NEWARK, N.J. - A New Jersey federal judge on June 11 declined to dismiss two counterclaims filed in a fraudulent billing dispute but dismissed a counterclaim for common-law fraud, saying that the claim failed to meet pleading requirements (Connecticut General Life Insurance Co. v. Roseland Ambulatory, No. 12-5941, D. N.J.; 2014 U.S. Dist. LEXIS 79189).
SAN FRANCISCO - Two doctors and the U.S. government on June 10 argued before a Ninth Circuit U.S. Court of Appeals panel on the constitutionality of a Medicare-price setting commission established under the Patient Protection and Affordable Care Act (ACA) and whether the as-yet unstaffed group injured plaintiffs (Nick Coons, et al. v. Jacob Lew, et al., No. 13-15324, 9th Cir.).
WASHINGTON, D.C. - The Internal Revenue Service's current plan for educating employers regarding Patient Protection and Affordable Care Act (ACA) reporting compliance is "deficient," and the organization needs to employ a "full court press" of communication and outreach to ensure proper compliance, according to a June 11 advisory committee report.
GRAND RAPIDS, Mich. - A Sixth Circuit U.S. Court of Appeals panel on June 11 declined to enjoin implementation of the Patient Protection and Affordable Care Act (ACA) contraceptive mandate (Michigan Catholic Conference, et al. v. Kathleen Sebelius, et al., No. 13-2723, The Catholic Diocese of Nashville, et al. v. Kathleen Sebelius, et al., No. 13-6640, 6th Cir.).
SANTE FE, N.M. - A New Mexico appeals court on June 9 affirmed the dismissal of a state's case accusing a home health care provider of Medicaid violations, saying a failure to comply with criminal screening requirements for caregivers does not support liability under state Medicaid laws (State of New Mexico ex rel. Gary K. King, Attorney General v. Behavioral Home Care Inc., No. 31,682, N.M. App.; 2014 N.M. App. LEXIS 60).
FRESNO, Calif. - A California appeals court on June 10 held that a trial court incorrectly interpreted a statute governing the reimbursement of noncontract providers for the payment of Medicare services, which resulted in evidence of the reasonable and customary value of services provided being limited to a hospital's full billed charges (Children's Hospital Central California v. Blue Cross of California, et al., No. F065603, Calif. App., 5th Dist.; 2014 Cal. App. LEXIS 503).
NEW ORLEANS - A Louisiana federal judge on June 9 denied a motion to reconsider his determination that plaintiffs could continue their Employee Retirement Income Security Act claims in a health care reimbursement suit, saying that the defendant failed to raise any new issues (Center for Restorative Breast Surgery, et al. v. Humana Health Benefit Plan of Louisiana, et al., No. 10-4346, E.D. La.).
WASHINGTON, D.C. - The Patient Protection and Affordable Care Act (ACA) burdens home health care workers providing services for Medicare recipients with "complex, unnecessary, and unauthorized physician documentation requirements," an advocacy group argues in a June 5 complaint (National Association for Home Care & Hospice Inc. v. Kathleen Sebelius, et al., and Marilyn B. Tavenner, et al., No. 14-950, D. D.C.).
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).