ATLANTA - The provider of medical devices to health plan participants lacks standing to bring a reimbursement action against the plan insurer under the Employee Retirement Income Security Act because the provider did not demonstrate that it possessed valid written assignments of benefits from the participants or beneficiaries, the 11th Circuit U.S. Court of Appeals affirmed April 1 in an unpublished opinion (Medicomp, Inc. v. United Healthcare Insurance Co., et al., No. 13-13849, 11th Cir.; 2014 U.S. App. LEXIS 6041).
MUSKOGEE, Okla. - An Oklahoma federal magistrate judge on March 31 dismissed a defendant from a denial of benefits suit after finding that the health insurer did not have sufficient contacts with the state for the court to have jurisdiction over the defendant (Samuel Howard Logan Jr. v. Healthcare International Global Networks, et al., No. 13-1444, E.D. Okla.; 2014 U.S. Dist. LEXIS 44710).
NEWARK, N.J. - Although it was enacted in 2010, sections of the Patient Protection and Affordable Care Act (ACA) barring discrimination based on the licensing or certification of physicians became effective only after conduct alleged in two doctors' lawsuit, a New Jersey federal judge held March 31 (Neelendu Bose d/b/a High Crest, et al. v. Horizon Blue Cross Blue Shield of New Jersey, et al., No. 12-4671, D. N.J.; 2014 U.S. Dist. LEXIS 43244).
SEATTLE - In an unpublished opinion, a Washington appeals court on March 31 affirmed the denial of benefits for a patient seeking inpatient rehabilitation services, saying the health plan at issue clearly limited the amount it would pay for such services (Bruce Pleasant, et al. v. Regence Blue Shield, No. 69143-1-1, Wash. App., Div. 1; 2014 Wash. App. LEXIS 743).
WASHINGTON, D.C. - The secretary of the U.S. Department of Health and Human Service (HHS) did not provide adequate notice and opportunity to comment before promulgating a rule that changed how disproportionate-share hospitals (DSH) received payment through Medicare, a panel of the District of Columbia Circuit U.S. Court of Appeals affirmed April 1. However, the lower court erred in directing the secretary on how to recalculate the hospitals' reimbursements using an alternative methodology and should just have remanded after identifying the error, the court added (Allina Services, et al. v. Kathleen Sebelius, Secretary of the U.S. Department of Health and Human Services, Nos. 13-5011, 13-5015, D.C. Cir.; 2014 U.S. App. LEXIS 5976).
CAMDEN, N.J. - A New Jersey federal judge on March 31 partially granted a plaintiff's motion to remand to state court a proposed class action case over liens asserted by a health insurer against proceeds from personal injury cases but said additional discovery was needed to determine whether an exception to the Class Action Fairness Act (CAFA) also supported remand (Michelle Roche v. Aetna Health Inc., et al., No. 13-3933, D. N.J.; 2014 U.S. Dist. LEXIS 43239).
CHICAGO - An Illinois federal judge on March 28 held that a chiropractic association was entitled to injunctive relief in its suit against a Blue Cross Blue Shield entity for failing to provide adequate notice and appeal notices prior to recouping money from previously paid claims (Pennsylvania Chiropractic Association, et al. v. Blue Cross Blue Shield Association, et al., No. 09-5619, N.D. Ill; 2014 U.S. Dist. LEXIS 41749).
BOSTON - A Massachusetts federal judge on March 26 denied the plaintiffs' motion for summary judgment in a health care reimbursement suit and partially granted the defendant's motion, leaving only one count involving 11 disputed claims to continue (Spinal Imaging Inc. v. Aetna Health Management, et al.; Radiology Diagnostics v. Aetna Health Management, et al., Nos. 09-11873, 12-11521, D. Mass.; 2014 U.S. Dist. LEXIS 40099).
PHILADELPHIA - A Pennsylvania federal judge on March 27 dismissed a suit challenging the coverage and reimbursement of chiropractor claims, saying that one plaintiff failed to exhaust administrative remedies and that two other plaintiffs lacked standing (American Chiropractic Association, et al. v. American Specialty Health Inc., et al., No. 12-7243, E.D. Pa.; 2014 U.S. Dist. LEXIS 41769).
NEW ORLEANS - A Louisiana federal judge on Marcy 27 partially dismissed a health care reimbursement dispute brought by the provider of post-mastectomy breast reconstruction medical services against an insurance company, leaving claims brought under the Employee Retirement Income Security Act and state law claims for detrimental reliance, fraud, negligent misrepresentation and breach of contract (Center for Restorative Breast Surgery, et al. v. Humana Health Benefit Plan of Louisiana, et al., No. 10-4346, E. D. La.; 2014 U.S. Dist. LEXIS 41134).
WASHINGTON, D.C. - The U.S. Supreme Court on March 31 denied petitions for certiorari from two nonprofit religious groups claiming that the contraceptive mandate contained in the Patient Protection and Affordable Care Act (ACA) violates the Religious Freedom Restoration Act (RFRA) (Priests for Life, et al. v. Kathleen Sebelius, et al., No. 13-891, U.S. Sup., Roman Catholic Archbishop of Washington, et al. v. Kathleen Sebelius, et al., No. 13-829, U.S. Sup.)
CHICAGO - An Illinois federal judge on March 26 dismissed a Medicare payment dispute, saying that the plaintiffs failed to exhaust the administrative review process before filing suit and that, therefore, the court lacked jurisdiction (Center for Dermatology and Skin Cancer, et al. v. Kathleen Sebelius, et al., No. 13 C 4926, N.D. Ill.; 2014 U.S. Dist. LEXIS 39907).
ATLANTA - The Patient Protection and Affordable Care Act (ACA)'s contraceptive mandate violates the Religious Freedom Restoration Act as it applies to two Georgia dioceses and related entities, a federal judge held March 26 in permanently enjoining its enforcement (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.; 2014 U.S. Dist. LEXIS 39617).
WASHINGTON, D.C. - Open enrollment under the Patient Protection and Affordable Care Act (ACA) will continue past the March 31 deadline for those with pending applications, those who have been stymied by errors and others with exceptional circumstances, the U.S. Department of Health and Human Services (HHS) said March 26.
PORTLAND, Maine - A Maine federal judge on March 25 granted the secretary of Health and Human Services' (HHS) motion for summary judgment in a Medicare reimbursement dispute, finding that the secretary's decision was supported by substantial evidence and not arbitrary or capricious (Maine Medical Center v. Kathleen Sebelius, Secretary of the U.S. Department of Health and Human Services, No. 13-118, D. Maine; 2014 U.S. Dist. LEXIS 39100).
WASHINGTON, D.C. - In a sometimes combative setting before a District of Columbia U.S. Circuit Court of Appeals panel, parties argued March 25 over whether premium assistance is available under the Patient Protection and Affordable Care Act (ACA) for individuals who purchase insurance through the federal exchange because their state has not enacted an exchange (Jacqueline Halbig, et al. v. Kathleen Sebelius, et al., No. 14-5018, D.C. Cir.).
WASHINGTON, D.C. - The U.S. Supreme Court on March 25 heard arguments in two cases that will decide whether for-profit, secular businesses have to provide contraceptive services as part of their health insurance packages to employees even if they oppose such measures on religious grounds (Kathleen Sebelius, et al. v. Hobby Lobby Stores Inc., et al., No. 13-354, U.S. Sup.; Conestoga Woods Specialties Corp., et al. v. Kathleen Sebelius, et al., No. 13-356, U.S. Sup.).
WASHINGTON, D.C. - A federal judge in the District of Columbia on March 21 held that the Health and Human Services (HHS) secretary's methodology for achieving budget neutrality for Medicare reimbursement rates is a rational interpretation of the Medicare Act (Adirondack Medical Center, et al. v. Kathleen Sebelius, No. 11-313, D. D.C.; 2014 U.S. Dist. LEXIS 27305).
EAST BATON ROUGE, La. - A Louisiana appeals court on March 20 reversed the dismissal of a breach of health insurance contract, saying a state statute related to peremption periods did not extend to insurance companies (Laura E. Sibley v. Blue Cross Blue Shield of Louisiana, Nos. 2013 CA 0924, 2013 CA 0925, La. App., 1st Cir.; 2014 La. App. LEXIS 721).
WASHINGTON, D.C. - The U.S. Supreme Court on March 24 denied a petition for writ of certiorari filed by multiple licensed ambulatory surgical centers, leaving in place the dismissal of their health care reimbursement suit against multiple health insurance companies (Sanctuary Surgical, et al. v. Aetna Health Inc., et al., No. 13-932, U.S. Sup.).
ATLANTA - A Georgia appeals court on March 20 reversed class action status in a case challenging a hospital's lien practice against patients and remanded the case with instructions for the trial court to reconsider its summary judgment decision in light of an appeal's court decision in a similar case issued after the trial court rendered its opinion (MCG Health Inc. v. Donna Perry, et al., No. A13A1996, Ga. App., 4th Div.; 2014 Ga. App. LEXIS 190).
NEW YORK - A New York federal judge on March 19 denied a plaintiff's motion to remand a breach of contract dispute over payment for home health care services and instead dismissed the suit, saying that the Employee Retirement Income Security Act preempted the plaintiff's claim, which really was for "right of payment" and not "amount of payment" (Star Multi Care Services Inc. v. Empire Blue Cross Blue Shield, et al., No. 13-1138, E.D. N.Y.; 2014 U.S. Dist. LEXIS 36287).
MADISON, Wis. - A Wisconsin federal judge on March 19 dismissed a health care reimbursement dispute between a health care provider and health insurance plan for lack of venue (University of Wisconsin Hospital and Clinics Authority, et al. v. RFMS Inc. Mutual Medical Plans, No. 13-610, W.D. Wis.; 2014 U.S. Dist. LEXIS 36075).
MILWAUKEE - The alleged reduction in clients physicians who accept only cash might face from the delayed implementation of the Patient Protection and Affordable Care Act (ACA)'s employer mandate is too attenuated to provide standing to sue the Internal Revenue Service, a Wisconsin federal judge held March 18 (Association of American Physicians & Surgeons Inc., and Robert T. McQueeney v. John Koskinen, commissioner of the Internal Revenue Service, in his official capacity, No. 13-1214, E.D. Wis.; 2014 U.S. Dist. LEXIS 34980).
SELMA, Ala. - A health insurance provider on March 14 removed a denial of health care benefits case to an Alabama federal court and moved to dismiss the case, saying the Employee Retirement Income Security Act preempted the plaintiffs' claims (Jane Wallace, et al. v. Blue Cross Blue Shield, No. 14-119, S.D. Ala.).