DETROIT - Burwell v. Hobby Lobby Stores, Inc. (134 S. Ct. 2751 ) dispensed with the idea that for-profit companies cannot follow religious tenets and requires reversal of a ruling denying injunction relief in a Patient Protection and Affordable Care Act (ACA) contraceptive mandate challenge, a company told the Sixth Circuit U.S. Court of Appeals on Aug. 14 (Mersino Management Co., et al. v. Sylvia Burwell, et al., No. 13-1944, 6th Cir.).
CHICAGO - In reversing a lower court decision, a panel of the Seventh Circuit U.S. Court of Appeals on Aug. 18 held that the secretary of Health and Human Services' determination that residents' pure research activities should not be compensable as part of the "indirect medical education" (IME) costs in calculating reimbursement rates for Medicare was entitled to deference (Rush University Medical Center v. Sylvia Mathews Burwell, secretary of Health and Human Service, No. 13-3285, 7th Cir.).
TAMPA, Fla. - A Florida federal judge on Aug. 14 declined to remand a health care reimbursement suit to state court, finding that federal question jurisdiction existed pursuant to the Employee Retirement Income Security Act, but also declined to dismiss the claims, saying it was unclear to what extent the claims involved ERISA plans (United Surgical Assistants LLC v. Aetna Life Insurance Co., No. 14-211, M. D. Fla.; 2014 U.S. Dist. LEXIS 112816).
NEW ORLEANS - Even with the availability of an opt out, the Patient Protection and Affordable Care Act (ACA)'s contraceptive mandate's requirement that a nonprofit religious employer provide insurance coverage for four contraceptives it finds objectionable violates religious beliefs and imposes a substantial burden, a Louisiana federal judge held Aug. 13 (Louisiana College v. Kathleen Sebelius, et al., No. 12-0463, W.D. La.; 2014 U.S. Dist. LEXIS 113083).
SHREVEPORT, La. - A Louisiana appeals court on Aug. 13 decertified a class action lawsuit challenging a hospital's practice of billing insured patients involved in motor vehicle accidents when a third party is liable for the accident, saying that more courts must have experience with the Health Care Consumer Billing and Disclosure Protection and Act before a class could be certified (Prentiss Baker, et al. v. PHC-Minden L.P. d/b/a Minden Medical Center, No. 49,122-CA, La. App., 2nd Cir.; 2014 La. App. LEXIS 1955).
INDIANAPOLIS - A state and 39 school districts challenging the legality of payments imposed on large employers under the Internal Revenue Services' implementation and interpretation of Patient Protection and Affordable Care Act (ACA) regulations allege an addressable injury in fact, an Indiana federal judge held Aug. 12 (State of Indiana v. Internal Revenue Service, et al., 13-1612, S.D. Ind.).
WASHINGTON, D.C. - More than half of large employers will offer employees a consumer directed health plan (CDHP) in 2015, and those plans will be the sole option at almost a third of large employers, according to an Aug. 13 National Business Group on Health (NBGH) survey.
NEW ORLEANS - A panel of the Fifth Circuit U.S. Court of Appeals on Aug. 11 affirmed a decision denying a motion to dismiss a False Claims Act (FCA) case, saying the defendants did not have qualified immunity (United States of America, ex rel. M.D. Dakshesh Kumar Parikh, et al. v. David Brown, et al., No. 13-41088, 5th Cir.; 2014 U.S. App. LEXIS 15465).
BURLINGTON, Vt. - A Vermont federal judge on Aug. 8 dismissed without prejudice a qui tam action asserting that a mental health and substance abuse facility engaged in fraudulent and improper claims and refund practices and policies, saying that many of the claims were time-barred and that the plaintiff failed to plead other claims with required specificity (United States of America, ex rel. Thomas Joseph v. The Brattleboro Retreat, No. 13-55, D. Vt.; 2014 U.S. Dist. LEXIS 110154).
DENVER - A health plan participant's state law contract and tort claims against a health care provider were properly removed to federal court because a single claim for tortious interference with contract, which was related to the discount for services provided by the participant's health plan, was completely preempted by the Employee Retirement Income Security Act, the 10th Circuit U.S. Court of Appeals affirmed Aug. 6 (Richard Salzer v. SSM Health Care of Oklahoma Inc., No. 13-6099, 10th Cir.; 2014 U.S. App. LEXIS 15122).
CHICAGO - A federal district court did not abuse its discretion in awarding retirees more than $400,000 in attorney fees under the Employee Retirement Income Security Act following the retirees' settlement of their claims that their employer's successor unlawfully eliminated their health care benefits, the Seventh Circuit U.S. Court of Appeals affirmed Aug. 6 (Shirley Temme, et al. v. Bemis Company, Incorporated, No. 14-1085, 7th Cir.; 2014 U.S. App. LEXIS 15174).
PORTLAND, Ore - An Oregon federal judge on Aug. 8 granted partial summary judgment in favor of the plaintiffs in a case alleging that a health insurance company violated federal and state law by denying coverage for applied behavioral analysis (ABA) therapy for the treatment of autism-related spectrum disorder to children who have been diagnosed as autistic, saying that the exclusion is prohibited by the Employee Retirement Income Security Act (A.F., by and through his parents and guardians, Brenna Legaard and Scott Fournier, et al. v. Providence Health Plan, No. 13-776, D. Ore.; 2014 U.S. Dist. LEXIS 109507).
OKLAHOMA CITY - An Oklahoma federal judge on Aug. 6 dismissed a woman's challenge to the Patient Protection and Affordable Care Act (ACA), saying the woman lacked standing to challenge the suit, failed to establish that the court had jurisdiction to hear the case and failed to state a plausible claim for relief (Kimberly Willis v. U.S. Department of Health and Human Services, et al., No. 14-261, W.D. Okla.; 2014 U.S. Dist. LEXIS 108072).
SAN FRANCISCO - A panel of the Ninth Circuit U.S. Court of Appeals on Aug. 7 affirmed dismissal of two plaintiffs' claims challenging the Patient Protection and Affordable Care Act (ACA)'s individual mandate on privacy grounds, challenging a new Medicare payment advisory board as unconstitutional and challenging preemption of Arizona's Health Care Freedom Act as preempted by the ACA (Nick Coons, et al. v. Jacob L. Lew, et al., No. 13-15324, 9th Cir.).
DENVER - The son of a nursing home patient who allegedly died due to the negligence of the facility's personnel has presented a compelling need for discovery of an employee disciplinary document, a Colorado federal magistrate judge found Aug. 1, granting the plaintiff's motion to compel (Donald Bennett v. SSC Palisade Operating Co. LLC, No. 1:14-cv-00923, D. Colo.; 2014 U.S. Dist. LEXIS 105349).
CINCINNATI - The Sixth Circuit U.S. Court of Appeals on Aug. 4 affirmed that the Employee Retirement Income Security Act does not preempt a Michigan state law established to generate revenue necessary to fund the state's obligations under Medicaid (Self-Insurance Institute of America v. Rick Snyder, et al., No. 12-2264, 6th Cir.; 2014 U.S. App. LEXIS 14905).
KANSAS CITY, Kan. - A Kansas federal judge on Aug. 5 held that a state law prohibiting subrogation clauses in health insurance contracts is preempted by the Federal Employees Health Benefit Act (FEHBA) (Lee Ann Helfrich v. Blue Cross Blue Shield Association, et al., No. 13-2620, D. Kan.; 2014 U.S. Dist. LEXIS 107126).
NASHVILLE, Tenn. - Community Health Systems Inc. has agreed to pay $98 million to settle seven cases accusing the hospital chain of submitting false claims to Medicare and Medicaid, according to an Aug. 4 announcement by the U.S. Department of Justice.
KANSAS CITY, Kan. - A Kansas federal judge on July 31 granted a health insurer's motion for summary judgment in a wrongful denial of benefits case, saying the plan excluded coverage for treatments considered experimental or investigative and studies confirmed a lack of support for the treatment involved to treat abdominal cancers (Doug Burton, in his capacity as executor of the Estate of Marsha Burton v. Blue Cross and Blue Shield of Kansas, No. 13-2099, D. Kan.; 2014 U.S. Dist. LEXIS 104328).
GRAND RAPIDS, Mich. - A Michigan federal judge on July 30 dismissed a plaintiff's false Medicaid billing claims, but allowed a wrongful termination claim to continue (Susan K. Hendricks v. Bronson Methodist Hospital Inc., et al., No. 13-294, W.D. Mich.; 2014 U.S. Dist. LEXIS 103538).
DALLAS - A Texas federal judge on July 30 granted a health care provider's motion to remand a reimbursement suit to state court, saying the Employee Retirement Income Security Act did not preempt the plaintiff's claims (Methodist Hospitals of Dallas v. Aetna Health, No. 13-4992, N.D. Texas; 2014 U.S. Dist. LEXIS 104291).
SACRAMENTO, Calif. - A California appeals court on July 29 held that a health care provider must actually contract for the right to preserve its right to recover its customary billing rates through a Hospital Lien Act (HLA) lien or it forfeits the right to recover the customary billing rate for emergency room services from third-party tortfeasors (Dameron Hospital Association v. AAA Northern California, et al., No. C070475, Calif. App., 3rd. Dist.; 2014 Cal. App. LEXIS 684).
PHILADELPHIA - A panel of the Third Circuit U.S. Court of Appeals on July 29 held that the Medicare as a Secondary Payer Act (MSP Act) authorizes the government to seek reimbursement from a settlement a plaintiff receives from a tortfeasor because the funds came from a "primary plan" and that the plaintiff cannot invoke a New Jersey state law to avoid her reimbursement obligations (Cecelia A. Taransky v. Secretary of the U.S. Department of Health and Human Services, et al., No. 13-3483, 3rd Cir.; 2014 U.S. App. LEXIS 14408).
WASHINGTON, D.C. - A plaintiff challenging the individual mandate of the Patient Protection and Affordable Care Act (ACA) cannot do so by arguing that the requirement is a revenue measure that should have originated in the U.S. House of Representatives, a unanimous federal appeals court ruled July 29 (Matt Sissel v. United States Department of Health and Human Services, et al., No. 13-5202, D.C. Cir.).
GREENBELT, Md. - A health insurance company on July 25 sued multiple ambulatory service centers in a Maryland federal court for allegedly conspiring to submit fraudulent bills for services provided to patients covered by the plaintiff (Connecticut General Life Insurance Co., et al. v. Advanced Surgery Center of Bethesda, et al., No. 14-2376, D. Md.).