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.
WASHINGTON, D.C. - The U.S. Supreme Court on March 3 denied review of a Ninth Circuit U.S. Court of Appeals ruling that a district court abused its discretion when it remanded a claim for denial of health benefits under the Employee Retirement Income Security Act to the plan administrator (The Beverly Hills Hotel and Bungalows Employee Benefit Trust Employee Welfare Plan v. Ana Martinez, No. 13-818, U.S. Sup.).
SAN FRANCISCO - In a Medicaid reimbursement case, a California appeals court on Feb. 28 affirmed a demurrer in favor of the defendant, saying that based on changes in law, states are not required to consider provider costs in setting reimbursement rates (Tim Keffeler, et al. v. Partnership Healthplan of California, No. A135536, Calif. App., 1st. Dist., Div.1; 2014 Cal. App. LEXIS 200).
CINCINNATI - In an unpublished opinion, a panel of the Sixth Circuit U.S. Court of Appeals on Feb. 27 affirmed a denial of benefits, saying Medicare did not provide coverage for the equipment sought (Mary K. Woodfill v. Secretary of Health and Human Services, No. 13-3729, 6th Cir.; 2014 U.S. App. LEXIS 3874).
ST. LOUIS - A Missouri federal judge on Feb. 27 denied defendants' motion to dismiss a dispute over prescription drug rebates but granted a motion to transfer the case to another federal court (Express Scripts Inc. v. Jefferson Health System Inc., et al., No. 13-379, E.D. Mo.; 2014 U.S. Dist. LEXIS 25057).
DALLAS - A Texas federal judge on Feb. 27 remanded a health care reimbursement suit between a health care provider and insurer to state court, saying the claims were not preempted (Texas Center for Obesity Surgery v. UnitedHealthCare of Texas Inc., et al., No. 13-922, N.D. Texas; 2014 U.S. Dist. LEXIS 24996).
NEWARK, N.J. - A New Jersey federal judge on Feb. 27 granted partial summary judgment in favor of an insurer in a health care benefits reimbursement dispute, dismissing the claims asserted by the plaintiff but denying the defendant's motion for recovery for its counterclaim and request for attorney fees (New Jersey Back Institute ASO Juan Rodriguez v. Horizon Blue Cross Blue Shield Insurance Co., No. 12-4985, D. N.J.; 2014 U.S. Dist. LEXIS 25639).
ST. LOUIS - The federal government on Feb. 27 filed a brief with the Eighth Circuit U.S. Court of Appeals, urging the court to affirm the denial of a preliminary injunction in a case brought by a Missouri family challenging the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) (Paul Wieland, et al. v. U.S. Department of Health and Human Services, No. 13-3528, 8th Cir.).
RICHMOND, Va. - A Fourth Circuit U.S. Court of Appeals panel on Feb. 21 held that a relator who sued his former employer for allegedly filing false Medicare and Medicaid claims failed to allege that the defendants made a false statement or that they acted with the necessary scienter. The appeals court also affirmed that the lower court did not abuse its discretion in denying the relator's request to file a third amended complaint (United States ex rel. Barry Rostholder v. Omnicare Inc., et al., No. 12-2431, 4th Cir.; 2015 U.S. App. LEXIS 3269).
CHICAGO - A divided Seventh Circuit U.S. Court of Appeals panel on Feb. 21 affirmed a decision denying the University of Notre Dame's motion for a preliminary injunction in its case challenging the birth control mandate contained in the Patient Protection and Affordable Care Act (University of Notre Dame v. Kathleen Sebelius, et al., No. 13-3853, 7th Cir.; 2014 U.S. App. LEXIS 3326).
HARRISBURG, Pa. - A divided Commonwealth Court of Pennsylvania on Feb. 19 reversed a decision ordering the disclosure of the rates managed care organizations (MCOs) paid to subcontractors and the rates the subcontractors paid to the providers of Medicaid dental services (Dental Benefit Providers Inc., et al. v. James Eiseman Jr., et al., Nos. 945 C.D. 2013, 957 C.D. 2013, 958 C.D. 2013, Pa. Comm.; 2014 Pa. Commw. LEXIS 113).
ATLANTA - In an unpublished per curiam opinion, a panel of the 11th Circuit U.S. Court of Appeals on Feb. 20 affirmed the dismissal of a class action complaint brought by a group of medical associations and medical providers against multiple health insurers for allegedly wrongfully reducing payments for out-of-network services provided to the insureds' members, agreeing that the claims were "released claims" barred by settlement agreements in a similar case (The American Medical Association, et al. v. Connecticut General Life Insurance Co., et al., No. 13-10916, 11th Cir.; 1014 U.S. App. LEXIS 3088).
LOS ANGELES - In reversing a lower court decision, a California appeals panel on Feb. 19 held that emergency room physicians alleged sufficient facts to reflect the existence of a claim for negligent delegation asserted against health maintenance organizations for allegedly knowing that their independent practice associations (IPAs) were unable to pay the physicians for providing statutorily required services (Centinela Freeman Emergency Medical Associates, et al. v. Health Net of California Inc., et al., No. B238867, Calif. App., 2nd. Dist., Div. 3; 2014 Cal. App. LEXIS 158).
HARRISBURG, Pa. - A Pennsylvania federal judge on Feb. 19 partially dismissed a dispute related to the payment of health care benefits for the treatment of autism, dismissing claims for legal damages and breach of contract but leaving a claim for equitable remedies (Patrick C. Jarman v. Capital Blue Cross, et al., No. 13-932, M.D. Pa.; 2014 U.S. Dist. LEXIS 20464).
WASHINGTON, D.C. - The U.S. Supreme Court on Feb. 24 denied a petition for writ of certiorari, leaving in place a Ninth Circuit U.S. Court of Appeals decision affirming that Arizona cannot bar state Medicaid patients from obtaining covered family planning services from health care providers who also perform elective abortions (Tom Betlach, et al. v. Planned Parenthood of Arizona Inc., No. 13-621, U.S. Sup.).
MADISON, Wis. - A Wisconsin federal judge on Feb. 18 dismissed a Medicare false claims suit but gave the plaintiff permission to amend her suit (United States of America ex rel. Jodi Miller v. SSM Health Care Corp., et al., No. 12-885, W.D. Wis.; 2014 U.S. Dist. LEXIS 19722).
HOUSTON - A Texas federal judge on Feb. 13 dismissed a class action lawsuit related to the denial of health care benefits based on a plan's subrogation provisions, saying that some claims were preempted by federal law and that the plan administrator acted in accordance with plan terms in denying benefits (Joe Hollingshead v. Aetna Health Inc., No. 13-231, S.D. Texas; 2014 U.S. Dist. LEXIS 18770).
SAN JUAN, Puerto Rico - A Puerto Rico federal judge on Feb. 13 dismissed a Medicare dispute, saying the court lacked jurisdiction because the plaintiff had yet to receive a "final decision" from Medicare's Departmental Appeals Board (DAB) (Centro Radiologico Rolon Inc., et al. v. United States of America, et al., No. 12-2051, D. P.R.; 2014 U.S. Dist. LEXIS 19112).
FORT WORTH, Texas - A federal Texas judge on Feb. 12 remanded a prompt-pay case to state court, saying that the Employee Retirement Income Security Act did not preempt the claims (Texas Health Resources v. Aetna Health Inc., No. 13-1013, N.D. Texas; 2014 U.S. Dist. LEXIS 17939).
ATLANTA - An 11th Circuit U.S. Court of Appeals panel on Feb. 14 affirmed that the Employee Retirement Income Security Act preempted several provisions of Georgia's state code related to prompt payment of health care claims (America's Health Insurance Plans v. Ralph T. Hudgens, in his Official Capacity as Georgia Insurance and Safety Fire Commissioner, No. 13-10349, 11th Cir.; 2014 U.S. App. LEXIS 2771).
ROCK ISLAND, Ill. - A federal judge in Illinois on Feb. 5 ruled that where a health plan governed by the Employee Retirement Income Security Act requires a plan participant to reimburse the plan for benefits received from a third-party recovery, the participant was not relieved of his reimbursement obligation by the plan's failure to follow procedures in a document other than the plan's governing document (Plumbers and Pipefitters Local No. 25 Welfare Fund, et al. v. Wes Sedam, No. 12-4114, C.D. Ill.; 2014 U.S. Dist. LEXIS 14436).
NEW YORK - In a Feb. 7 unpublished opinion, a panel of the Second Circuit U.S. Court of Appeals affirmed with a modification a lower court's decision to grant a preliminary injunction to keep a health insurance company group from terminating approximately 2,200 physicians from its Medicare Advantage program (Fairfield County Medical Association, et al. v. United Healthcare of New England, et al., No.13-4608, 2nd Cir.; 2014 U.S. App. LEXIS 2319).
PEORIA, Ill. - An Illinois federal judge on Jan. 31 partially granted a defendant's motion to dismiss a suit alleging that the health care provider submitted false claims pursuant to Medicare and Medicaid, leaving only a state law claim (United States of America, ex rel. Gail McGinnis v. OSF Healthcare System, et al., No. 11-1392, C.D. Ill.; 2014 U.S. Dist. LEXIS 12600).