LexisNexis® Legal Newsroom
    Mealey's Health Law - Government: Bulletin Clarifies Enrollment In Exchange May Be Retroactive

    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.).

    Mealey's Health Law - Government Asks Florida Federal Court To Nix Contraceptive Mandate Challenge

    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.).

    Mealey's Health Law - Panel Partly Reverses Ruling In Coverage Suit Arising From Experimental Vaccine

    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.).

    Mealey's Health Law - Couple Sues In Mississippi Federal Court, Says Coverage Wrongfully Canceled

    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.).

    Mealey's Health Law - Suit Filed In Texas Federal Court Alleges Coverage For Stroke Treatment Denied

    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).

    Mealey's Health Law - Arkansas Federal Judge Dismisses Medicare Subrogation Case; Remedies Not Exhausted

    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).

    Mealey's Health Law - Judge: Likelihood Of Success Demonstrated In Contraceptive Mandate Case

    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).

    Mealey's Health Law - New York Appeals Court: Prompt-Pay Law Provides Private Right Of Action

    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).

    Mealey's Health Law - Florida Federal Judge Declines To Dismiss Fraud Claims; No Preemption Exists

    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).

    Mealey's Health Law - District Of Columbia Appeals Panel Affirms Dismissal Of ACA Suit

    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.).

    Mealey's Health Law - Calif. Senator Sues State, Claiming Improper Cancellation Of Insurance Policies

    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.).

    U.S. House Passes Bill Delaying ACA Mandate Penalties

    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.

    Mealey's Health Law - CBO: Delaying ACA Mandate Penalty Saves $10B, Leaves 2M Uninsured

    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.

    Mealey's Health Law - High Court Won't Hear Case Involving Remand Of Benefits Claim To Plan

    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.).

    Mealey's Health Law - Appeals Court: Provider Costs Need Not Be Considered In Setting Payment Rates

    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).

    Mealey's Health Law - 6th Circuit Affirms Denial Of Benefits In Medicare Coverage Case

    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).

    Mealey's Health Law - Missouri Federal Judge Grants Transfer Of Drug Rebate Case

    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).

    Mealey's Health Law - Texas Federal Judge Remands Reimbursement Suit To State Court

    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).

    Mealey's Health Law - New Jersey Federal Judge Grants Defendant Partial Judgment In Reimbursement Suit

    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).

    Mealey's Health Law - 8th Circuit Urged To Affirm Denial Of Injunction In Birth Control Case

    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.).

    Mealey's Health Law - 4th Circuit Affirms Dismissal Of False Claims Act Case

    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).

    Mealey's Health Law - Split 7th Circuit Affirms Denial Of Injunction In Birth Control Case

    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).

    Mealey's Health Law - Pa. Commonwealth Court Reverses Decision Ordering Release Of Medicaid Records

    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).

    Mealey's Health Law - 11th Circuit Affirms Dismissal Of Class Action Reimbursement Case

    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).

    Mealey's Health Law - California Appeals Court Reverses Decision Over Payment Of Emergency Services

    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).