CHICAGO - Saying it faces "a terrible choice" just days from now, a Christian liberal arts college on June 24 asked an Illinois federal judge to reconsider his decision to not enjoin the Patient Protection and Affordable Care Act (ACA) contraceptive mandate (Wheaton College v. Sylvia Mathews Burwell, et al., No. 13-8910, N.D. Ill.; 2014 U.S. Dist. LEXIS 85194).
RICHMOND, Va. - A Fourth Circuit U.S. Court of Appeals panel on June 23 affirmed the conviction and forfeiture order requiring the president of a medical transportation company to forfeit almost $1 million after finding that there was sufficient evidence presented to a jury showing that he knowingly submitted false claims to Medicare and a private insurance company for the transportation of three dialysis patients who did not medically require the company's services (United States of America v. Eddie Wayne Louthian Sr., No. 13-4231, 4th Cir.; 2014 U.S. App. LEXIS 11752).
PITTSBURGH - Providing or facilitating the provision of contraceptive coverage imposes a substantial burden on religious freedom and absent an injunction would leave plaintiffs choosing between their beliefs and costly fines, a Pennsylvania federal judge held June 20 (Most Reverend Lawrence E. Brandt, et al. v. Sylvia Burwell, et al., No. 14-681, W.D. Pa.).
MONTGOMERY, Ala. - Plaintiffs challenging the Patient Protection and Affordable Care Act (ACA) contraceptive mandate lack evidence that they will prevail on their claims, an Alabama federal judge held June 19 in denying a preliminary injunction pending appeal of an order partially dismissing their case (Eternal Word Television Network Inc. and State of Alabama v. Sylvia M. Burwell, et al., No. 13-521, S.D. Ala.).
WASHINGTON, D.C. - Individuals who obtained insurance through the federal Patient Protection and Affordable Care Act (ACA) marketplace had, on average, access to 47 plans offered by five health insurers and paid just $69 per month for the most popular "silver plan" after tax credits, according to a June 18 Department of Health and Human Services report.
SAN FRANCISCO - A California federal judge on June 12 dismissed a wrongful denial of health care benefits suit, saying the health plans at issue excluded treatment at residential treatment facilities that were not staffed 24/7 with licensed mental health professionals, but granted leave to amend the complaint (Elizabeth L., et al. v. Aetna Life Insurance Co., No. 13-2554, N.D. Calif.; 2014 U.S. Dist. LEXIS 80988).
LANSING, Mich. - In reversing an appeals court decision and reinstating a trial court's decision, the Michigan Supreme Court on June 11 held that plaintiffs in a qui tam lawsuit and two class action lawsuits failed to plead with sufficient specificity that the pharmacy defendants had submitted false claims under Medicaid (State of Michigan ex rel Marcia Gurganus v. VS Caremark Corp.; City of Lansing v. Rite Aid of Michigan Inc.; City of Lansing v. CVS Caremark Corp., Nos. 142791, 146792, 146793, Mich. Sup.; 2014 Mich. LEXIS 1047).
SAN ANTONIO - A Texas federal judge on June 11 declined to remand a health care reimbursement suit to state court, holding that the Employee Retirement Income Security Act preempted at least some of the claims (Innova Hospital San Antonia v. Humana Insurance Co., et al., No. 13-1089, W.D. Texas; 2014 U.S. Dist. LEXIS 79155).
NEWARK, N.J. - A New Jersey federal judge on June 11 declined to dismiss two counterclaims filed in a fraudulent billing dispute but dismissed a counterclaim for common-law fraud, saying that the claim failed to meet pleading requirements (Connecticut General Life Insurance Co. v. Roseland Ambulatory, No. 12-5941, D. N.J.; 2014 U.S. Dist. LEXIS 79189).
SAN FRANCISCO - Two doctors and the U.S. government on June 10 argued before a Ninth Circuit U.S. Court of Appeals panel on the constitutionality of a Medicare-price setting commission established under the Patient Protection and Affordable Care Act (ACA) and whether the as-yet unstaffed group injured plaintiffs (Nick Coons, et al. v. Jacob Lew, et al., No. 13-15324, 9th Cir.).
WASHINGTON, D.C. - The Internal Revenue Service's current plan for educating employers regarding Patient Protection and Affordable Care Act (ACA) reporting compliance is "deficient," and the organization needs to employ a "full court press" of communication and outreach to ensure proper compliance, according to a June 11 advisory committee report.
GRAND RAPIDS, Mich. - A Sixth Circuit U.S. Court of Appeals panel on June 11 declined to enjoin implementation of the Patient Protection and Affordable Care Act (ACA) contraceptive mandate (Michigan Catholic Conference, et al. v. Kathleen Sebelius, et al., No. 13-2723, The Catholic Diocese of Nashville, et al. v. Kathleen Sebelius, et al., No. 13-6640, 6th Cir.).
SANTE FE, N.M. - A New Mexico appeals court on June 9 affirmed the dismissal of a state's case accusing a home health care provider of Medicaid violations, saying a failure to comply with criminal screening requirements for caregivers does not support liability under state Medicaid laws (State of New Mexico ex rel. Gary K. King, Attorney General v. Behavioral Home Care Inc., No. 31,682, N.M. App.; 2014 N.M. App. LEXIS 60).
FRESNO, Calif. - A California appeals court on June 10 held that a trial court incorrectly interpreted a statute governing the reimbursement of noncontract providers for the payment of Medicare services, which resulted in evidence of the reasonable and customary value of services provided being limited to a hospital's full billed charges (Children's Hospital Central California v. Blue Cross of California, et al., No. F065603, Calif. App., 5th Dist.; 2014 Cal. App. LEXIS 503).
NEW ORLEANS - A Louisiana federal judge on June 9 denied a motion to reconsider his determination that plaintiffs could continue their Employee Retirement Income Security Act claims in a health care reimbursement suit, saying that the defendant failed to raise any new issues (Center for Restorative Breast Surgery, et al. v. Humana Health Benefit Plan of Louisiana, et al., No. 10-4346, E.D. La.).
WASHINGTON, D.C. - The Patient Protection and Affordable Care Act (ACA) burdens home health care workers providing services for Medicare recipients with "complex, unnecessary, and unauthorized physician documentation requirements," an advocacy group argues in a June 5 complaint (National Association for Home Care & Hospice Inc. v. Kathleen Sebelius, et al., and Marilyn B. Tavenner, et al., No. 14-950, D. D.C.).
NASHVILLE, Tenn. - In reversing a trial court's decision, a Tennessee appeals court on June 6 held that the Uniform Administrative Procedures Act (UAPA) did not divest the court of jurisdiction to hear a Medicaid reimbursement dispute because the plaintiff was not challenging the applicability or validity of the regulations (The Chattanooga Hamilton County Hospital Authority d/b/a Erlanger Health System v. United Healthcare Plan of the River Valley Inc., et al., No. M2013-00942-COA-R9-CV, Tenn. App.; 2014 Tenn. App. LEXIS 332).
JONESBORO, Ark. - Two physicians and an ambulatory surgery center on June 5 sued a joint venture physician hospital organization and a health insurer in an Arkansas federal court, alleging antitrust violations (Tri State Advanced Surgery Center, et al. v. Health Choice, et al., No. 14-143, E.D. Ark.).
SOUTH BEND, Ind. - The Patient Protection and Affordable Care Act (ACA)'s contraceptive mandate is a regulatory scheme imposing belief-violating requirements that the court cannot permissibly judge, religious groups told the Seventh Circuit U.S. Court of Appeals on June 5 (Grace Schools and Biola University Inc. and Diocese of Fort Wayne-South Bend Inc., et al. v. Kathleen Sebelius, et al., Nos. 14-1430, 14-1431, 7th Cir.).
TRENTON, N.J. - In a per curiam opinion, a New Jersey appeals court on June 5 affirmed the dismissal of a reimbursement suit brought by dentists and a dental association against two health insurers for allegedly wrongfully recouping overpayments made, saying statutory provisions allowed the insurers to withhold payment on subsequent claims for the overpayments (New Jersey Dental Association, et al. v. Horizon Blue Cross Blue Shield of New Jersey, et al., No. A-1834-12T3, N.J. Super., App. Div.; 2014 N.J. Super. Unpub. LEXIS 1291).
WASHINGTON, D.C. - The U.S. Senate on June 5 confirmed Sylvia Mathews Burwell as the new secretary of Health and Human Services in a 78-17 vote, according to the White House.
WASHINGTON, D.C. - The Congressional Budget Office (CBO) said June 5 that it now expects 2 million fewer people to pay the Patient Protection and Affordable Care Act (ACA)'s penalty for being uninsured in 2016, cutting $3 billion in revenue for the year.
HARRISBURG, Pa. - A deeply divided Pennsylvania House of Representative committee on June 4 staved off attempts to derail legislation expanding Medicaid eligibility under the Patient Protection and Affordable Care Act (ACA).
WASHINGTON, D.C. - The Patient Protection and Affordable Care Act (ACA)'s expansion of Medicaid and the Children's Health Insurance Program (CHIP) resulted in insurance coverage for 6 million more individuals through April, according to a government official.
OKLAHOMA CITY - Standing exists for two groups challenging the Patient Protection and Affordable Care Act (ACA) contraceptive mandate, and the law imposes a substantial burden on those plaintiffs, an Oklahoma federal judge held June 4 in partially granting a preliminary injunction (The Catholic Benefits Association LCA, et al. v. Kathleen Sebelius, et al., No. 14-240, W.D. Okla.).