Mealey's Health Care / ACA : Mealey's : Legal News & Analysis

Mealey's Health Care / ACA

February 29, 2024
Drugmaker, Woman Square Off On ACA’s Impact On Mirena Class Action

SAN JOSE, Calif. — The Patient Protection and Affordable Care Act (ACA) mandates that insurers cover contraceptive drugs at no out-of-pocket cost, so a woman’s lawyers should have known that she couldn’t have suffered an economic injury sufficient for standing to pursue her claims that she wouldn’t have paid for the drug had she known about its cancer risks, the manufacturer says in seeking sanctions and opposing her motion to amend. But in reply, the woman says all the evidence in the case suggests that she does have an injury and that adding named plaintiffs who can more readily produce evidence of their own injury won’t prejudice the company.
February 29, 2024
Judge Finds Medicare Act Precludes Drug Pricing Suit, Court Lacks Jurisdiction

SAN ANTONIO — The Medicare Act precludes a constitutional challenge to recent legislation permitting negotiation over the price the government pays for certain drugs, and dismissal of the lone defendant over which the court had jurisdiction leaves requires dismissal of the remaining two, a federal judge in Texas said in dismissing the case.
February 29, 2024
Parties Brief Corner Post In Health Plans’ Consolidated Illegal Exaction Cases

WASHINGTON, D.C. — In supplemental briefing in the U.S. Court of Federal Claims, the government and group health plans both say a pending U.S. Supreme Court case will not resolve their dispute in consolidated cases where the plans allege that the government illegally exacted contributions from them under the Transitional Reinsurance Program (TRP) of the Patient Protection and Affordable Care Act (ACA).
February 23, 2024
Vaccine Injury Case Properly Dismissed As Untimely, Federal Circuit Says

WASHINGTON, D.C. — The Federal Circuit U.S. Court of Appeals found no error in a decision by the U.S. Court of Federal Claims that held that equitable tolling did not apply to a vaccine injury case and that the petition was untimely.
February 23, 2024
Providers Say Pro Se Ruling Provides No Insight Into Arbitration Dispute

HOUSTON — A ruling in a case involving a pro se litigant having nothing to do with the No Suprises Act (NSA) arbitration process sheds no light on a dispute and wastes the court’s time, air ambulance providers argue in a response to an insurer’s notice of supplemental authority filed in Texas federal court.
February 22, 2024
Judge To Hold Single Argument On Summary Judgment In Drug Pricing Challenges

TRENTON, N.J. — Oral arguments on summary judgment in four cases challenging the Medicare drug negotiation rules enacted by the Inflation Reduction Act of 2022 (IRA) will be heard together, a federal judge in New Jersey said in a docket-only text order.
February 22, 2024
$169M Deal To Resolve Part Of ACA Reinsurance Row Gets Preliminary OK

WASHINGTON, D.C. — A U.S. Court of Federal Claims judge on Feb. 21 granted preliminary approval of a class settlement under which the amount the government has to pay to resolve part of a case over the Transitional Reinsurance Program (TRP) of the Patient Protection and Affordable Care Act (ACA) would drop from $185,230,024.42 to $169,022,397.28.
February 21, 2024
Government Would Get Discount Under Class Deal In ACA Reinsurance Row

WASHINGTON, D.C. — The amount the government has to pay to resolve part of a case over the Transitional Reinsurance Program (TRP) of the Patient Protection and Affordable Care Act (ACA) would drop from $185,230,024.42 to $169,022,397.28 under a class settlement proposed in the U.S. Court of Federal Claims.
February 20, 2024
U.S. High Court Won’t Review ERISA Ruling On Long-Term Residential Coverage

WASHINGTON, D.C. — The U.S. Supreme Court on Feb. 20 denied a certiorari petition in which a health benefits plan and insurer that administers it challenged two aspects of a 10th Circuit U.S. Court of Appeals ruling concerning long-term residential treatment facility coverage and argued that the opinion improperly “imposes new burdens on” such plans.
February 15, 2024
Woman Can’t Show Coverage For Combo Bariatric-Hernia Surgery, Judge Says

LOS ANGELES — A woman has not shown that she is entitled to benefits under her Employee Retirement Income Security Act health plan for a hernia surgery performed in conjunction with a gastric sleeve procedure, a federal judge in California said in findings of fact and conclusions of law.
February 13, 2024
Judge Orders Notices On Corner Post In Consolidated Illegal Exaction Cases

WASHINGTON, D.C. — A U.S. Court of Federal Claims judge has directed notices to be filed on whether a pending U.S. Supreme Court case is relevant to consolidated cases in which group health plans allege that the government illegally exacted contributions from them under the Transitional Reinsurance Program (TRP) of the Patient Protection and Affordable Care Act (ACA).
February 12, 2024
Catholic Group Urges Court To Break Stay-Challenge Cycle In Gender Transition Case

FARGO, N.D. — Despite years of litigation losses and expenses, the government wants to continue a cycle where it stays a case pending formulation of a new rule governing health insurance discrimination that will only require a new challenge once it issues, a Catholic benefits group told a federal judge in North Dakota in a challenge over gender transition care guidelines.
February 08, 2024
Panel That Upheld Judgment For Insurers In Facility Fees Row Won’t Rehear Case

NEW YORK — Saying only that it “considered the request,” a Second Circuit U.S. Court of Appeals panel that issued a summary order affirming judgment for a health insurer and related entities in a class suit over reimbursement for facility fees in New York denied a petition for panel rehearing.
February 07, 2024
Judge Wants Briefing On Due Process Standing In Drug Negotiation Case

WILMINGTON, Del. — Parties must file supplemental briefing on whether drugmaker AstraZeneca Pharmaceuticals LP enjoys standing to pursue due process claims challenging a federal government agency’s guidance for how the government selects drugs for inclusion in the Medicare negotiation program, a federal judge in Delaware said Feb. 6.
February 07, 2024
Judge: Provider Can’t Show Misconduct In No Surprises Act Arbitration Challenge

TRENTON, N.J. — An arbitrator adequately explained the reason for its decision in a dispute over reimbursement for out-of-network health care, but even if it mistakenly failed to consider all the relevant factors in its decision, that would not warrant vacating the award, which requires evidence of misconduct, a federal judge said in dismissing a case with prejudice.
February 07, 2024
Cigna: ERISA Plans Bar Algorithm Health Care Claims; UCL Claims Lack Specificity

SACRAMENTO, Calif. — Insureds’ cannot demonstrate denial of claims based solely on review by an algorithm or that the use of such a tool would violate the provisions of their Employee Retirement Income Security Act plans, the insurer tells a federal judge in California in a motion to dismiss while arguing that the plaintiffs fail to plead their California unfair competition law (UCL) claims with requisite specificity.
February 06, 2024
Amici Tout Reasons Behind, Successes Of Medicare Drug Price Law

TRENTON, N.J. — Health and consumer advocates and experts in economics and health policy were among a handful of amici curiae filing briefs on Feb. 5 in a federal court in New Jersey touting the recently enacted Medicare drug negotiation program, its successes and why the program should survive manufacturers’ motion for summary judgment.
February 06, 2024
Government Wants ACA Gender Transition Case Stayed Pending New Rules

FARGO, N.D. — Government defendants asked a federal judge in North Dakota to stay a challenge to rules promulgated under the Patient Protection and Affordable Care Act (ACA) that require insurance plans cover gender transition services, saying forthcoming rule making will replace the challenged rules and likely simplify the case.
February 06, 2024
ERISA Fiduciary Breach Claims Asserted Over J&J Drug Plan That Used PBM

CAMDEN, N.J. — Calling herself a “whistleblower” and asserting fiduciary breach claims under the Employee Retirement Income Security Act, an employee on Feb. 5 filed a putative class case against Johnson and Johnson (J&J) and related entities and individuals over alleged “mismanagement of prescription-drug benefits” involving a pharmacy benefits manager (PBM).
February 02, 2024
DOL Files ERISA Suit Against TPA Over Handling Of MinnesotaCare Tax

MINNEAPOLIS — The U.S. Department of Labor (DOL) has sued a third-party administrator (TPA) in Minnesota federal court over what it alleges was at least $66.8 million the TPA collected from self-funded health benefit plans without authorization between 2016 and 2020 for a Minnesota provider tax.
February 02, 2024
11th Circuit Denies Dermatologist’s Bid To Void 8 Years Of ERISA Rulings

ATLANTA — Two 11th Circuit U.S. Court of Appeals judges have denied a request addressed to U.S. Supreme Court Justice Clarence Thomas but filed in their court in which a dermatologist sought relief including the voiding of nearly 20 rulings the 11th Circuit issued in her Employee Retirement Income Security Act cases over the last eight years.
February 01, 2024
Accounting Denied As To Disputed $185 Million Attorney Fees In Insurers’ ACA Row

WASHINGTON, D.C. — A U.S. Court of Federal Claims judge denied in part objecting class members’ motion for an accounting of a vacated $185 million attorney fee award in suits filed by insurers, some of which are insolvent, over risk-corridor payments under the Patient Protection and Affordable Care Act (ACA), finding that because the court has not yet considered a renewed fee request, the accounting is unnecessary at this time.
January 30, 2024
Judge: Twins’ Care Claims Survive ERISA Preemption, But Exhaustion Issues Remain

MIAMI — The Employee Retirement Income Security Act does not preempt contract claims brought by a medical provider seeking compensation for care provided to premature twins, but any future complaint must adequately allege exhaustion of administrative remedies, a federal judge in Florida said while granting a motion to dismiss in part.
January 24, 2024
Stay Pending Appeal Best Choice In ACA Discrimination Case, Judge Says

TACOMA, Wash. — Staying a case while an insurer appeals a ruling finding that it violated Patient Protection and Affordable Care Act (ACA) Section 1557’s prohibition on discrimination by imposing a blanket exclusion on gender-affirming care ensures that it does not have to take actions that would be difficult to undo and leaves the plaintiffs with the status quo, a federal judge in Washington said in granting the relief.
January 24, 2024
Court: Lost Income Allegations Can’t Form No Surprises Act Takings Clause Claim

NEW YORK — A medical provider’s vague allegation about the loss of future income as a result of the enactment of the No Surprises Act’s ban on balance billing and creation of a dispute resolution process do not allege a regulatory taking, a panel of the Second Circuit U.S. Court of Appeals said Jan. 23 in partially affirming dismissal of a case.