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LOS ANGELES - In an unpublished July 15 opinion, a California appeals court affirmed a health insurance company's demurrer without leave to amend in a health care reimbursement suit, finding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).
WASHINGTON, D.C. - In reversing a lower court, a District of Columbia Circuit U.S. Court of Appeals panel on July 8 held that the secretary of the U.S. Department of Health and Human Services' (HHS) conclusion that a group of long-term care hospitals operating out of buildings previously owned by hospital entities are not "new hospitals" for purposes of reimbursement of equity capital under Medicare (Select Specialty Hospitals - Bloomington, et al. v. Sylvia Mathews Burwell, secretary of U.S. Department of Health and Human Services, No. 12-5355, D.C. Cir.; 2014 U.S. App. LEXIS 12805).
WASHINGTON, D.C. - A District of Columbia federal judge on July 7 partially granted plaintiffs' motion to amend their complaint challenging regulations governing Medicare reimbursements and allow the plaintiffs to include factual allegations concerning a Final Interim Rule, but not allowing the plaintiffs to include claims that the secretary's failure to disclose the rule and its contents violated the federal code (Banner Health fbo Banner Good Samaritan Medical Center, et al. v. Sylvia M. Burwell, secretary, Department of Health and Human Services, No. 10-1638, D. D.C.; 2014 U.S. Dist. LEXIS 91668).
WASHINGTON, D.C. - The U.S. Department of Health and Human Services is making $100 million available to expand access to primary care under the Patient Protection and Affordable Care Act (ACA), the government announced July 8.
WASHINGTON, D.C. - To fund the "extraordinary" costs of its Patient Protection and Affordable Care Act (ACA) health insurance exchange, the District of Columbia assesses fees on insurers with no products in the exchange, a trade association alleges in a July 3 complaint (American Council of Life Insurers v. District of Columbia Health Benefits Exchange Authority, et al., No. 14-1138, D. D.C.).
NEW ORLEANS - A divided Louisiana Supreme Court on July 1 held that a health insurance beneficiary has a private right of action for damages against a health care provider under the state's balance billing act (Yana Anderson v. Ochsner Health System, et al., No. 3-13-2970, La. Sup.; 2014 La. LEXIS 1556).
PEORIA, Ill. - An Illinois federal judge on July 1 dismissed with prejudice a first amended complaint alleging that a health care provider submitted false claims pursuant to Medicare and Medicaid, holding that the plaintiff failed to adequately plead his claims and would not be able to correct the deficiencies with further amendment (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 89167).
NEW ORLEANS - A divided Louisiana Supreme Court on July 1 held that a participant in a health insurance plan can sue her insurer for alleged violations of the state's balance billing law committed by a health care provider contracting with the insurer (Aaron Emigh, et al. v. West Calcasieu Cameron Hospital, et al., No. 2013-2985, La. Sup.; 2014 La. LEXIS 1555).
CINCINNATI - A panel of the Sixth Circuit U.S. Court of Appeals on July 1 affirmed that a coordination of benefits provision in an employee welfare benefit plan governed by the Employee Retirement Income Security Act trumped a coordination of benefits policy in a regular health insurance policy, thus making the regular insurer the primary party responsible for paying medical claims when beneficiaries had coverage under both plans (Central States, Southeast and Southwest Areas and Welfare Fund v. First Agency Inc., et al., No. 13-2077, 6th Cir.; 2014 U.S. App. LEXIS 12370).
WASHINGTON, D.C. - The Supreme Court on July 3 enjoined enforcement of the Patient Protection and Affordable Care Act (ACA)'s contraceptive mandate while a nonprofit Christian liberal arts college appeals an adverse ruling (Wheaton College v. Sylvia Mathews Burwell, et al., No. 13A1284, U.S. Sup.).
ST LOUIS - Finding that the Patient Protection and Affordable Care Act (ACA) contraceptive mandate imposed a substantial burden on the religious beliefs of two groups and that the government had not instituted the least restrictive method of achieving its goals, a Missouri federal judge granted a motion for preliminary injunction June 30 (Archdiocese of St. Louis and Catholic Charities of St. Louis v. Sylvia M. Burwell, et al., No. 13-2300, E.D. Mo.; 2014 U.S. Dist. LEXIS 88918).
WASHINGTON, D.C. - The Supreme Court should deny a nonprofit Christian liberal arts college's request for an emergency injunction of the Patient Protection and Affordable Care Act (ACA) contraceptive mandate while it appeals an adverse ruling, the government said July 2 in its first post-Burwell v. Hobby Lobby Stores Inc. (573 U.S. ___ ) filing (Wheaton College v. Sylvia Mathews Burwell, et al., No. 13A1284, U.S. Sup.).
CHICAGO - A battle over Patient Protection and Affordable Care Act (ACA) fund disbursement is heading back to state court after the Seventh Circuit U.S. Court of Appeals ruled June 27 that practical considerations cannot overcome the lack of federal jurisdiction (Hartland Lakeside Joint No. 3 School District, Oconomowoc Area School District, and Arrowhead Union High School District v. WEA Insurance Corp., et al., No. 13-3787, 7th Cir.).