LexisNexis® Legal Newsroom
    Mealey's Health Law - 7th Circuit: Provider Not Entitled To Hearings To Challenge Deficiencies

    CHICAGO - A Seventh Circuit U.S. Court of Appeals panel on Nov. 8 affirmed that a Medicaid nursing home provider was not entitled to a hearing to challenge deficiency findings under state and federal Medicaid regulations (Bryn Mawr Care Inc. v. Kathleen Sebelius, No. 12-3687, 7th Cir.; 2014 U.S. App. LEXIS 6451).

    Mealey's Health Law - Judge Grants Unopposed Injunction Against ACA's Employer Mandate

    WASHINGTON, D.C. - A District of Columbia federal judge on April 3 granted an unopposed motion enjoining the government from applying the Patient Protection and Affordable Care Act (ACA) employer mandate (John F. Stewart, et al. v. Kathleen Sebelius, et al., No. 13-1879, D. D.C.).

    Mealey's Health Law - Pennsylvania Court Says Change To Medicaid Payment System Appropriate

    HARRISBURG, Pa. - In an unpublished April 3 opinion, a panel of the Commonwealth Court of Pennsylvania affirmed a decision denying a hospital's challenge to the implementation of a new Medicaid payment system (Monongahela Valley Hospital Inc. v. Department of Public Welfare, No. 1110 C.D. 2013, Pa. Commw.; 2014 Pa. Commw. Unpub. LEXIS 202).

    Mealey's Health Law - 3rd Circuit Reverses Decision In Medicare Reimbursement Dispute

    PHILADELPHIA - In holding that the Health and Human Services secretary had a rational basis for distinguishing between two types of patient days in determining Medicare reimbursement rates, a panel of the Third Circuit U.S. Court of Appeals on April 1 reversed a lower court's decision (Nazareth Hospital, et al. v. Secretary, U.S. Department of Health and Human Services, No. 13-2627, 3rd Cir.; 2014 U.S. App. LEXIS 6082).

    Mealey's Health Law - Participant Has Standing To Assert Claims In Coordination Of Benefits Dispute

    NEW YORK - A federal district court erred in ruling that a health plan participant did not have standing under the Employee Retirement Income Security Act to challenge calculations of benefits for members who are eligible for Medicare, the Second Circuit U.S. Court of Appeals ruled April 4 in an unpublished opinion remanding the case to the trial court (Marianne Gates v. UnitedHealthGroup Incorporated, et al., No. 13-2114-cv, 2nd Cir.; 2014 U.S. App. LEXIS 6136).

    Mealey's Health Law - U.S. House Passes Bill Redefining Full-Time Employees Under ACA

    WASHINGTON, D.C. - The U.S. House of Representative on April 3 passed legislation redefining a full-time employee for purposes of the Patient Protection and Affordable Care Act (ACA)'s employer mandate as an individual who works on average 40 hours per week.

    Mealey's Health Law - Montana Top Court Rejects Challenge To ACA Defunding Legislation

    HELENA, Mont. - The Montana Supreme Court on April 2 denied a petition challenging the constitutionality and legal sufficiency of a proposed ballot measure barring the use of state resources to administer the Patient Protection and Affordable Care Act (ACA) (Travis Hoffman, Melissa Smylie and Kim Abbott v. State of Montana, et al., No. 14-0146, Mont. Sup.; 2014 Mont. LEXIS 107).

    Mealey's Health Law - Medical Device Provider Failed To Demonstrate ERISA Standing, 11th Circuit Rules

    ATLANTA - The provider of medical devices to health plan participants lacks standing to bring a reimbursement action against the plan insurer under the Employee Retirement Income Security Act because the provider did not demonstrate that it possessed valid written assignments of benefits from the participants or beneficiaries, the 11th Circuit U.S. Court of Appeals affirmed April 1 in an unpublished opinion (Medicomp, Inc. v. United Healthcare Insurance Co., et al., No. 13-13849, 11th Cir.; 2014 U.S. App. LEXIS 6041).

    Mealey's Health Law - Oklahoma Federal Magistrate Judge Dismisses Defendant From Denial Of Benefits Suit

    MUSKOGEE, Okla. - An Oklahoma federal magistrate judge on March 31 dismissed a defendant from a denial of benefits suit after finding that the health insurer did not have sufficient contacts with the state for the court to have jurisdiction over the defendant (Samuel Howard Logan Jr. v. Healthcare International Global Networks, et al., No. 13-1444, E.D. Okla.; 2014 U.S. Dist. LEXIS 44710).

    Mealey's Health Law - Judge Finds Statute's Effective Date Bars ACA Discrimination Claim

    NEWARK, N.J. - Although it was enacted in 2010, sections of the Patient Protection and Affordable Care Act (ACA) barring discrimination based on the licensing or certification of physicians became effective only after conduct alleged in two doctors' lawsuit, a New Jersey federal judge held March 31 (Neelendu Bose d/b/a High Crest, et al. v. Horizon Blue Cross Blue Shield of New Jersey, et al., No. 12-4671, D. N.J.; 2014 U.S. Dist. LEXIS 43244).

    Mealey's Health Law - Washington Appeals Court Affirms Denial Of Health Care Benefits

    SEATTLE - In an unpublished opinion, a Washington appeals court on March 31 affirmed the denial of benefits for a patient seeking inpatient rehabilitation services, saying the health plan at issue clearly limited the amount it would pay for such services (Bruce Pleasant, et al. v. Regence Blue Shield, No. 69143-1-1, Wash. App., Div. 1; 2014 Wash. App. LEXIS 743).

    Mealey's Health Law - D.C. Circuit Affirms Notice Of Medicare Rule Change Inadequate

    WASHINGTON, D.C. - The secretary of the U.S. Department of Health and Human Service (HHS) did not provide adequate notice and opportunity to comment before promulgating a rule that changed how disproportionate-share hospitals (DSH) received payment through Medicare, a panel of the District of Columbia Circuit U.S. Court of Appeals affirmed April 1. However, the lower court erred in directing the secretary on how to recalculate the hospitals' reimbursements using an alternative methodology and should just have remanded after identifying the error, the court added (Allina Services, et al. v. Kathleen Sebelius, Secretary of the U.S. Department of Health and Human Services, Nos. 13-5011, 13-5015, D.C. Cir.; 2014 U.S. App. LEXIS 5976).

    Mealey's Health Law - Judge Partially Grants Remand Motion, Orders Discovery On Jurisdiction Question

    CAMDEN, N.J. - A New Jersey federal judge on March 31 partially granted a plaintiff's motion to remand to state court a proposed class action case over liens asserted by a health insurer against proceeds from personal injury cases but said additional discovery was needed to determine whether an exception to the Class Action Fairness Act (CAFA) also supported remand (Michelle Roche v. Aetna Health Inc., et al., No. 13-3933, D. N.J.; 2014 U.S. Dist. LEXIS 43239).

    Mealey's Health Law - Judge: Chiropractic Group Entitled To Injunctive Relief In Recoupment Dispute

    CHICAGO - An Illinois federal judge on March 28 held that a chiropractic association was entitled to injunctive relief in its suit against a Blue Cross Blue Shield entity for failing to provide adequate notice and appeal notices prior to recouping money from previously paid claims (Pennsylvania Chiropractic Association, et al. v. Blue Cross Blue Shield Association, et al., No. 09-5619, N.D. Ill; 2014 U.S. Dist. LEXIS 41749).

    Mealey's Health Law - Massachusetts Federal Judge's Summary Judgment Order Leaves 1 Count

    BOSTON - A Massachusetts federal judge on March 26 denied the plaintiffs' motion for summary judgment in a health care reimbursement suit and partially granted the defendant's motion, leaving only one count involving 11 disputed claims to continue (Spinal Imaging Inc. v. Aetna Health Management, et al.; Radiology Diagnostics v. Aetna Health Management, et al., Nos. 09-11873, 12-11521, D. Mass.; 2014 U.S. Dist. LEXIS 40099).

    Mealey's Health Law - Pennsylvania Federal Judge Dismisses Claims In Reimbursement Dispute

    PHILADELPHIA - A Pennsylvania federal judge on March 27 dismissed a suit challenging the coverage and reimbursement of chiropractor claims, saying that one plaintiff failed to exhaust administrative remedies and that two other plaintiffs lacked standing (American Chiropractic Association, et al. v. American Specialty Health Inc., et al., No. 12-7243, E.D. Pa.; 2014 U.S. Dist. LEXIS 41769).

    Mealey's Health Law - Louisiana Federal Judge Leaves Federal And State Claims In Reimbursement Dispute

    NEW ORLEANS - A Louisiana federal judge on Marcy 27 partially dismissed a health care reimbursement dispute brought by the provider of post-mastectomy breast reconstruction medical services against an insurance company, leaving claims brought under the Employee Retirement Income Security Act and state law claims for detrimental reliance, fraud, negligent misrepresentation and breach of contract (Center for Restorative Breast Surgery, et al. v. Humana Health Benefit Plan of Louisiana, et al., No. 10-4346, E. D. La.; 2014 U.S. Dist. LEXIS 41134).

    Mealey's Health Law - Top Court Rejects Religious Groups' Challenges In Birth Control Cases

    WASHINGTON, D.C. - The U.S. Supreme Court on March 31 denied petitions for certiorari from two nonprofit religious groups claiming that the contraceptive mandate contained in the Patient Protection and Affordable Care Act (ACA) violates the Religious Freedom Restoration Act (RFRA) (Priests for Life, et al. v. Kathleen Sebelius, et al., No. 13-891, U.S. Sup., Roman Catholic Archbishop of Washington, et al. v. Kathleen Sebelius, et al., No. 13-829, U.S. Sup.)

    Mealey's Health Law - Illinois Federal Judge Dismisses Medicare Dispute For Lack Of Jurisdiction

    CHICAGO - An Illinois federal judge on March 26 dismissed a Medicare payment dispute, saying that the plaintiffs failed to exhaust the administrative review process before filing suit and that, therefore, the court lacked jurisdiction (Center for Dermatology and Skin Cancer, et al. v. Kathleen Sebelius, et al., No. 13 C 4926, N.D. Ill.; 2014 U.S. Dist. LEXIS 39907).

    Mealey's Health Law - Contraceptive Mandate Violates Religious Freedom Act, Georgia Federal Judge Says

    ATLANTA - The Patient Protection and Affordable Care Act (ACA)'s contraceptive mandate violates the Religious Freedom Restoration Act as it applies to two Georgia dioceses and related entities, a federal judge held March 26 in permanently enjoining its enforcement (The Roman Catholic Archdiocese of Atlanta, et al. v. Kathleen Sebelius, in her official capacity as Secretary, United States Department of Health and Human Services, et al., No. 12-3489, N.D. Ga.; 2014 U.S. Dist. LEXIS 39617).

    Mealey's Health Law - HHS Delays Closing Of ACA Open Enrollment For Certain Individuals

    WASHINGTON, D.C. - Open enrollment under the Patient Protection and Affordable Care Act (ACA) will continue past the March 31 deadline for those with pending applications, those who have been stymied by errors and others with exceptional circumstances, the U.S. Department of Health and Human Services (HHS) said March 26.

    Mealey's Health Law - Maine Federal Judge Affirms Secretary's Decision In Medicare Billing Dispute

    PORTLAND, Maine - A Maine federal judge on March 25 granted the secretary of Health and Human Services' (HHS) motion for summary judgment in a Medicare reimbursement dispute, finding that the secretary's decision was supported by substantial evidence and not arbitrary or capricious (Maine Medical Center v. Kathleen Sebelius, Secretary of the U.S. Department of Health and Human Services, No. 13-118, D. Maine; 2014 U.S. Dist. LEXIS 39100).

    Mealey's Health Law - Parties Brief D.C. Circuit Over Premium Support In Federally Created Exchange

    WASHINGTON, D.C. - In a sometimes combative setting before a District of Columbia U.S. Circuit Court of Appeals panel, parties argued March 25 over whether premium assistance is available under the Patient Protection and Affordable Care Act (ACA) for individuals who purchase insurance through the federal exchange because their state has not enacted an exchange (Jacqueline Halbig, et al. v. Kathleen Sebelius, et al., No. 14-5018, D.C. Cir.).

    Mealey's Health Law - High Court Hears Arguments In Birth Control Mandate Cases

    WASHINGTON, D.C. - The U.S. Supreme Court on March 25 heard arguments in two cases that will decide whether for-profit, secular businesses have to provide contraceptive services as part of their health insurance packages to employees even if they oppose such measures on religious grounds (Kathleen Sebelius, et al. v. Hobby Lobby Stores Inc., et al., No. 13-354, U.S. Sup.; Conestoga Woods Specialties Corp., et al. v. Kathleen Sebelius, et al., No. 13-356, U.S. Sup.).

    Mealey's Health Law - Federal Court Finds Secretary Properly Determined Medicare Reimbursement Rates

    WASHINGTON, D.C. - A federal judge in the District of Columbia on March 21 held that the Health and Human Services (HHS) secretary's methodology for achieving budget neutrality for Medicare reimbursement rates is a rational interpretation of the Medicare Act (Adirondack Medical Center, et al. v. Kathleen Sebelius, No. 11-313, D. D.C.; 2014 U.S. Dist. LEXIS 27305).