LexisNexis® Legal Newsroom
    Mealey's Health Law - Health Plan Properly Excluded Coverage Of Prosthetics, 9th Circuit Rules

    SAN FRANCISCO - A health insurer's categorical exclusion of myoelectric prosthetics from coverage under a health insurance plan governed by the Employee Retirement Income Security Act does not violate the California Health and Safety Code, the Ninth Circuit U.S. Court of Appeals affirmed May 8 (Martha Garcia v. PacifiCare of California, Inc., et al., No. 8:12-cv-02022, 9th Cir.; 2014 U.S. App. LEXIS 8659).

    Mealey's Health Law - Plaintiffs Argue ACA Was Revenue Bill, Improperly Originated In Senate

    HOUSTON - Supreme Court precedent and the "long history" of the origination clause of the U.S. Constitution render the Patient Protection and Affordable Care Act (ACA) and its individual mandate unconstitutional, plaintiffs told the Fifth Circuit U.S. Court of Appeals in a May 8 brief (Steven F. Hotze, M.D., et al. v. Kathleen Sebelius, et al., No. 14-20039, 5th Cir.).

    Mealey's Health Law - Federal Judge Denies Injunction In Suspension Of Medicaid Payment Suit

    WASHINGTON, D.C. - A District of Columbia judge on May 9 denied a motion by multiple licensed home health care providers for a preliminary injunction to halt the suspension of Medicaid payments for their services, saying that the plaintiffs were unlikely to succeed on the merits of their claim that they were terminated from the Medicaid program in violation of their due process rights and that they failed to exhaust administrative services (ABA Inc., et al. v. District of Columbia, No. 14-550, D. D.C.; 2014 U.S. Dist. LEXIS 64126).

    Mealey's Health Law - Judge Denies Temporary Restraining Order, Grants Plaintiff's Motion To Dismiss

    LOS ANGELES - A California federal judge on May 9 vacated an order to show cause issued May 8 after a plaintiff moved to voluntarily dismiss its case seeking a temporary restraining order to stop the U.S. Department of Health and Human Service (HHS) from terminating its privileges to provide ambulance services to Medicare patients (Royalty Ambulance Services Inc. v. Department of Health and Human Services, et al., No. 14-2936, C.D. Calif.; 2014 U.S. Dist. LEXIS 64000).

    Mealey's Health Law - Federal Appeals Court Hears Oral Arguments Over Contraceptive Mandate

    WASHINGTON, D.C. - A District of Columbia U.S. Circuit Court of Appeals panel on May 8 heard oral arguments over whether the Patient Protection and Affordable Care Act (ACA)'s contraceptive mandate substantially burdens Catholic groups' religious freedoms (Priests for Life, et al. v. U.S. Department of Health and Human Services, et al., No. 113-5368; Roman Catholic Archbishop of Washington, et al. v. Kathleen Sebelius, et al., No. 13-5371, D.C. Cir.).

    Mealey's Health Law - Catholic Groups, Government Debate Birth Control Mandate Before 6th Circuit

    GRAND RAPIDS, Mich. - The Sixth Circuit U.S. Court of Appeals on May 8 heard oral arguments from the federal government and Catholic organizations over whether the government provided proper notice of the Patient Protection and Affordable Care Act (ACA)'s contraceptive mandate and whether its application substantially burdens religious practices (Michigan Catholic Conference, et al. v. Kathleen Sebelius, et al., No. 13-2723, 6th Cir., The Catholic Diocese of Nashville, et al. v. Kathleen Sebelius, et al., No. 13-6640, 6th Cir.).

    Mealey's Health Law - Court Hears Arguments In Origination-Clause Challenge To Individual Mandate Tax

    WASHINGTON, D.C. - A District of Columbia Circuit U.S. Court of Appeals panel on May 8 heard arguments over whether the Patient Protection and Affordable Care Act (ACA)'s individual mandate tax constitutes a revenue measure and should properly have originated in the U.S. House of Representatives (Matt Sissel v. U.S. Department of Health and Human Services, et al., No. 13-5202, D.C. Cir.).

    Mealey's Health Law - Missouri Official: ACA Allows For State Licensing Of Exchange Navigators

    JEFFERSON CITY, Mo. - The Patient Protection and Affordable Care Act (ACA) specifically allows states to impose licensing and other regulatory requirements in areas typically falling under their jurisdiction, a Missouri official told the Eighth Circuit U.S. Court of Appeals on May 7 (St. Louis Effort for Aids, et al. v. John Huff, director of the Missouri Department of Insurance, Financial Institutions and Professional Registration, No. 14-1520, U.S. App., 8th Cir.).

    Mealey's Health Law - ACA Prevented 15,000 Hospital Deaths, Saved $4.1B, HHS Report Says

    WASHINGTON, D.C. - The Patient Protection and Affordable Care Act (ACA) prevented nearly 15,000 hospital deaths and 560,000 patient harms and saved $4.1 billion in costs in 2011 and 2012, according to a May 7 U.S. Department of Health and Human Services report.

    Mealey's Health Law - Health Plan Provides For Equitable Lien Over Settlement Funds, Judge Rules

    HOUSTON - A health benefits plan is entitled to an equitable lien over funds that a participant received in a third-party settlement pursuant to the plan's reimbursement/subrogation provision under the Employee Retirement Income Security Act, a federal judge in Texas ruled May 2 in granting the plan's motion for summary judgment (Humana Health Plan, Inc. v. Patrick Nguyen, et al., No. H-13-1793, S.D. Texas; 2014 U.S. Dist. LEXIS 61239).

    Mealey's Health Law - 2nd Circuit: Case Over Distribution Of Funds Properly Remanded To State Court

    NEW YORK - The Second Circuit U.S. Court of Appeals on May 6 affirmed that a lower court correctly remanded to state court a dispute over the failure to return surplus distributions to a not-for-profit corporation that provided comprehensive health services to individuals primarily made up of Medicaid patients, holding that the defendant failed to demonstrate that removal was proper (James J. Veneruso, as temporary receive for Community Choice Health Plan of Westchester Inc., v. Mount Vernon Neighborhood Health Center, No. 13-1572, 2nd Cir.; 2014 U.S. App. LEXIS 8449).

    Mealey's Health Law - 5th Circuit Affirms State Must Return Medicaid Funds To Federal Government

    NEW ORLEANS - In an unpublished opinion, the Fifth Circuit U.S. Court of Appeals on May 6 affirmed that the State of Louisiana must return to the federal government an excess of nearly $240 million it received in Medicaid funds for charity care (State of Louisiana Department of Health and Hospitals v. U.S. Department of Health and Human Services, et al., No. 13-30240, 5th Cir.; 2014 U.S. App. LEXIS 8520).

    Mealey's Health Law - 3rd Circuit Reverses Decision, Says Providers Do Not Need To Arbitrate Claims

    PHILADELPHIA - In reversing a lower court, a Third Circuit U.S. Court of Appeals panel on May 6 held that health care providers' direct and derivative claims fall outside the scope of an arbitration agreement with a health insurance provider and thus the claims at issue are not subject to arbitration (CardioNet Inc., et al. v. CIGNA Health Corp., No. 13-2496, 3rd Cir.; 2014 U.S. App. LEXIS 8468).

    Mealey's Health Law - Federal Judge Dismisses ERISA Claim Based On Denial Of Same-Sex Spousal Benefits

    NEW YORK - A health benefits plan that excludes benefits for same sex and domestic partners does not violate Employee Retirement Income Security Act Section 510's prohibition of interference with the attainment of benefits, a federal judge in New York ruled May 1 (Jane Roe, et al. v. Empire Blue Cross Blue Shield, et al., No. 12-cv-04788, S.D. N.Y.; 2014 U.S. Dist. LEXIS 61345).

    Mealey's Health Law - Massachusetts Explores 'Off-The-Shelf,' Federal Option After Abandoning Exchange

    BOSTON - Massachusetts will abandon its Patient Protection and Affordable Care Act (ACA) health insurance exchange and purchase an "off-the-shelf" exchange or default to the federal exchange, according to a May 5 press release.

    Mealey's Health Law - Minnesota Appeals Court Affirms Denial Of Long-Term Care Coverage

    ST. PAUL, Minn. - In an unpublished May 5 opinion, a Minnesota appeals court affirmed a decision denying payment under Medicaid for a plaintiff's long-term care, saying that federal and state law provided coverage only for emergency medical conditions for unqualified "aliens" (Sekou Bamba v. Minnesota Department of Human Services, et al., No. A13-1717, Minn. App.; 2014 Minn. App. Unpub. LEXIS 423).

    Mealey's Health Law - Alabama Federal Judge Grants Judgment In Benefits Suit; Wrong Party Sued

    MOBILE, Ala. - An Alabama federal judge on May 5 granted summary judgment in favor of the defendants in a breach of fiduciary duty and wrongful denial of health care benefits suit, finding that the plaintiff failed to sue the proper parties (Melisa Courtney v. ART Applied Reimbursement Techniques Inc., et al., No. 12-311, S.D. Ala.; 2014 U.S. Dist. LEXIS 61624).

    Mealey's Health Law - IRS Finalizes Regulations Governing Exchange Data Reporting

    WASHINGTON, D.C. - The Internal Revenue Service on May 2 issued final regulations governing information reporting related to enrollment in health insurance exchanges.

    Mealey's Health Law - Committee Report: 67 Percent Of ACA Enrollees Paid; Youth Constitute 25 Percent

    WASHINGTON, D.C. - Only 67 percent of those who enrolled in insurance through the Patient Protection and Affordable Care Act (ACA)'s federal exchange paid the first month premium, and 25 percent were between the ages of 18 and 34, according to a report released by the U.S. House of Representatives Energy and Commerce Committee.

    Mealey's Health Law - Notice Of Appeal Filed In Antitrust Case Challenging Rival's Discounting Program

    TRENTON, N.J. - A pharmaceutical manufacturer that alleged that its competitor violated federal and state antitrust laws by using market-share discounting practices and exclusionary contracts with hospitals filed a notice of appeal on April 23 to the Third Circuit U.S. Court of Appeal of the trial court's order granting summary judgment against it (Eisai Inc. v. Sanofi-Aventis U.S., LLC, et al., No. 08-4168, D. N.J.).

    Mealey's Health Law - Missouri Federal Judge Finds Drug Company Did Not Violate Telephone Laws

    ST. LOUIS - A Missouri federal judge on April 25 granted summary judgment in favor of a prescription benefit management company accused of violating the Telephone Consumer Protection Act (TCPA) and a do-not-call law, saying that the plaintiff had consented to the calls when she provided her phone number on the enrollment form for health care benefits (Suzy Elkins v. Medco Health Solutions Inc., No. 12-2141, E.D. Mo.; 2014 U.S. Dist. LEXIS 57633).

    Mealey's Health Law - Florida Federal Judge Allows Discovery Into Reviewer's Conflict Of Interest

    MIAMI - A Florida federal judge on April 25 held that an external appeal upholding a plaintiff's denial of medical benefits is conclusive to the issue of medical necessity but said she would allow the plaintiff to conduct discovery as to whether the external reviewer had any conflict of interest that may have biased the decision (Alexandra H. v. Oxford Health Insurance Inc., et al., No. 11-23948, S.D. Fla.; 2014 U.S. Dist. LEXIS 57863).

    Mealey's Health Law - Appeals Court: Autism Therapy Can Be Provided By Board-Certified Therapists

    LOS ANGELES - A divided California appeals court on April 23 reversed a trial court's decision in part and modified it to enjoin the California Department of Managed Health Care (DMHC) from upholding a plan's denial of applied behavioral analysis (ABA) therapy on the grounds that a Behavior Analyst Certification Board (BACB)-certified provider is not licensed. The court further held that even when a health plan is exempted from the ABA statute, the DMHC may not uphold a denial of coverage for ABA performed or supervised by therapists who are BACB certified on the basis the provider is not licensed (Consumer Watchdog, et al. v. Department of Managed Health Care, et al., No. B232338, Calif. App., 2nd Dist. Div. 3; 2014 Cal. App. LEXIS 352).

    Mealey's Health Law - Appeals Court Won't Rehear Challenge In ACA Individual Mandate Case

    WASHINGTON, D.C. - The District of Columbia U.S. Circuit Court of Appeals on April 28 denied a petition seeking rehearing in a case challenging the Patient Protection and Affordable Care Act (ACA) individual mandate (Association of American Physicians & Surgeons Inc., et al. v. Kathleen G. Sebelius, et al., No. 13-5003, D.C. Cir.).

    Mealey's Health Law - Texas Federal Judge Rules On Dismissal Motion In Reimbursement Dispute

    HOUSTON - A Texas federal judge on April 23 partially granted a health insurance company's motion to dismiss a reimbursement suit brought by a health care provider related to the payment of out-of-network services (Mid-Town Surgical Center v. Humana Health Plan of Texas Inc., No. 13-2620, S.D. Texas; 2014 U.S. Dist. LEXIS 56260).