LexisNexis® Legal Newsroom
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.).

Mealey's Banking & Finance - ACA Medical Loss Ratio Includes Insurer's Settlement Payments, Judge Says

LOS ANGELES - More than $34 million an insurer paid as a result of improperly categorizing out-of-network providers counts as incurred claims for purposes of the Patient Protection and Affordable Care Act (ACA)'s medical loss ratio (MLR), a federal judge in California held May 1 in denying remand and dismissing a California unfair competition law action (Rebecca Morris, et al. v. Blue Shield of California, et al., No. 16-5914, C.D. Calif., 2017 U.S. Dist. LEXIS 66043).

Mealey's Bankruptcy - Failed ACA Insurer Claims HHS Improperly Withholds Reinsurance Funds

COLUMBIA, S.C. - The government is improperly withholding payments from, and setting off debts owed by, a failed South Carolina Patient Protection and Affordable Care Act (ACA) co-operative insurer, illegally placing its own interests before those of policyholders and others entitled to priority, the insurer's liquidator allege in an April 12 federal complaint filed in South Carolina (Raymond G. Farmer, et al. v. The United States of America, et al., No. 17-956, D. S.C.).

Mealey's Insurance - Failed ACA Insurer Claims HHS Improperly Withholds Reinsurance Funds

COLUMBIA, S.C. - The government is improperly withholding payments from, and setting off debts owed by, a failed South Carolina Patient Protection and Affordable Care Act (ACA) co-operative insurer, illegally placing its own interests before those of policyholders and others entitled to priority, the insurer's liquidator allege in an April 12 federal complaint filed in South Carolina (Raymond G. Farmer, et al. v. The United States of America, et al., No. 17-956, D. S.C.).

Mealey's Health Law - Failed ACA Insurer Claims HHS Improperly Withholds Reinsurance Funds

COLUMBIA, S.C. - The government is improperly withholding payments from, and setting off debts owed by, a failed South Carolina Patient Protection and Affordable Care Act (ACA) co-operative insurer, illegally placing its own interests before those of policyholders and others entitled to priority, the insurer's liquidator allege in an April 12 federal complaint filed in South Carolina (Raymond G. Farmer, et al. v. The United States of America, et al., No. 17-956, D. S.C.).

Mealey's Insurance - Judge Finds Jurisdiction Lacking In Insolvent Insurer's Suit Over ACA Payments

ST. LOUIS - An insolvent insurer's suit 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, a federal judge in Iowa said March 17 in finding that she lacked jurisdiction and entering judgment (Nick Gerhart, et al. v. United States Department of Health and Human Services, et al., No. 16-151, S.D. Iowa, 2017 U.S. Dist. LEXIS 37620).

Mealey's Health Law - Judge Finds Jurisdiction Lacking In Insolvent Insurer's Suit Over ACA Payments

ST. LOUIS - An insolvent insurer's suit 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, a federal judge in Iowa said March 17 in finding that she lacked jurisdiction and entering judgment (Nick Gerhart, et al. v. United States Department of Health and Human Services, et al., No. 16-151, S.D. Iowa, 2017 U.S. Dist. LEXIS 37620).

Mealey's Insurance - ACA Reinsurance Program Applies To State Employers, 6th Circuit Affirms

CINCINNATI - The Patient Protection and Affordable Care Act (ACA)'s reinsurance program applies to state employers, the Sixth Circuit U.S. Court of Appeals affirmed Feb. 17 (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 Health Law - Judge Orders Liquidation Of ACA Health Care Provider

TRENTON, N.J. - A New Jersey judge on Feb. 3 ordered a Patient Protection and Affordable Care Act (ACA) consumer-operated and oriented plan insurer's liquidation and appointed the state's insurance commissioner as liquidator (In the Matter of Freelancers Consumer Operated and Oriented Program of New Jersey d/b/a Health Republic Insurance of New Jersey, No. MCR-C-000063-16, N.J. Super., Mercer Co., Chanc. Div.).

Mealey's Insurance - Judge Orders Liquidation Of ACA Health Care Provider

TRENTON, N.J. - A New Jersey judge on Feb. 3 ordered a Patient Protection and Affordable Care Act (ACA) consumer-operated and oriented plan insurer's liquidation and appointed the state's insurance commissioner as liquidator (In the Matter of Freelancers Consumer Operated and Oriented Program of New Jersey d/b/a Health Republic Insurance of New Jersey, No. MCR-C-000063-16, N.J. Super., Mercer Co., Chanc. Div.).

Mealey's Insurance - In Opening Salvo, Insurer Argues ACA Mandates Yearly Risk-Corridor Payments

WASHINGTON, D.C. - The government did not make an "informed, reasoned decision" in deciding to make the Patient Protection and Affordable Care Act (ACA) risk-corridor program budget-neutral, but instead simply reneged on its promises and ignored the statutory language mandating annual payments, an insurer told a federal appeals court Jan. 31 (Land of Lincoln Mutual Health Insurance Co. v. The United States of America, No. 17-1224, Fed. Cir.).

Mealey's Labor & Employment - Texas Federal Judge Dismisses Gender Identity Discrimination Claims

DALLAS - A Texas federal judge on Jan. 13 dismissed claims alleging gender identity discrimination under Section 1557 of the Patient Protection and Affordable Care Act (ACA) against an insurer and an employer because the plaintiff failed to cite any controlling precedent that recognizes a cause of action under Section 1557 for gender identity discrimination (Charlize Marie Baker v. Aetna Life Insurance Co., et al., No. 15-3679, N.D. Texas; 2017 U.S. Dist. LEXIS 5665).

Mealey's Health Law - Texas Federal Judge Dismisses Gender Identity Discrimination Claims

DALLAS - A Texas federal judge on Jan. 13 dismissed claims alleging gender identity discrimination under Section 1557 of the Patient Protection and Affordable Care Act (ACA) against an insurer and an employer because the plaintiff failed to cite any controlling precedent that recognizes a cause of action under Section 1557 for gender identity discrimination (Charlize Marie Baker v. Aetna Life Insurance Co., et al., No. 15-3679, N.D. Texas; 2017 U.S. Dist. LEXIS 5665).

Mealey's Insurance - Texas Federal Judge Dismisses Gender Identity Discrimination Claims

DALLAS - A Texas federal judge on Jan. 13 dismissed claims alleging gender identity discrimination under Section 1557 of the Patient Protection and Affordable Care Act (ACA) against an insurer and an employer because the plaintiff failed to cite any controlling precedent that recognizes a cause of action under Section 1557 for gender identity discrimination (Charlize Marie Baker v. Aetna Life Insurance Co., et al., No. 15-3679, N.D. Texas; 2017 U.S. Dist. LEXIS 5665).

Mealey's Litigation Procedure - California Women Files Class Action Over Denial Of Breastfeeding Support

OAKLAND, Calif. - A California woman on Jan. 13 filed a class action complaint in federal court alleging that she and other women have been wrongfully denied access to and coverage for a vital women's preventive service - breastfeeding support, supplies and counseling - for which coverage is mandated by the Patient Protection and Affordable Care Act (ACA) (Rachel Condry, et al. v. UnitedHealth Group Inc., et al., No. 4:17-cv-00183, N.D. Calif.).

Mealey's Health Law - California Women Files Class Action Over Denial Of Breastfeeding Support

OAKLAND, Calif. - A California woman on Jan. 13 filed a class action complaint in federal court alleging that she and other women have been wrongfully denied access to and coverage for a vital women's preventive service - breastfeeding support, supplies and counseling - for which coverage is mandated by the Patient Protection and Affordable Care Act (ACA) (Rachel Condry, et al. v. UnitedHealth Group Inc., et al., No. 4:17-cv-00183, N.D. Calif.).

Mealey's Labor & Employment - California Woman Files Class Action Over Denial Of Breastfeeding Support

OAKLAND, Calif. - A California woman on Jan. 13 filed a class action complaint in federal court alleging that she and other women have been wrongfully denied access to and coverage for a vital women's preventive service - breastfeeding support, supplies and counseling - for which coverage is mandated by the Patient Protection and Affordable Care Act (ACA) (Rachel Condry, et al. v. UnitedHealth Group Inc., et al., No. 4:17-cv-00183, N.D. Calif.).

Mealey's Health Law - 6th Circuit Panel: Insureds Lack Sufficient Injury To Claim Insurer Shirked ERISA Duties

CINCINNATI - A Sixth Circuit U.S. Court of Appeals panel on Dec. 21 affirmed an Ohio federal judge's ruling that hypothetical situations lack the necessary concrete injury required to pursue claims that an insurer shirked its obligations under the Employee Retirement Income Security Act and the Patient Protection and Affordable Care Act (ACA) (Daniel Soehnlen, et al. v. Fleet Owners Insurance Fund, et al., No. 16-3124, 6th Cir.; 2016 U.S. App. LEXIS 22914).

Mealey's Labor & Employment - 6th Circuit Panel: Insureds Lack Sufficient Injury To Claim Insurer Shirked ERISA Duties

CINCINNATI - A Sixth Circuit U.S. Court of Appeals panel on Dec. 21 affirmed an Ohio federal judge's ruling that hypothetical situations lack the necessary concrete injury required to pursue claims that an insurer shirked its obligations under the Employee Retirement Income Security Act and the Patient Protection and Affordable Care Act (ACA) (Daniel Soehnlen, et al. v. Fleet Owners Insurance Fund, et al., No. 16-3124, 6th Cir.; 2016 U.S. App. LEXIS 22914).

Mealey's Health Law - Rehabilitator Asks Court To Order ACA Insurer Into Liquidation

TRENTON, N.J. - New Jersey's banking and insurance commissioner on Dec. 15 asked a state court to order an insolvent Patient Protection and Affordable Care Act (ACA) consumer-operated and oriented plan insurer's liquidation (Richard J. Badolato, Commissioner of the Department of Banking and Insurance of New Jersey v. Freelancers Consumer Operated and Oriented Program of New Jersey d/b/a Health Republic Insurance of New Jersey, No. MCR-C-000063-16, N.J. Super., Mercer Co., Chancery Div.).

Mealey's Insurance - Rehabilitator Asks Court To Order ACA Insurer Into Liquidation

TRENTON, N.J. - New Jersey's banking and insurance commissioner on Dec. 15 asked a state court to order an insolvent Patient Protection and Affordable Care Act (ACA) consumer-operated and oriented plan insurer's liquidation (Richard J. Badolato, Commissioner of the Department of Banking and Insurance of New Jersey v. Freelancers Consumer Operated and Oriented Program of New Jersey d/b/a Health Republic Insurance of New Jersey, No. MCR-C-000063-16, N.J. Super., Mercer Co., Chancery Div.).

Mealey's Health Law - Class Claims Insurer Misrepresents Quality Of Replacement Plans

LOS ANGELES - Anthem Blue Cross promises Patient Protection and Affordable Care Act (ACA) exchange customers re-enrollment in a similar plans when cancellations occur, while in reality providing far inferior plans with no out-of-network coverage, according to a class action lawsuit filed Oct. 31 in California court, alleging violation of the state unfair competition law (UCL) (Paul Simon, et al. v. Blue Cross of California, d/b/a Anthem Blue Cross; and DOES 1-100, inclusive, No. BC639205, Calif. Super., Los Angeles Co.).