated $29 billion merger of pharmaceutical benefit management companies Express Scripts Inc. (ESI) and Medco Health Solutions Inc. were not entitled to a preliminary injunction because they failed to establish the likelihood of immediate, irreparable harm that could be alleviated by the issuance of a preliminary injunction (National Association of Chain Drug Stores, et al. v. Express Scripts, Inc., et al., No. 2:12-cv-00395-CB, W.D. Pa.; 2012 U.S. Dist. LEXIS 57884). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2012%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank WASHINGTON, D.C. - A District of Columbia federal judge on April 17 granted a motion by the secretary of the U.S. Department of Health and Human Services (DHHS) to remand a Medicare dispute to the department, saying an appeals court opinion invalidating the reimbursement rule in question required remand to the department for further review (Baptist Medical Center, et al. v. Kathleen Sebelius, No. 11-1273, D. D.C.; 2012 U.S. Dist. LEXIS 53840). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2013%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank TACOMA, Wash. - A Washington federal judge on April 25 denied a motion for preliminary injunction in a case in which Medicaid managed care organization (MCO) providers are seeking to stop the state's Medicaid administrator from entering into contracts with new MCOs (Columbia United Providers Inc., et al. v. State of Washington, Health Care Authority, No. C12-5174BHS, W.D. Wash.; 2012 U.S. Dist. LEXIS 58105). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2014%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank SAN FRANCISCO - The First District California Court of Appeal, Division Two, on April 24 affirmed a trial court ruling sustaining defendant Health Net Inc.'s demurrers in a Medicare Part D, prescription drug benefit, denial of benefits cause of action. The appeals court agreed with the lower court that the negligence claims against the insurance company are subject to administrative exhaustion and that the state fraud and unfair trade practices claims are preempted by the federal Medicare Act (Jordan Rosenberg v. Health Net Inc., No. A131756, Calif. App., 1st Dist., Div. 2; 2012 Cal. App. Unpub. LEXIS 3087). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2015%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank WASHINGTON, D.C. - A District of Columbia federal judge on April 17 affirmed an administrative order by Health and Human Services (HHS) Secretary Kathleen Sebelius denying the payment of fees under Medicare for graduate medical education (GME), saying the plaintiff hospital failed to have a contemporaneous agreement in place with the off-site training facility regarding payment for dental residents (University Medical Center Inc. v. Kathleen Sebelius, U.S. Department of Health and Human Services, No. 11-260, D. D.C.; 2012 U.S. Dist. LEXIS 53395). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2016%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank BOSTON - The Massachusetts Appeals Court on April 17 affirmed a trial court order affirming the state's Medicaid program's denial of long-term care benefits because of the existence of countable assets (Michael J. Lombardi v. Director of the Office of Medicaid, No. 11-P-1208, Mass. App.; 2012 Mass. App. Unpub. LEXIS 479). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2017%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank PHILADELPHIA - The Third Circuit U.S. Court of Appeals on April 20 affirmed the denial of attorney fees and costs in a Medicare overpayment dispute between the U.S. Department of Health and Human Services and a Medicare provider. The appellate court concluded that the trial court properly denied the fees sought under the Equal Access to Justice Act (EAJA) but further concluded that the trial court incorrectly determined that the proceedings were not adversarial as required under the EAJA (John D. Handron v. Secretary Department of Health and Human Services, et al., No. 10-1021, 3rd Cir.; 2012 U.S. App. LEXIS 8015). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2018%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank HOUSTON - A health insurance company on April 18 sued a multispecialty surgery center in Texas federal court, alleging that the defendant submitted excessively high claims for out-of-network services provided in a scheme to receive millions of dollars in unwarranted fees from the insurance company (Aetna Life Insurance Co. v. Humble Surgical Hospital, No. 12-1206, S.D. Texas). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2019%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank BIRMINGHAM, Ala. - An Alabama man and his employer filed a class action lawsuit on April 17 in federal court against Blue Cross companies, alleging antitrust violations for allegedly conspiring to divide and allocate markets for commercial, consumer health insurance in the state (Fred R. Richards, et al. v. Blue Cross and Blue Shield of Alabama, et al., No. 12-1133, N.D. Ala.). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-9%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2020%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank President Obama signed the Patient Protection and Affordable Care Act (PPACA), as amended by the Health Care and Education Reconciliation Act, on March 23, 2010. One of the main requirements of the act is that most Americans without insurance obtain coverage or face a penalty. Other provisions will stop insurance companies from dropping or denying care to people with pre-existing conditions and expand the federal-state Medicaid insurance program for the poor to cover people with incomes up to 133 percent of the federal poverty level and to cover childless adults for the first time, starting in 2014. http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%201%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank NEW ORLEANS - Following oral arguments in an appeal challenging the Patient Protection and Affordable Care Act (PPACA), the federal government on April 5 filed a letter at the request of the Fifth Circuit U.S. Court of Appeals to provide the U.S. Department of Justice's views regarding judicial review of the constitutionality of acts of Congress; the plaintiffs filed a response to the letter on April 9 (Physician Hospitals of America, et al. v. Kathleen Sebelius, No. 11-40631, 5th Cir.; See 3/7/12, Page 14). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%202%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank SANTA ANA, Calif. - A California man whose challenge to the Patient Protection and Affordable Care Act (PPACA) was dismissed filed a notice April 3 in a California federal court, indicating that he would be appealing the dismissal to the Ninth Circuit U.S. Court of Appeals (David Boyle v. Kathleen Sebelius, in her official capacity as United States Secretary of the Department of Health and Human Services, No. 11-7868, C.D. Calif.; See 2/15/12, Page 8). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%203%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank RENO, Nev. - A Nevada federal judge on April 5 granted summary judgment in favor of insurance providers in a reimbursement dispute, saying that the plaintiffs had not received preauthorization as required and had no grounds to seek payment after undergoing surgery on their own accord (Kenneth Anderson, et al. v. PacifiCare of Nevada Inc., et al., No. 10-1279, D. Nev.; 2012 U.S. Dist. LEXIS 48194). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%204%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank NEWARK, N.J. - A New Jersey federal judge on April 16 in an unpublished opinion granted summary judgment in favor of a health insurer in a reimbursement dispute, holding that the plaintiff health care provider failed to exhaust administrative remedies before filing suit (Patient Care Associates v. New Jersey Carpenters Health Fund, No. 10-1669, D. N.J.; 2012 U.S. Dist. LEXIS 52878). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%205%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank NEW ORLEANS - A Louisiana federal judge on April 10 denied partial summary judgment to a plaintiff in a reimbursement dispute, saying that fact issues remained as to what company was responsible for denying benefits and that the plaintiff failed to show that he was injured by one of the defendants not filing confidential information under seal (Thomas H. Kingsmill v. Louisiana Health Service & Indemnity Co., et al., No. 09-6787, E.D. La.; 2012 U.S. Dist. LEXIS 49969). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%206%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank DETROIT - A Michigan federal judge on March 30 dismissed a health insurance company from a class action lawsuit that accused the insurer and 21 hospital and health systems of illegally contracting, conspiring and engaging in anticompetitive conduct through the execution of "most favored nation" (MFN) clauses in contracts between the parties (City of Pontiac v. Blue Cross Blue Shield of Michigan, et al., No. 11-10276, E.D. Mich.; 2012 U.S. Dist. LEXIS 45088; See 2/2/11, Page 21). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%207%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank PHILADELPHIA - A Third Circuit U.S. Court of Appeals panel on April 3 affirmed a lower court's decision that an arbitrator correctly held that an agreement between a physician and health insurer did provide for class arbitration (John Ivan Sutter, M.D. v. Oxford Health Plans, No. 11-1773, 3rd. Cir.; 2012 U.S. App. LEXIS 6618; See 4/18/07, Page 4). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%208%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank WASHINGTON, D.C. - A District of Columbia federal judge on March 20 dismissed a reimbursement dispute involving Medicaid, saying the plaintiff hospitals, medical systems and health systems lacked standing (Urban Health Care Coalition, et al. v. Kathleen Sebelius, No. 06-2220, D. D.C.; 2012 U.S. Dist. LEXIS 43177). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%209%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank CINCINNATI - A federal judge in Ohio on April 11 granted a motion to certify a class of veterans and spouses of veterans seeking injunctive relief regarding how the Ohio Medicaid program calculates eligibility for the state's Home and Community Based Medicaid Waiver Program (Betty A. Ledford, et al., v. Michael B. Colbert, in his capacity as Director of the Ohio Department of Job and Family Services, No. 1:10cv706, S.D. Ohio, Western Div.; 2012 U.S. Dist. LEXIS 50613). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2010%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank COLUMBUS, Ohio - The 10th District Ohio Court of Appeals on April 5 affirmed an order terminating a Medicaid provider agreement with a home health aide, saying the trial court did not abuse its discretion in finding that the home health aide violated administrative rules meant to protect the welfare of totally dependent individuals in the state's home and community-based Medicaid waiver program (Karen Burden v. Ohio Department of Job and Family Services, No. 11AP-832, Ohio App. 10th Dist., Franklin Co.; 2012 Ohio App. LEXIS 1366). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2011%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank AKRON, Ohio - The Ninth District Ohio Court of Appeals on April 11 affirmed the denial of Medicaid nursing home benefits by the Summit County Department of Job and Family Services (DJFS) because the plaintiff had more than $1,500 in resources in her bank account and a revocable trust (Elma Gsellman v. Ohio Department of Job & Family Services, et al., No. 25954, Ohio App., 9th Dist., Summit Co.; 2012 Ohio App. LEXIS 1421). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2012%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank WASHINGTON, D.C. - The U.S. Court of Appeals for Veterans Claims on April 2 reversed and remanded an appeal of a Board of Veterans' Appeals decision denying increased benefits for bilateral hearing loss and arthritis of the cervical spine, finding that the appeals board did not provide an adequate statement as to why the board denied increased and new benefits to the plaintiff, an Army veteran (Alvin L. Saltsman v. Eric K. Shinseki, Secretary of Veterans Affairs, No. 10-3597, U.S. App. Vet. Clms.; 2012 U.S. App. Vet. Claims LEXIS 628). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2013%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank PHOENIX - An Arizona couple on April 3 sued their health insurers in an Arizona federal court, saying the defendants wrongfully denied coverage for the treatment of their child's autism (Michael and Christina LaSpina, on behalf of their minor child, A.L. v. Anthem Blue Cross Life and Health Insurance Co., et al., No. 12-707, D. Ariz.). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2014%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank ANCHORAGE, Alaska - An Alaska man on April 10 sued his health insurer, health plan and employer in federal court for wrongfully denying benefits for dental work, saying that his claim should have been processed under his medical policy and not his dental policy because the work done was related to complications from cancer treatment (Allen Reynolds v. Aetna Life Insurance Co., et al., No. 12-78, D. Alaska). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2015%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank PENSACOLA, Fla. - A Florida woman on April 2 sued her health insurer in federal court, seeking to have her insurance coverage reinstated after the company allegedly wrongfully canceled her policy (Shannon B. Vilardi v. Humana Health Insurance Company of Florida Inc., No. 12-155, N.D. Fla.). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=16-8%20Mealey%27s%20Man.%20Care%20Liab.%20Rep.%2016%20(2012)&view=full&ORIGINATION_CODE=00144 target=_blank President Obama signed the Patient Protection and Affordable Care Act (PPACA), as amended by the Health Care and Education Reconciliation Act, on March 23, 2010. One of the main requirements of the act is that most Americans without insurance obtain coverage or face a penalty. Other provisions will stop insurance companies from dropping or denying care to people with pre-existing conditions and expand the federal-state Medicaid insurance program for the poor to cover people with incomes up to 133 percent of the federal poverty level and to cover childless adults for the first time, starting in 2014.