LexisNexis® Legal Newsroom
    Mealey's Health Law - Judge Refuses Philadelphia Archdiocese ACA Injunctive Relief Request

    PHILADELPHIA - Catholic plaintiffs misconstrue the effects of the Patient Protection and Affordable Care Act (ACA) opt out, which does not trigger contraceptive coverage by third parties, a Pennsylvania federal judge held June 26 in denying injunctive relief (Catholic Charities of the Archdiocese of Philadelphia, et al. v. Sylvia Burwell, in her official capacity as Secretary of the Department of Health and Human Services, et al., No. 14-3096, E.D. Pa.).

    Mealey's Health Law - ACA Injunction Excludes New Benefits Group Members, Oklahoma Judge Says

    OKLAHOMA CITY - Expanding a Patient Protection and Affordable Care Act (ACA) contraceptive mandate injunction to new parties threatens creation of "open-ended" relief and would do little to assist judicial economy, an Oklahoma federal judge held June 26 (The Catholic Benefits Association LCA, et al. v. Sylvia M. Burwell, et al., No. 14-240, W.D. Okla.).

    Mealey's Health Law - Colorado Federal Judge Finds ACA Birth Control Mandate Burdens Christian College

    DENVER - Saying the ease with which a Christian college can opt out of the Patient Protection and Affordable Care Act (ACA) contraceptive mandate ignores that that the school finds facilitating such coverage "religiously repugnant," a Colorado federal judge on June 20 enjoined application of the statute (Colorado Christian University v. Kathleen Sebelius, et al., No. 13-2105, D. Colo.; 2014 U.S. Dist. LEXIS 84234).

    Mealey's Health Law - College Seeks Reconsideration Of Ruling Denying Injunction In Birth Control Case

    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).

    Mealey's Health Law - 4th Circuit Upholds Conviction, Forfeiture Ruling In Ambulance Fraud Case

    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).

    Mealey's Health Law - Pa. Federal Judge Grants Preliminary Injunction In Birth-Control Mandate Case

    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.).

    Mealey's Health Law - Judge Rejects Challenge To ACA Birth-Control Mandate, Injunction During Appeal

    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.).

    Mealey's Health Law - HHS Report: Most Silver Plan Enrollees Received Credits; Average Credit: $276

    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.

    Mealey's Health Law - Calif. Federal Judge Dismisses Wrongful Denial Of Health Care Benefits Suit

    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).

    Mealey's Health Law - Mich. High Court Reverses Medicaid Decision, Says Claims Not Adequately Pleaded

    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).

    Mealey's Health Law - Texas Federal Judge Denies Remand, Says ERISA Preemption Exists

    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).

    Mealey's Health Law - Federal Judge Dismisses 1 Claim In Fraudulent Billing Case; 2 Remain

    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).

    Mealey's Health Law - Doctors, Government Debate Constitutionality Of ACA Commission In 9th Circuit

    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.).

    Mealey's Health Law - IRS Report: ACA Education Efforts Deficient, Require 'Full Court Press'

    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.

    Mealey's Health Law - 6th Circuit Affirms Denial Of Birth Control Mandate Injunction

    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.).

    Mealey's Health Law - New Mexico Appeals Court Affirms Dismissal Of Medicaid Dispute

    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).

    Mealey's Health Law - California Appeals Court Reverses Ruling In Medicare Payment Dispute

    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).

    Mealey's Health Law - Louisiana Federal Judge Declines To Reconsider Ruling In Reimbursement Dispute

    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.).

    Mealey's Health Law - Home-Care Group Claims ACA Documentation Rules Impose 'Unnecessary' Burden

    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.).

    Mealey's Health Law - Tennessee Appeals Court: Trial Court Has Authority To Hear Medicaid Case

    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).

    Mealey's Health Law - Suit Filed In Arkansas Federal Court Alleges Antitrust Violations

    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.).

    Mealey's Health Law - Birth-Control Challengers Tell 7th Circuit Mandate Violates Beliefs

    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.).

    Mealey's Health Law - New Jersey Panel: Insurers Can Withhold Payments To Recoup Overpayments

    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).

    Mealey's Health Law - U.S. Senate Confirms Burwell As New HHS Secretary

    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.

    Mealey's Health Law - Report: 2 Million More Likely To Escape ACA Penalty, Loss Of $3 Billion In 2016

    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.