NASHVILLE, Tenn. - In reversing a trial court's decision, a Tennessee appeals court on June 6 held that the Uniform Administrative Procedures Act (UAPA) did not divest the court of jurisdiction to hear a Medicaid reimbursement dispute because the plaintiff was not challenging the applicability or validity of the regulations (The Chattanooga Hamilton County Hospital Authority d/b/a Erlanger Health System v. United Healthcare Plan of the River Valley Inc., et al., No. M2013-00942-COA-R9-CV, Tenn. App.; 2014 Tenn. App. LEXIS 332).
JONESBORO, Ark. - Two physicians and an ambulatory surgery center on June 5 sued a joint venture physician hospital organization and a health insurer in an Arkansas federal court, alleging antitrust violations (Tri State Advanced Surgery Center, et al. v. Health Choice, et al., No. 14-143, E.D. Ark.).
SOUTH BEND, Ind. - The Patient Protection and Affordable Care Act (ACA)'s contraceptive mandate is a regulatory scheme imposing belief-violating requirements that the court cannot permissibly judge, religious groups told the Seventh Circuit U.S. Court of Appeals on June 5 (Grace Schools and Biola University Inc. and Diocese of Fort Wayne-South Bend Inc., et al. v. Kathleen Sebelius, et al., Nos. 14-1430, 14-1431, 7th Cir.).
TRENTON, N.J. - In a per curiam opinion, a New Jersey appeals court on June 5 affirmed the dismissal of a reimbursement suit brought by dentists and a dental association against two health insurers for allegedly wrongfully recouping overpayments made, saying statutory provisions allowed the insurers to withhold payment on subsequent claims for the overpayments (New Jersey Dental Association, et al. v. Horizon Blue Cross Blue Shield of New Jersey, et al., No. A-1834-12T3, N.J. Super., App. Div.; 2014 N.J. Super. Unpub. LEXIS 1291).
WASHINGTON, D.C. - The U.S. Senate on June 5 confirmed Sylvia Mathews Burwell as the new secretary of Health and Human Services in a 78-17 vote, according to the White House.
WASHINGTON, D.C. - The Congressional Budget Office (CBO) said June 5 that it now expects 2 million fewer people to pay the Patient Protection and Affordable Care Act (ACA)'s penalty for being uninsured in 2016, cutting $3 billion in revenue for the year.
HARRISBURG, Pa. - A deeply divided Pennsylvania House of Representative committee on June 4 staved off attempts to derail legislation expanding Medicaid eligibility under the Patient Protection and Affordable Care Act (ACA).
WASHINGTON, D.C. - The Patient Protection and Affordable Care Act (ACA)'s expansion of Medicaid and the Children's Health Insurance Program (CHIP) resulted in insurance coverage for 6 million more individuals through April, according to a government official.
OKLAHOMA CITY - Standing exists for two groups challenging the Patient Protection and Affordable Care Act (ACA) contraceptive mandate, and the law imposes a substantial burden on those plaintiffs, an Oklahoma federal judge held June 4 in partially granting a preliminary injunction (The Catholic Benefits Association LCA, et al. v. Kathleen Sebelius, et al., No. 14-240, W.D. Okla.).
ATLANTA - A finding that the Patient Protection and Affordable Care Act (ACA) contraceptive mandate infringes on Religious Freedom Restoration Act (RFRA) rights does not rest on the plans being statutory "church plans," a Georgia federal judge held May 30 (The Roman Catholic Archdiocese of Atlanta, et al. v. Kathleen Sebelius, in her official capacity as Secretary, United States Department of Health and Human Services, et al., No. 12-3489, N.D. Ga.).
NEW ORLEANS - A Fifth Circuit U.S. Court of Appeals panel on June 4 affirmed the dismissal of a False Claims Act (FCA) case accusing a Texas Planned Parenthood organization of submitting fraudulent claims to Medicaid for lack of subject matter (United States of America; the State of Texas, ex rel, Abby Kristen Johnson v. Planned Parenthood of Houston and Southeast Texas Inc., No. 13-20206, 5th Cir.).
SANTA ANA, Calif. - A father sued his medical plan and health insurance company in a California federal court on June 2 for allegedly wrongfully denying coverage for inpatient care for the treatment of his daughter's anorexia nervosa and obsessive compulsive disorder (John Ellis v. Kofax Inc. Flexible Benefits Plan, et al., No. 14-839, C.D. Calif.).
SAN FRANCISCO - A Ninth Circuit U.S. Court of Appeals panel on June 3 reversed a lower court's decision denying Planned Parenthood of Arizona's motion for a preliminary injunction and remanded with instructions for the district court to issue the injunction in a case seeking to enjoin enforcement of an Arizona law prohibiting the use of certain drugs to induce abortions (Planned Parenthood of Arizona Inc., et al. v. William Humble, director of the Arizona Department of Health Services, No. 14-15624, 9th Cir.).
LITTLE ROCK, Ark. - In what it called a matter of first impression, a divided Arkansas Supreme Court on May 29 held that a spouse's individual retirement account (IRA) and 401(k) may be countable resources under the Medicare Catastrophic Coverage Act (MCCA) for purposes of determining eligibility for long-term Medicaid benefits (Arkansas Department of Human Services v. Gordon Pierce, No. 13-870, Ark. Sup.; 2014 Ark. LEXIS 334).
BOSTON - The Supreme Judicial Court of Massachusetts on June 2 held that the board of selectmen, and not the town meeting, has the authority to establish the percentage of the total monthly premium for insurance coverage by a health maintenance organization that is to be paid by a town's retired employees (Gail E. Twomey, et al. v. Town of Middleborough, et al., No. SJC-11435, Mass. Sup.; 2014 Mass. LEXIS 395).
GREENBELT, Md. - A mother sued her health insurer in Maryland federal court on May 30 for allegedly wrongfully denying benefits for her son's inpatient care at a neurobehavioral unit (Jane Doe, individually and as guardian of John Doe, a minor, v. Aetna Health Inc., et al., No. 14-1745, D. Md.).
SAN FRANCISCO - A California federal judge on May 30 denied the plaintiffs' motion to voluntarily dismiss their case challenging the California Department of Health Care Services (DHCS) decision implementing Medicaid reimbursement rate reductions, saying that the motion was an attempt to avoid litigating the federal issue in federal court after an agency's final decision (Santa Rosa Memorial Hospital, et al. v. David Maxwell-Jolly, director of the California Department Of Health Care Services, No. 08-5173, N.D. Calif.; 2014 U.S. Dist. LEXIS 74213).
NEWARK, N.J. - In an unpublished opinion, a New Jersey federal judge on May 30 allowed a doctor to pursue the submission of false claims made by his medical practice to a diagnostic testing laboratory but dismissed claims involving allegations of false claims involving other providers to the laboratory (United States of America, ex rel. James J. Judd, M.D. v. Quest Diagnostics Inc., No. 10-4914, D. N.J.; 2014 U.S. Dist. LEXIS 73760).
BROOKLYN, N.Y. - Religious groups opting out of the Patient Protection and Affordable Care Act (ACA) contraceptive mandate are not giving third-party administrators of their church plans a "permission slip" to provide such coverage, the government told the Second Circuit U.S. Court of Appeals on May 27 (The Roman Catholic Archdiocese of New York, et al. v. Kathleen Sebelius, No. 14-427, 2nd Cir.).
ATLANTA - A Georgia federal judge on May 23 granted the defendants' summary judgment in a qui tam action, finding that the relator presented no evidence that the defendants were knowingly submitting claims for off-label prescription drugs for reimbursement under Medicare Part D (United States of America ex rel. Fox Rx Inc. v. Omnicare Inc., No. 11-962, N.D. Ga.; 2014 U.S. Dist. LEXIS 70902).
MADISON, Wis. - A Wisconsin federal judge on May 23 denied the plaintiffs' summary judgment motion in their challenge to a Wisconsin statute requiring that every physician who provides abortions in the state to have admitting privileges at a hospital within 30 miles of the health center where the abortion is performed, saying a genuine issue of material fact exists as to whether admitting privileges are being denied arbitrarily or for improper reasons by hospitals without an adequate opportunity for review by a governmental entity (Planned Parenthood of Wisconsin Inc., et al. v. J.B. Van Hollen, et al., No. 13-465, W.D. Wis.; 2014 U.S. Dist. LEXIS 71377).
AUSTIN, Texas - A professional organization of oncologists on May 23 sued a health insurance company in Texas federal court for allegedly wrongfully reduce the rates it paid to the plaintiff for services covered under the defendants' health plans as a result of the federal government's decreasing payments it made to Medicare Advantage Organizations (MAOs) and other managed care organizations (Texas Oncology v. Humana Insurance Co., et al., No. 14-476, W.D. Texas).
HANNIBAL, Mo. - Separate regulations govern a third party's decision to provide contraceptive coverage after religious groups opt out of providing such coverage under the Patient Protection and Affordable Care Act (ACA), and the opt out is neither a facilitation of such coverage nor a substantial burden on their religious practices, the government argues in a May 22 brief in the Eighth Circuit U.S. Court of Appeals (Sharpe Holdings Inc., et al. v. Kathleen Sebelius, et al., No. 13-1507, 8th Cir.).
WASHINGTON, D.C. - A District of Columbia federal judge on May 23 granted a pharmaceutical manufacturer's motions for an injunction and summary judgment in a case challenging a final rule of the U.S. Department of Health and Human Service (HHS) related to when an orphan drug may be offered at a discounted price, saying that HHS lacked the authority to engage in the rulemaking process in this instance (Pharmaceutical Research and Manufacturers of America v. U.S. Department of Health and Human Service, No. 13-1501, D. D.C.; 2014 U.S. Dist. LEXIS 70894).
WASHINGTON, D.C. - A man pursuing an origination-clause challenge to the Patient Protection and Affordable Care Act (ACA) must file a brief showing that the individual mandate applies to him and, therefore, that he has standing, a District of Columbia Circuit U.S. Court of Appeals panel ordered May 22 (Matt Sissel v. U.S. Department of Health and Human Services, et al., No. 13-5202, D.C. Cir.).