68 results for 'cat:"Health Care" AND cat:"Insurance"'.
J. Walker grants a health insurance company’s motion to dismiss a lawsuit brought against it by a hospital trying to have the insurance company cover healthcare services it provided to one of its insured. The hospital did not exhaust the administrative process in trying to get the insurance company to cover the cost of services it provided.
Court: USDC Maine, Judge: Walker, Filed On: April 23, 2024, Case #: 2:23cv258, NOS: Other Contract - Contract, Categories: health Care, insurance, Contract
J. Chen allows some disability discrimination claims to proceed against CVS from around a half-dozen CVS health plan participants who say the plans are designed to discriminate against people living with HIV/AIDS. The participants say the company makes it needlessly inconvenient and complicated for them to get their medications and that CVS ignores requests from participants looking to opt-out. At least one of the half-dozen participants has proven that they reached out to CVS to opt-out several times, but were ignored or denied each time. This is enough to show that they were denied benefits under their plan, allowing some of the claims to continue to the next stage.
Court: USDC Northern District of California, Judge: Chen, Filed On: April 18, 2024, Case #: 3:18cv1031, NOS: Other Labor Litigation - Labor, Categories: health Care, insurance
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J. Johnston grants the air ambulance service's motion for summary judgment in its suit challenging the West Virginia Insurance commissioner's enforcement of the Air Ambulance Protection Act. Using the 1993 film '"Groundhog Day" as a backdrop, the court finds the insurance commissioner's continuous attempt to declare the membership-based EMS service as being in the business of insurance futile, since the Airline Deregulation Act of 1978 preempts AAPA.
Court: USDC Southern District of West Virginia, Judge: Johnston , Filed On: March 26, 2024, Case #: 2:21cv105, NOS: Other Statutory Actions - Other Suits, Categories: health Care, insurance, Injunction
J. Flanagan denies a health insurance company’s motion to dismiss breach of contract claims brought by a class of its consumers after it denied them coverage of necessary medical treatment. Two men in the class both had diagnoses of prostate cancer and their providers proposed using an allegedly highly effective form of radiation treatment. The company denied their requested benefits through ERISA because its medical policies would not allow for this “investigational” treatment. However, the company’s third party investigation into the claims likely agreed with the company’s perspective even though it was contractually obligated to treat the men, giving them protection under the Unfair and Deceptive Trade Practices Act.
Court: USDC Eastern District of North Carolina, Judge: Flanagan, Filed On: March 26, 2024, Case #: 5:23cv354, NOS: Employee Retirement Income Security Act (ERISA) - Labor, Categories: health Care, insurance, Class Action
J. Xinis grants, in part, the insurers motion to dismiss this healthcare insurance coverage dispute brought by two surgery centers. The surgery centers allege the insurers violated MPCA and ERISA by denying close to 600 healthcare benefit claims. The court granted the parties many times to cure pleading deficiencies and the surgery centers never complained during discovery. Therefore, the surgery centers cannot cure the deficiencies moving forward to the dismissed claims before this amended complaint but may seek leave to amend the alternative equitable theory of relief by the assignees.
Court: USDC Maryland, Judge: Xinis, Filed On: March 21, 2024, Case #: 8:21cv2680, NOS: Insurance - Contract, Categories: health Care, insurance
J. Reidinger grants default judgment in favor of an insurance underwriting company after a client defrauded Medicare, violating a policy the company financed. The client, a clinical laboratory firm, knowingly submitted false claims to Medicare. Therefore, the policy between the company and firm is null and the company is free from indemnifying the firm.
Court: USDC Western District of North Carolina, Judge: Reidinger, Filed On: March 18, 2024, Case #: 1:20cv41, NOS: Insurance - Contract, Categories: Fraud, health Care, insurance
J. Yarbrough finds that the lower court properly entered a take-nothing judgment against the appellant in this lawsuit alleging that an insurance company wrongfully drafted his bank account following the expiration of a hospital policy. The appellant sought a refund of the insurance premiums, and he testified that the policy was meant to be for two years only. However, he failed to revoke the authorization for the withdrawals in writing, and he "incorrectly interpreted the two-year termination provision which applied only to authorization for release of medical records." Affirmed.
Court: Texas Courts of Appeals, Judge: Yarbrough, Filed On: March 13, 2024, Case #: 07-23-00248-CV, Categories: Civil Procedure, health Care, insurance
J. Shea denies, in part, the insurer's motion to dismiss, ruling that although the Covid-19 testing provider has not supplied evidence of the insurer's denial of other companies, its proof of hundreds of denied claims for reimbursement of its own testing services is sufficient to establish a plausible claim for an unjust business practice under the Connecticut Unfair Trade Practices Act.
Court: USDC Connecticut, Judge: Shea, Filed On: March 12, 2024, Case #: 3:22cv83, NOS: Insurance - Contract, Categories: health Care, insurance, Covid-19
J. Melloy finds a lower court properly dismissed the Pharmaceutical Research and Manufacturers of America's claims that federal law impliedly preempts Act 1103, which prohibits drug manufacturers from placing limits on covered entities' ability to contract with outside pharmacies. The PhRMA argued that Section 340B program and the Federal Food, Drug, and Cosmetic Act preempt Act 1103. However, the commissioner of the State's insurance department sufficiently showed in court that the Act is not an obstacle for drug makers, but rather a mechanism to fulfill the purpose of 340B. Affirmed.
Court: 8th Circuit, Judge: Melloy, Filed On: March 12, 2024, Case #: 22-3675, Categories: Government, health Care, insurance
J. Oliver denies, in part, the insurance company's motion to dismiss, ruling the lead plaintiff has standing to pursue damages for disparate treatment under the Affordable Care Act despite no longer being a member of the insurance plan. The previous denials of benefits for artificial insemination procedures are traceable to the insurer and can be redressed through damages. However, because the lead plaintiff will not suffer future harm as a result of her leaving the plan, she cannot seek prospective relief through a declaratory judgment, and that portion of her complaint will be dismissed.
Court: USDC Connecticut, Judge: Oliver, Filed On: March 12, 2024, Case #: 3:22cv229, NOS: Other Civil Rights - Civil Rights, Categories: health Care, insurance, Class Action
J. Quattlebaum finds the lower court properly granted summary judgment to the insurance company. Patients sued a pediatric clinic after discovering the clinic’s in-house psychologists had lied about her credentials. The clinic's insurance company proved they could rescind its policy because the owner misrepresented that she had thoroughly checked her employees' credentials. Affirmed.
Court: 4th Circuit, Judge: Quattlebaum, Filed On: February 16, 2024, Case #: 22-1994, Categories: health Care, insurance, Contract
J. Jaquith finds the board improperly denied the Navy veteran total disability. The veteran sought a total disability rating based on unemployability and was denied for lack of service connection. Though the veteran received service connection benefits for an acquired psychiatric disorder, the board made no evidentiary findings on the unemployability claim and did not thoroughly consider its merits. Vacated
Court: Court Of Appeals For Veterans Claims, Judge: Jaquith, Filed On: February 16, 2024, Case #: 21-4193, Categories: health Care, insurance, Veterans
J. Bourgeois grants a request by a health care facility that treated a personal injury litigant, quashing parts of a subpoena by an insurer for information regarding the facility’s methods for determining the amounts to charge different patients for the litigant’s type of procedure. The insurer’s discovery requests impose an undue burden on the treatment facility because they include no time periods for assessing patient records. The treatment facility also has legitimate concerns that disclosure of its billing methods could affect its ability to negotiate a higher payment for its services from the insurer.
Court: USDC Middle District of Louisiana, Judge: Bourgeois, Filed On: February 15, 2024, Case #: 3:23cv582, NOS: Motor Vehicle - Torts - Personal Injury, Categories: health Care, insurance, Vehicle
J. Ryan finds the lower court erroneously upheld family services' denial of Medicaid benefits to the long-term care resident. The rejection notice failed to include a required denial code that would have provided her with adequate information about why her claim had been refused. Additionally, the resident's assignment of several life insurance policies to a funeral home reduced the amount of resources she could allocate toward daily care at the long-term facility, which qualified her for Medicaid benefits. Reversed.
Court: Ohio Court Of Appeals, Judge: Ryan, Filed On: January 18, 2024, Case #: 2024-Ohio-160, Categories: health Care, insurance, Medicaid
J. Mendoza finds that the district court improperly dismissed an ERISA action brought by a surgery center which sought reimbursement from Anthem Blue Cross, an insurer and claims administrator, for the costs of medical services provided to patients. Under longstanding precedent, a healthcare provider has derivative authority to enforce ERISA’s protections if it has received a valid assignment of rights. The patients effectuated a valid assignment under the surgery center's “Assignment of Benefits.” Reversed.
Court: 9th Circuit, Judge: Mendoza, Filed On: January 10, 2024, Case #: 22-55717, Categories: Erisa, health Care, insurance
J. Reidinger grants a health benefits management firm’s motion to dismiss a claim brought by a mother when her child, a beneficiary, was treated at a residential mental health facility. The firm denied the claim citing an exclusion in the mother’s health care plan. The mother exhausted the appeals process with the firm, then filed the current action to recover the cost of the claim through ERISA. However, the firm is no longer the claims administrator for the mother’s plan and so cannot provide relief.
Court: USDC Western District of North Carolina, Judge: Reidinger, Filed On: December 6, 2023, Case #: 1:21cv265, NOS: Employee Retirement Income Security Act (ERISA) - Labor, Categories: Erisa, health Care, insurance
J. Daniel denies a group of medical care providers’ motions to dismiss allegations that they submitted false claims to private insurance companies and government payors. The federal and Illinois governments claim the providers gave people seeking Covid-19 testing in 2020 a superfluous round of testing for unrelated illnesses, passed the costs on to insurers, and then raked in as much as $3.6 million of inflated reimbursements. The court finds the government has sufficiently alleged these allegations for fraud and false claims.
Court: USDC Northern District of Illinois, Judge: Daniel, Filed On: November 27, 2023, Case #: 1:21cv2544, NOS: Other Statutory Actions - Other Suits, Categories: Fraud, health Care, insurance
J. Gonzalez dismisses an antitrust complaint that alleges United Healthcare, a health care insurance provider, leveraged its dominant market power to force anesthesia practices located in the New York metropolitan area to accept dramatically lower reimbursement rates, in some cases 80% less, for out-of-network services provided to public sector employees enrolled under its Empire insurance plan. The care providers fail to allege the market as a whole suffered significant harm as a result of the administrator’s actions for the purposes of its antitrust claims.
Court: USDC Eastern District of New York, Judge: Gonzalez, Filed On: November 21, 2023, Case #: 2:22cv4040, NOS: Antitrust - Other Suits, Categories: Antitrust, health Care, insurance
J. DeGiusti denies the defendant insurance company's motion for summary judgment in this breach of contract lawsuit involving a customer's medical claims and its decision to rescind his health insurance policy over an answer on his insurance application. The customer did not consent to the rescission based on the return of his premium payments. Additionally, there is a question of fact precluding summary judgment on the customer's bad faith claim, specifically as to the reasonableness of the company's investigation.
Court: USDC Western District of Oklahoma , Judge: DeGiusti, Filed On: November 13, 2023, Case #: 5:22cv155, NOS: Insurance - Contract, Categories: health Care, insurance
J. Edmondson finds the court of civil appeals improperly reversed the trial court’s holding that the insurance company’s release failed to include an assignment from the party injured in a car accident. The insurer disputed charges by the medical providers in its release and the trial court ruled that there was no assignment by the injured party. The Oklahoma Supreme Court finds there is no assignment in the release and no questions of fact. Without evidence of fraud, precontract negotiations are superseded by the release. The appeals court is vacated, and the matter is remanded to the trial court.
Court: Oklahoma Supreme Court, Judge: Edmondson, Filed On: November 7, 2023, Case #: 119644, Categories: health Care, insurance
J. Cadish finds the district court properly dismissed this complaint brought by the hospital association challenging the constitutionality of a bill in the Nevada Unfair Trade Practices Act preventing health care providers from incentivizing use of certain providers, and other acts constituting restraint on trade. The association does not set forth sufficient facts regarding its claimed significant burden of the bill on interstate commerce. Simply saying that the bill burdens commerce fails to meet the notice-pleading standard. Affirmed.
Court: Nevada Supreme Court, Judge: Cadish, Filed On: November 6, 2023, Case #: 84991, Categories: Constitution, health Care, insurance