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.).
WASHINGTON, D.C. - The U.S. Department of Health and Human Services on March 18 issued a proposed rule covering what changes to an existing policy constitute a discontinuation of that policy under the Patient Protection and Affordable Care Act (ACA), altering risk corridor regulations and governing civil penalties for fraud in the exchanges.
WASHINGTON, D.C. - Patient Protection and Affordable Care Act (ACA) insurers must accept payment from federal and state programs that provide premium and cost-sharing support for specific individuals, the U.S. Department of Health and Human Services announced March 14.
DAYTON, Ohio - An Ohio appeals court on March 14 affirmed that a hospital provider and a Medicaid managed care payer were required to arbitrate all of their claims related to a payment dispute (Kettering Health Network v. CareSource, No. 25928, Ohio App., 2nd Dist.; 2014 Ohio App. LEXIS 895).
SAN FRANCISCO - A California federal judge on March 14 affirmed that the Medicare Appeals Council correctly denied a request by a claimant for a referral to a specialist, saying the claimant failed to exhaust the administrative appeals process (Theodore McElhone v. Kathleen Sebelius, No. 12-6090, N. D. Calif.; 2014 U.S. Dist. LEXIS 33944).
WASHINGTON, D.C. - Patient Protection and Affordable Care Act (ACA) insurance plans offering same-sex coverage must also offer opposite-sex coverage starting in 2015, Health and Human Services official Matthew Heinz clarified in a March 14 blog post.
NEWARK, N.J. - On March 13, just two days after plaintiffs filed a brief in a New Jersey federal court in support of a $120 million settlement agreement in a dispute over out-of-network reimbursement rates, defendant Aetna Inc. filed a notice of termination of the settlement, saying opt-outs from the settlement exceed allowed thresholds (In Re: Aetna UCR Litigation, Master File No. 07-3541, MDL 2020, D. N.J.).
TRENTON, N.J. - In an unpublished opinion, a New Jersey federal judge on March 13 affirmed that a magistrate judge correctly denied a plaintiff's request to file a third amended complaint in a dispute over Consolidated Omnibus Budget Reconciliation Act (COBRA) benefits (Stephen J. Simoni v. Meridian Health Systems Inc., et al., No. 11-7528, D. N.J.; 2014 U.S. Dist. LEXIS 33145).
WASHINGTON, D.C. - The U.S. House on March 11 passed a trio of bills seeking to grant additional religious exemptions from the Patient Protection and Affordable Care Act (ACA)'s individual mandate and excluding military personnel and emergency services volunteers from the law's individual and employer mandates.
WASHINGTON, D.C. - The federal government on March 7 responded to a letter filed in the District of Columbia Circuit U.S. Court of Appeals by plaintiffs in a case challenging an Internal Revenue Service regulation imposed under the Patient Protection and Affordable Care Act (ACA) that extends eligibility for premium assistance subsidies to people who purchase health insurance through exchanges established by the ACA. The plaintiffs' letter addresses a bulletin issued by the Center for Medicare and Medicaid Services (CMS) discussing the tax credits available for individuals who purchase health care coverage through exchanges (Jacqueline Halbig, et al. v. Kathleen Sebelius, et al., No. 14-5018, D.C. Cir.).
MIAMI - The Patient Protection and Affordable Care Act (ACA) provides a simple opt-out procedure for employers with religious objections to the contraceptive mandate, and those with such objections should not be permitted to bar insurers from complying with the law, the government told a Florida federal judge in a March 10 motion to dismiss (Ave Maria School of Law v. Kathleen Sebelius, et al., No. 13-795, M.D. Fla.).
CHICAGO - An Illinois appeals panel on March 7 found that a lower court erred in finding that a directors and officers liability insurer had a duty to indemnify its insured for a $3 million settlement with former patients who sought compensation for the insured's decision to discontinue an experimental breast cancer vaccine program, concluding that only the primary and excess health care liability insurer has a duty to indemnify the insured (Rosalind Franklin University of Medicine and Science v. Lexington Insurance Co., et al., No. 06 CH 14486, Ill. App., 1st Dist., 5th Div.).
HATTIESBURG, Miss. - A Mississippi couple on March 7 filed a lawsuit in federal court, alleging that they are wrongfully being held responsible for more than $50,000 in medical claims after the company responsible for making premium payments for their Pre-existing Condition Insurance Plan (PCIP) provided for under the Patient Protection and Affordable Care Act (ACA) failed to make the payments (Thomas and Wanda Carruth v. The Outsource Group, et al., No. 14-33, S.D. Miss.).
AUSTIN, Texas - A Texas woman on March 7 sued her health insurer in federal court for allegedly wrongfully denying coverage for treatment related to her husband's stroke (Eleanor Crose v. Humana Insurance Co., No. 14-205, W.D. Texas).
FORT SMITH, Ark. - An Arkansas federal judge on March 10 dismissed a subrogation dispute, saying the plaintiff failed to exhaust administrative remedies as required by the Medicare Act before filing the suit (Darrell Richard Cupp v. Dane F. Johns, et al., No. 14-2016, W.D. Ark.; 2014 U.S. Dist. LEXIS 30537).
OKLAHOMA CITY - Religious groups demonstrate a substantial likelihood of success in their Religious Freedom Restoration Act of 1993 (RFRA) challenge to the Patient Protection and Affordable Care Act (ACA)'s contraceptive mandate, an Oklahoma federal judge held March 10 (Reaching Souls International Inc., et al. v. Kathleen Sebelius, et al., No. 13-1092, W.D. Okla.; 2014 U.S. Dist. LEXIS 30497).
BROOKLYN, N.Y. - In a matter of first impression, a New York appeals court on March 5 affirmed that the state's prompt-pay law affords claimants a private right of action to recover payment for health care services provided based on a violation of the law (Maimonides Medical Center v. First United American Life Insurance Co., No. 2012-03138, N.Y. Sup., App. Div., 2nd Dept.; 2014 N.Y. App. Div. LEXIS 1409).
WEST PALM BEACH, Fla. - A Florida federal judge on March 6 denied a motion to dismiss claims asserted against ambulatory surgical centers and billing companies for allegedly fraudulently billing for chiropractic services, saying that the Employee Retirement Income Security Act did not preempt the claims (United Healthcare Services Inc., et al. v. Sanctuary Surgical Inc., et al., No. 10-81589, S.D. Fla.; 2014 U.S. Dist. LEXIS 28824).
WASHINGTON, D.C. - Plaintiffs cannot squeeze the individual insurance mandate in the Patient Protection and Affordable Care Act (ACA) into an "arbitrary as-applied" exemption to Congress' taxing power, a panel of the District of Columbia Circuit U.S. Court of Appeals affirmed March 7 (Association of American Physicians & Surgeons Inc., et al. v. Kathleen G. Sebelius, et al., No. 13-5003, D.C. Cir.).
LOS ANGELES - California's health exchange forced the cancellation of 1 million residents' health plans and threatens millions more, despite the Patient Protection and Affordable Care Act's (ACA) exclusion of existing policies from its coverage mandates, a state senator claims in a March 4 complaint (Edward Gaines, Gaines Insurance Agency Inc., et al. v. Peter Lee, in his official capacity as Executive Director of the California Health Benefit Exchange, et al., No. BS147414, Calif. Super., Los Angeles Co.).
WASHINGTON, D.C. - The U.S. States House of Representatives on March 5 passed, by a 250-to-160 vote, legislation seeking to delay the penalty for failing to comply with the individual mandate in the president's health care legislation.
WASHINGTON, D.C. - Legislation introduced Feb. 28 seeking to delay the penalty for failing to comply with the individual mandate in the president's health care legislation would cut $10 billion from the federal deficit between its enactment and 2019 and result in 2 million more uninsured individuals in 2015, the Congressional Budget Office (CBO) said in a March 4 analysis.