LexisNexis® Legal Newsroom
Mealey's Health Law - ACA, UCL Claims Against Health Care Provider Survive In Transgender Case

SAN DIEGO - Allegations that an emergency health care provider touted its compassion toward those with gender dysphoria and then repeatedly referred to a transgender boy as female support his mother's Patient Protection and Affordable Care Act (ACA) and California unfair competition law claims, a federal judge in California held Sept. 27 (Katharine Prescott, et al. v. Rady Children's Hospital - San Diego, No. 16-2408, S.D. Calif., 2017 U.S. Dist. LEXIS 160259).

Mealey's Antitrust/Unfair Competition - ACA, UCL Claims Against Health Care Provider Survive In Transgender Case

SAN DIEGO - Allegations that an emergency health care provider touted its compassion toward those with gender dysphoria and then repeatedly referred to a transgender boy as female support his mother's Patient Protection and Affordable Care Act (ACA) and California unfair competition law claims, a federal judge in California held Sept. 27 (Katharine Prescott, et al. v. Rady Children's Hospital - San Diego, No. 16-2408, S.D. Calif., 2017 U.S. Dist. LEXIS 160259).

Mealey's Insurance - Insurer Files Answer, Wants Immediate Review Of ACA Lactation Coverage Ruling

SAN FRANCISCO - In a motion seeking interlocutory review, an insurer argues that whether the Patient Protection and Affordable Care Act (ACA) requires an insurer to provide access to lactation services or merely forbids financial barriers to obtaining such services is exactly the type of question the Ninth Circuit U.S. Court of Appeals should address and, in an answer to the complaint filed Sept. 19 in a California federal court, the insurer says the plaintiffs' fail to state a claim under either the Employee Retirement Income Security Act (ERISA) and the ACA on which relief can be based (Rachel Condry, et al. v. UnitedHealth Group Inc., et al., No. 17-183, N.D. Calif.).

Mealey's Health Law - Insurer Files Answer, Wants Immediate Review Of ACA Lactation Coverage Ruling

SAN FRANCISCO - In a motion seeking interlocutory review, an insurer argues that whether the Patient Protection and Affordable Care Act (ACA) requires an insurer to provide access to lactation services or merely forbids financial barriers to obtaining such services is exactly the type of question the Ninth Circuit U.S. Court of Appeals should address and, in an answer to the complaint filed Sept. 19 in a California federal court, the insurer says the plaintiffs' fail to state a claim under either the Employee Retirement Income Security Act (ERISA) and the ACA on which relief can be based (Rachel Condry, et al. v. UnitedHealth Group Inc., et al., No. 17-183, N.D. Calif.).

Mealey's Labor & Employment - Insurer Files Answer, Wants Immediate Review Of ACA Lactation Coverage Ruling

SAN FRANCISCO - In a motion seeking interlocutory review, an insurer argues that whether the Patient Protection and Affordable Care Act (ACA) requires an insurer to provide access to lactation services or merely forbids financial barriers to obtaining such services is exactly the type of question the Ninth Circuit U.S. Court of Appeals should address and, in an answer to the complaint filed Sept. 19 in a California federal court, the insurer says the plaintiffs' fail to state a claim under either the Employee Retirement Income Security Act (ERISA) and the ACA on which relief can be based (Rachel Condry, et al. v. UnitedHealth Group Inc., et al., No. 17-183, N.D. Calif.).

Mealey's Insurance - Court: ACA Lifetime Benefit Cap Provision Doesn't Cover ERISA Retiree Plan

PASADENA, Calif. - The Patient Protection and Affordable Care Act (ACA)'s ban on lifetime benefit maximums does not apply to retiree plans governed by the Employee Retirement Income Security Act, but the plan documents are sufficiently confusing to state a cause of action, a Ninth Circuit U.S. Court of Appeals held Sept. 8 (Gary King, et al. v. Blue Cross and Blue Shield of Illinois, et al., No. 15-55880, 9th Cir., 2017 U.S. App. LEXIS 17387).

Mealey's Litigation Procedure - Judge Allows Portions Of ACA Lactation Coverage Suit To Proceed

DES MOINES, Iowa - A pair of women may continue with their class action lawsuit claiming that their insurer violated the Patient Protection and Affordable Care Act (ACA) by charging for lactation consultation services, but nothing in the Employee Retirement Income Security Act requires insurers to list such providers separately, and the sex discrimination claims fail as well, a federal judge in Iowa held Sept. 6 (Jillian York, et al. v. Wellmark Inc., et al., No. 16-627, S.D. Iowa).

Mealey's Insurance - Judge Allows Portions Of ACA Lactation Coverage Suit To Proceed

DES MOINES, Iowa - A pair of women may continue with their class action lawsuit claiming that their insurer violated the Patient Protection and Affordable Care Act (ACA) by charging for lactation consultation services, but nothing in the Employee Retirement Income Security Act requires insurers to list such providers separately, and the sex discrimination claims fail as well, a federal judge in Iowa held Sept. 6 (Jillian York, et al. v. Wellmark Inc., et al., No. 16-627, S.D. Iowa).

Mealey's Labor & Employment - Court: ACA Lifetime Benefit Cap Provision Doesn't Cover ERISA Retiree Plan

PASADENA, Calif. - The Patient Protection and Affordable Care Act (ACA)'s ban on lifetime benefit maximums does not apply to retiree plans governed by the Employee Retirement Income Security Act, but the plan documents are sufficiently confusing to state a cause of action, a Ninth Circuit U.S. Court of Appeals held Sept. 8 (Gary King, et al. v. Blue Cross and Blue Shield of Illinois, et al., No. 15-55880, 9th Cir., 2017 U.S. App. LEXIS 17387).

Mealey's Insurance - Federal Court Stays Insolvent Insurer's ACA Risk-Corridor Suit

WASHINGTON, D.C. - Judgment on any ruling that the government improperly withheld funds from a bankrupt Patient Protection and Affordable Care Act (ACA) insurer would need to wait until resolution of pending appeals of risk-corridor rulings, a federal claims court judge held Sept. 5 in staying the case (Doug Ommen, et al. v. United States, No. 17-957, Fed. Clms., 2017 U.S. Claims LEXIS 1081).

Mealey's Litigation Procedure - Judge Declines Reconsideration Of ACA Out-Of-Network Lactation Coverage Ruling

WASHINGTON, D.C. - An insurer's alternative interpretation of the Patient Protection and Affordable Care Act (ACA)'s lactation services mandate did not require consideration of an affidavit stating that the company complied with the law, a federal judge in the District of Columbia held Aug. 14 in declining to reconsider a motion to dismiss (Lindsay Ferrer, et al. v. CareFirst Inc., et al., No. 16-2162, D. D.C., 2017 U.S. Dist. LEXIS 110304).

Mealey's Litigation Procedure - Judge Largely Allows ACA Lactation Insurance Coverage Suit To Proceed

SAN FRANCISCO - To the extent an insurer covers lactation services required by the Patient Protection and Affordable Care Act (ACA), allegations that it makes finding or using those providers impossible support a class action, a federal judge in California held Aug. 15 in largely denying a motion to dismiss (Rachel Condry, et al. v. UnitedHealth Group Inc., et al., No. 17-183, N.D. Calif., 2017 U.S. Dist. LEXIS 130089).

Mealey's Insurance - Health Plan's Claim Over Reinsurance Contributions Under ACA Fails, Judge Says

BALTIMORE - A self-funded, self-administered group health plan failed to allege a claim over which jurisdiction would exist under the Patient Protection and Affordable Care Act's (ACA) "internal revenue tax" or "any sum" provisions, a Maryland federal judge ruled July 21, dismissing the health plan's lawsuit alleging that it was improperly required to pay reinsurance contributions under the ACA (Electrical Welfare Trust Fund v. United States of America, et al., No. 16-2186, D. Md., 2017 U.S. Dist. LEXIS 113687).

Mealey's Health Law - Government Says Failed ACA Insurer Should File Case In Federal Claims Court

COLUMBIA, S.C. - A failed Patient Protection and Affordable Care Act (ACA) co-operative insurer's liquidator should file his lawsuit challenging a federal loan repayment demand in the U.S. Court of Federal Claims, the government says in a July 19 motion filed in South Carolina federal court (Raymond G. Farmer v. United States of America, et al., No. 17-cv-00956, D. S.C.).

Mealey's Insurance - Government Says Failed ACA Insurer Should File Case In Federal Claims Court

COLUMBIA, S.C. - A failed Patient Protection and Affordable Care Act (ACA) co-operative insurer's liquidator should file his lawsuit challenging a federal loan repayment demand in the U.S. Court of Federal Claims, the government says in a July 19 motion filed in South Carolina federal court (Raymond G. Farmer v. United States of America, et al., No. 17-cv-00956, D. S.C.).

Mealey's Health Law - Judge Finds Standing In ACA Out-Of-Network Lactation Coverage Suit

WASHINGTON, D.C. - A trio of women successfully allege standing in their class action claiming that an insurer improperly charged them for out-of-network lactation services in violation of the Patient Protection and Affordable Care Act (ACA), a federal judge in the District of Columbia held July 17 (Lindsay Ferrer, et al. v. CareFirst Inc., et al., No. 16-2162, D. D.C., 2017 U.S. Dist. LEXIS 110304.)

Mealey's Litigation Procedure - Judge Finds Standing In ACA Out-Of-Network Lactation Coverage Suit

WASHINGTON, D.C. - A trio of women successfully allege standing in their class action claiming that an insurer improperly charged them for out-of-network lactation services in violation of the Patient Protection and Affordable Care Act (ACA), a federal judge in the District of Columbia held July 17 (Lindsay Ferrer, et al. v. CareFirst Inc., et al., No. 16-2162, D. D.C., 2017 U.S. Dist. LEXIS 110304.)

Mealey's Health Law - Discovery Of Non-ACA Plan Information Denied In Insurer's Dialysis Fraud Suit

WEST PALM BEACH, Fla. - Finding that a health insurer's fraud claims related to kidney dialysis were pleaded only for its Patient Protection and Affordable Care Act (ACA) plans, a Florida federal magistrate judge on July 10 denied in part a motion to compel non-ACA plan information from the dialysis provider defendants (UnitedHealthcare of Florida Inc., et al. v. American Renal Associates Holdings Inc., et al., No. 9:16-cv-81180, S.D. Fla.).

Mealey's Insurance - Discovery Of Non-ACA Plan Information Denied In Insurer's Dialysis Fraud Suit

WEST PALM BEACH, Fla. - Finding that a health insurer's fraud claims related to kidney dialysis were pleaded only for its Patient Protection and Affordable Care Act (ACA) plans, a Florida federal magistrate judge on July 10 denied in part a motion to compel non-ACA plan information from the dialysis provider defendants (UnitedHealthcare of Florida Inc., et al. v. American Renal Associates Holdings Inc., et al., No. 9:16-cv-81180, S.D. Fla.).

Mealey's Litigation Procedure - Discovery Of Non-ACA Plan Information Denied In Insurer's Dialysis Fraud Suit

WEST PALM BEACH, Fla. - Finding that a health insurer's fraud claims related to kidney dialysis were pleaded only for its Patient Protection and Affordable Care Act (ACA) plans, a Florida federal magistrate judge on July 10 denied in part a motion to compel non-ACA plan information from the dialysis provider defendants (UnitedHealthcare of Florida Inc., et al. v. American Renal Associates Holdings Inc., et al., No. 9:16-cv-81180, S.D. Fla.).

Mealey's PI/Product Liability - Judge Excludes Speculative Future ACA Health Benefits From Bench Trial

NEW ORLEANS - The unpredictability of future health insurance coverage under the Patient Protection and Affordable Care Act (ACA) and the collateral source rule require excluding from trial evidence of how the potential coverage could reduce a man's ongoing medical expenses, a federal judge in Louisiana held July 7 (Kelvin Dunn v. Marquette Transportation Co. LLC, No. 16-13545, E.D. La., 2017 U.S. Dist. LEXIS 105066).

Mealey's Insurance - 8th Circuit Dismisses Appeal In Insolvent Insurer's ACA Suit Against Government

ST. LOUIS - The Eighth Circuit U.S. Court of Appeals on June 13 dismissed an appeal of a ruling that an insolvent insurer's case against the government over its handling of the Patient Protection and Affordable Care Act (ACA) risk corridor and how it offset debts properly belongs before the U.S. Court of Federal Claims (Doug Ommen, in his capacity as liquidator of CoOpportunity Health Inc.; Dan Watkins, in his capacity as special deputy liquidator of CoOpportunity Health Inc. v. U.S. Department of Health and Human Services, et al., No. 17-1662, 8th Cir.).

Mealey's Insurance - Insolvent Insurer Says U.S. Government Owes $157M In Affordable Care Act Funds

WASHINGTON, D.C. - Looking to recoup a solvency loan issued to an insolvent insurer under the Patient Protection and Affordable Care Act (ACA), the insurer's liquidators allege in their May 30 complaint in the U.S. Court of Federal Claims that the U.S. government improperly withheld $157 million in risk-sharing payments owed under the ACA (Doug Ommen, in his capacity as liquidator of CoOportunity Health Inc., and Dan Watkins, in his capacity as special deputy liquidator of CoOportunity Health Inc. v. The United States of America, No. 17-712, Fed. Clms.).

Mealey's Insurance - Panel Denies Rehearing, Holds ACA Reinsurance Program Applies To State Employers

CINCINNATI - Denying a petition for rehearing en banc, the Sixth Circuit U.S. Court of Appeals on May 26 allowed its prior decision that the Patient Protection and Affordable Care Act (ACA)'s reinsurance program applies to state employers to stand (The State of Ohio, et al. v. United States of America, et al., No. 16-3093, 6th Cir., 2017 U.S. App. LEXIS 2844).

Mealey's Insurance - Insurer: Government Misinterprets Law In ACA Risk-Corridor Spat

WASHINGTON, D.C. - The government attempts to muddle how its obligations form in attempting to dispel a case alleging underpayment under the Patient Protection and Affordable Care Act (ACA) risk-corridor program, an insurer told a federal judge May 15 (Health Republic Insurance Co. v. The United States of America, No. 16-259, Fed. Clms.).