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).
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).
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.)
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).
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).
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.
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).
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.).
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.).
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).
EAST BATON ROUGE, La. - A Louisiana appeals court on March 20 reversed the dismissal of a breach of health insurance contract, saying a state statute related to peremption periods did not extend to insurance companies (Laura E. Sibley v. Blue Cross Blue Shield of Louisiana, Nos. 2013 CA 0924, 2013 CA 0925, La. App., 1st Cir.; 2014 La. App. LEXIS 721).
WASHINGTON, D.C. - The U.S. Supreme Court on March 24 denied a petition for writ of certiorari filed by multiple licensed ambulatory surgical centers, leaving in place the dismissal of their health care reimbursement suit against multiple health insurance companies (Sanctuary Surgical, et al. v. Aetna Health Inc., et al., No. 13-932, U.S. Sup.).
ATLANTA - A Georgia appeals court on March 20 reversed class action status in a case challenging a hospital's lien practice against patients and remanded the case with instructions for the trial court to reconsider its summary judgment decision in light of an appeal's court decision in a similar case issued after the trial court rendered its opinion (MCG Health Inc. v. Donna Perry, et al., No. A13A1996, Ga. App., 4th Div.; 2014 Ga. App. LEXIS 190).
NEW YORK - A New York federal judge on March 19 denied a plaintiff's motion to remand a breach of contract dispute over payment for home health care services and instead dismissed the suit, saying that the Employee Retirement Income Security Act preempted the plaintiff's claim, which really was for "right of payment" and not "amount of payment" (Star Multi Care Services Inc. v. Empire Blue Cross Blue Shield, et al., No. 13-1138, E.D. N.Y.; 2014 U.S. Dist. LEXIS 36287).
MADISON, Wis. - A Wisconsin federal judge on March 19 dismissed a health care reimbursement dispute between a health care provider and health insurance plan for lack of venue (University of Wisconsin Hospital and Clinics Authority, et al. v. RFMS Inc. Mutual Medical Plans, No. 13-610, W.D. Wis.; 2014 U.S. Dist. LEXIS 36075).
MILWAUKEE - The alleged reduction in clients physicians who accept only cash might face from the delayed implementation of the Patient Protection and Affordable Care Act (ACA)'s employer mandate is too attenuated to provide standing to sue the Internal Revenue Service, a Wisconsin federal judge held March 18 (Association of American Physicians & Surgeons Inc., and Robert T. McQueeney v. John Koskinen, commissioner of the Internal Revenue Service, in his official capacity, No. 13-1214, E.D. Wis.; 2014 U.S. Dist. LEXIS 34980).
SELMA, Ala. - A health insurance provider on March 14 removed a denial of health care benefits case to an Alabama federal court and moved to dismiss the case, saying the Employee Retirement Income Security Act preempted the plaintiffs' claims (Jane Wallace, et al. v. Blue Cross Blue Shield, No. 14-119, S.D. Ala.).
WASHINGTON, D.C. - The U.S. Department of Health and Human Services on March 18 issued a proposed rule covering what changes to an existing policy constitute a discontinuation of that policy under the Patient Protection and Affordable Care Act (ACA), altering risk corridor regulations and governing civil penalties for fraud in the exchanges.
WASHINGTON, D.C. - Patient Protection and Affordable Care Act (ACA) insurers must accept payment from federal and state programs that provide premium and cost-sharing support for specific individuals, the U.S. Department of Health and Human Services announced March 14.
DAYTON, Ohio - An Ohio appeals court on March 14 affirmed that a hospital provider and a Medicaid managed care payer were required to arbitrate all of their claims related to a payment dispute (Kettering Health Network v. CareSource, No. 25928, Ohio App., 2nd Dist.; 2014 Ohio App. LEXIS 895).
SAN FRANCISCO - A California federal judge on March 14 affirmed that the Medicare Appeals Council correctly denied a request by a claimant for a referral to a specialist, saying the claimant failed to exhaust the administrative appeals process (Theodore McElhone v. Kathleen Sebelius, No. 12-6090, N. D. Calif.; 2014 U.S. Dist. LEXIS 33944).
WASHINGTON, D.C. - Patient Protection and Affordable Care Act (ACA) insurance plans offering same-sex coverage must also offer opposite-sex coverage starting in 2015, Health and Human Services official Matthew Heinz clarified in a March 14 blog post.
NEWARK, N.J. - On March 13, just two days after plaintiffs filed a brief in a New Jersey federal court in support of a $120 million settlement agreement in a dispute over out-of-network reimbursement rates, defendant Aetna Inc. filed a notice of termination of the settlement, saying opt-outs from the settlement exceed allowed thresholds (In Re: Aetna UCR Litigation, Master File No. 07-3541, MDL 2020, D. N.J.).
TRENTON, N.J. - In an unpublished opinion, a New Jersey federal judge on March 13 affirmed that a magistrate judge correctly denied a plaintiff's request to file a third amended complaint in a dispute over Consolidated Omnibus Budget Reconciliation Act (COBRA) benefits (Stephen J. Simoni v. Meridian Health Systems Inc., et al., No. 11-7528, D. N.J.; 2014 U.S. Dist. LEXIS 33145).
WASHINGTON, D.C. - The U.S. House on March 11 passed a trio of bills seeking to grant additional religious exemptions from the Patient Protection and Affordable Care Act (ACA)'s individual mandate and excluding military personnel and emergency services volunteers from the law's individual and employer mandates.