SACRAMENTO, Calif. - A California appeals court on July 29 held that a health care provider must actually contract for the right to preserve its right to recover its customary billing rates through a Hospital Lien Act (HLA) lien or it forfeits the right to recover the customary billing rate for emergency room services from third-party tortfeasors (Dameron Hospital Association v. AAA Northern California, et al., No. C070475, Calif. App., 3rd. Dist.; 2014 Cal. App. LEXIS 684).
PHILADELPHIA - A panel of the Third Circuit U.S. Court of Appeals on July 29 held that the Medicare as a Secondary Payer Act (MSP Act) authorizes the government to seek reimbursement from a settlement a plaintiff receives from a tortfeasor because the funds came from a "primary plan" and that the plaintiff cannot invoke a New Jersey state law to avoid her reimbursement obligations (Cecelia A. Taransky v. Secretary of the U.S. Department of Health and Human Services, et al., No. 13-3483, 3rd Cir.; 2014 U.S. App. LEXIS 14408).
WASHINGTON, D.C. - A plaintiff challenging the individual mandate of the Patient Protection and Affordable Care Act (ACA) cannot do so by arguing that the requirement is a revenue measure that should have originated in the U.S. House of Representatives, a unanimous federal appeals court ruled July 29 (Matt Sissel v. United States Department of Health and Human Services, et al., No. 13-5202, D.C. Cir.).
GREENBELT, Md. - A health insurance company on July 25 sued multiple ambulatory service centers in a Maryland federal court for allegedly conspiring to submit fraudulent bills for services provided to patients covered by the plaintiff (Connecticut General Life Insurance Co., et al. v. Advanced Surgery Center of Bethesda, et al., No. 14-2376, D. Md.).
WASHINGTON, D.C. - A woman's action alleging wrongful denial of reduced-cost medical care under the Patient Protection and Affordable Care Act (ACA) ignores that she was granted Medicaid coverage after an appeal, a District of Columbia federal court judge held July 22 (Stephanie Mykonos v. United States of America, et al., No. 13-1845, D. D.C.; 2014 U.S. Dist. LEXIS 98926).
WASHINGTON, D.C. - A resolution seeking authority to initiate a suit against President Barack Obama and various department head for the alleged failure to faithfully construe the Patient Protection and Affordable Care Act (ACA) passed through the U.S. House of Representatives Rules Committee on July 24.
OKLAHOMA CITY - Parties in a religious employers' challenge to the Patient Protection and Affordable Care Act (ACA) contraceptive mandate briefed the 10th Circuit U.S. Court of Appeals on July 22 on the impact of the U.S. Supreme Court's ruling in Hobby Lobby (Southerrn Nazarene University, et al. v. Sylvia Mathews Burewell, et al., No. 14-6026, 10th Cir.).
MOBILE, Ala. - A physician group and two clinics that are part of the Alabama-based Infirmary Health System Inc. (IHS) on July 21 agreed to pay $24 million to resolve a lawsuit brought by the federal government accusing the defendants of violating the False Claims Act by paying or receiving financial inducements in connection with claims to the Medicare program, according to a docket entry in Alabama federal court (United States of America, ex rel. Heesch v. Diagnostic Physicians Group P.C., et al., No. 11-0364-KD-B, S.D. Ala.).
RICHMOND, Va. - Patient Protection and Affordable Care Act (ACA) language governing whether individuals who enroll through the federal exchange are entitled to tax credits is ambiguous enough to defer to the Internal Revenue Service's interpretation, a Fourth Circuit U.S. Court of Appeals panel held July 22 (David King, et al. v. Kathleen Sebelius, et al., No. 14-1158, 4th Cir.).
FRESNO, Calif. - A California appeals court in an unpublished July 21 decision affirmed summary judgment in favor of a health care service plan in a suit brought by a hospital over reimbursement rates and agreed with the lower court that amendment would be futile because the trial court correctly concluded that the hospital failed to provide any evidence of a mutual mistake of fact and, therefore, amending the complaint would have been an idle act (Doctors Medical Center of Modesto Inc. v. Kaiser Foundation Health Plan Inc., No. F066017, Calif. App., 5th Div.; 2014 Cal. App. Unpub. LEXIS 5086).
GREEN BAY, Wis. - A U.S. senator lacks standing to challenge Patient Protection and Affordable Care Act (ACA) regulations governing insurance for congressional members and staffers, a Wisconsin federal judge held July 21 (Senator Ron Johnson, et al. v. U.S. Office of Personnel Management, et al., No. 14-09, E.D. Wis.).
WASHINGTON, D.C. - Patient Protection and Affordable Care Act (ACA) premium tax credits are available only for individuals who enrolled through state exchanges and not the federal exchange, a District of Columbia U.S. Circuit Court of Appeals panel majority held July 22. The dissent argued that the suit is a "not-so-veiled attempt to gut" the ACA (Jacqueline Halbig, et al. v. Sylvia Mathews Burwell, et al., No. 14-5018, D.C. Cir.).
RENO, Nev. - A Nevada woman on July 18 sued her health insurer in federal court for allegedly wrongfully denying benefits related to her transportation by air ambulance (Mary Hubbard v. Aetna Life Insurance Co., No. 14-380, D. Nev.).
CHICAGO - An Illinois federal judge on July 18 held that the secretary of Health and Human Services acted in an arbitrary and capricious manner in dismissing and refusing to reinstate a hospital's administrative appeal in a Medicare reimbursement dispute (The University of Chicago Medical Center v. Kathleen Sebelius, No. 13-4742, N.D. Ill.; 2014 U.S. Dist. LEXIS 97606).
CINCINNATI - A panel of the Sixth Circuit U.S. Court of Appeals held July 16 that a health care provider can bring a claim under Medicare Secondary Payer Act's private cause of action against a non-group health plan that denies coverage for a reason other than Medicare eligibility (Michigan Spine and Brain Surgeons v. State Farm Mutual Automobile Insurance Co., No. 13-2430, 6th Cir.; 2014 U.S. App. LEXIS 13499).
WASHINGTON, D.C. - Closely held companies terminating insurance coverage for contraceptive services mid-plan for religious reasons in light of Burwell v. Hobby Lobby, and subject to Employee Retirement Income Security Act (ERISA) regulations, must notify participants and beneficiaries of the change, the U.S. Department of Health and Human Services (HHS) confirmed July 17 in a "frequently asked question."
WASHINGTON, D.C. - A Democratic bill seeking to reverse the U.S. Supreme Court's recent opinion in Hobby Lobby and ensure employer-insurance-provided access to contraceptives under the Patient Protection and Affordable Care Act (ACA) failed to garner enough to votes to proceed on July 16.
WASHINGTON, D.C. - Republicans on July 15 introduced legislation that would direct the Food and Drug Administration to study whether contraceptives could be made available without prescription and would eliminate the Patient Protection and Affordable Care Act (ACA)'s restriction on payment methods for such products.
LOS ANGELES - In an unpublished July 15 opinion, a California appeals court affirmed a health insurance company's demurrer without leave to amend in a health care reimbursement suit, finding that there was no contractual agreement requiring the insurer to pay the provider its usual and customary rate (Orthopedic Specialists of Southern California v. California Public Employees' Retirement System, No. B248535, Calif. App., 2nd Dist.; 2014 Cal. App. Unpub. LEXIS 4955).
PITTSBURGH - A Pennsylvania federal judge on July 15 denied the government's request to postpone a hearing on whether to issue a permanent injunction in a case challenging the Patient Protection and Affordable Care Act (ACA) contraceptive mandate (Most Reverend Lawrence E. Brandt, et al. v. Sylvia Burwell, et al., No. 14-681, W.D. Pa.).
LOS ANGELES - In an unpublished opinion, a California federal judge on July 11 remanded a hospital's health care payment breach of contract case against a self-funded insurance plan to state court, saying the Employee Retirement Income Security Act did not preempt the claims (Cedars-Sinai Medical Center v. American Apparel Inc., et al., No. 13-6564, C.D. Calif.; 2014 U.S. Dist. LEXIS 94857).
NEWARK, N.J. - In an unpublished opinion, a New Jersey federal judge on July 9 granted final approval of a class action settlement over wrongful reimbursements for out-of-network health care services (Cathleen McDonough v. Horizon Blue Cross Blue Shield of New Jersey, No. 09-571, D. N.J.; 2014 U.S. Dist. LEXIS 93559).
CARSON CITY, Nev. - A divided Nevada Supreme Court on July 10 held that the Medicare Act preempts a plaintiff's state common-law negligence claims regarding the retention and investigation of contracted Medicare providers (Louis Morrison v. Health Plan of Nevada, et al., No. 61082, Nev. Sup.; 2014 Nev. LEXIS 67).
WASHINGTON, D.C. - The Patient Protection and Affordable Care Act (ACA)'s contraceptive mandate forces insurance coverage for items antithetical to the purpose of one of the nation's oldest pro-life organizations, March for Life alleges in a July 7 complaint (March for Life, Jeanne F. Monahan and Bethany A. Goodman v. Sylvia M. Burwell, et al., No. 14-1149, D. D.C.).
WASHINGTON, D.C. - A District of Columbia federal judge on July 7 dismissed a Medicaid vocational training program provider's claims challenging the termination of its Medicaid contract, saying that the plaintiff failed to adequately plead its claims and that amendment would be futile (New Vision Photography Program Inc. v. District of Columbia, et al., No. 13-1986, D. D.C.; 2014 U.S. Dist. LEXIS 91418).