20 results for 'nos:"Medicare Act - Contract"'.
J. Kelly grants the hospital's motion for summary judgment in its suit against the Secretary of Health and Human Services challenging an administrative finding that the Provider Reimbursement Review Board could not review the hospital's full-time equivalent resident cap for the years from 2004-2007, in which it inadvertently omitted four programs from reimbursement calculations. The Board's decision was based on a flawed reading of the Medicare Modernization Act. The hospital's full-time equivalent resident cap was not an unreviewable "determination" made by the Secretary. Even if it was, the 2006 and 2007 caps are not precluded from review, since the Secretary only used the hospital's 2002 cap in determining the hospital's "otherwise applicable resident limit."
Court: USDC District of Columbia, Judge: Kelly, Filed On: March 30, 2024, Case #: 1:20cv3160, NOS: Medicare Act - Contract, Categories: Administrative Law, Health Care
J. Jackson dismisses, for lack of subject matter jurisdiction, three hospitals’ lawsuit against the Department of Health and Human Services for how it calculated the funds due to the hospitals under Medicare’s disproportionate share hospital adjustment. The hospitals did not exhaust their administrative remedies before suing.
Court: USDC District of Columbia, Judge: Jackson, Filed On: March 29, 2024, Case #: 1:22cv2272, NOS: Medicare Act - Contract, Categories: Administrative Law, Jurisdiction, Medicare
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[Consolidated.] J. Lipman denies the laboratory company's summary judgment motion and partially grants the government defendant's competing motion in this lawsuit concerning the company's reimbursements "received on Medicare Part B claims" and an auditor's conclusions that the company was overpaid. The court concludes that the two counts regarding "a potential due process violation around the universe of claims and the failure to include zero-paid claims in the sampling" should be dismissed.
Court: USDC Western District of Tennessee , Judge: Lipman, Filed On: March 26, 2024, Case #: 2:22cv2770, NOS: Medicare Act - Contract, Categories: Government, Health Care
J. Scarsi grants an insurance company's motion to dismiss an insured's claims of breach of contract and elder abuse for not receiving benefits that he alleges he is due under his insurance policy. The insured has not exhausted Medicare’s administrative review procedures for his breach of contract or breach of the implied covenant of good faith and fair dealing claims. The insured is granted leave to amend his elder neglect claim.
Court: USDC Central District of California, Judge: Scarsi, Filed On: January 24, 2024, Case #: 2:23cv6324, NOS: Medicare Act - Contract, Categories: Insurance, Medicare, Contract
J. Kollar-Kotelly finds, in part, for a group of hospitals on their appeal of the Provider Reimbursement Review Board's dismissal of their administrative appeal challenging the Medicare compensation they received. Contrary to the board's determination, it had jurisdiction over their appeal, as the Centers for Medicare & Medicaid Services' publications are considered final determinations.
Court: USDC District of Columbia, Judge: Kollar-Kotelly, Filed On: October 31, 2023, Case #: 1:17cv545, NOS: Medicare Act - Contract, Categories: Administrative Law, Health Care, Medicare
J. Young denies an insurance company's motion to dismiss a claim brought against it and another insurance company for allegedly failing to make timely, appropriate reimbursements for their beneficiaries' medical expenses. The claim was brought against the insurance companies by a recovery specialist, which makes a plausible argument that the insurance companies have a responsibility to be primary payers because they are primary plans in this case.
Court: USDC Massachusetts, Judge: Young, Filed On: July 25, 2023, Case #: 1:22cv11681, NOS: Medicare Act - Contract, Categories: Health Care, Insurance
J. Casper allows the insurers' motion for judgment on the pleadings in a collection entity's suit under the Medicare Secondary Payer Act alleging they did not reimburse a Medicare Advantage Organization for medical expenses paid on behalf of insureds. The collection entity lacks standing to proceed with its claims since it did not plausibly allege "injury-in-fact or causation."
Court: USDC Massachusetts, Judge: Casper, Filed On: June 21, 2023, Case #: 1:22cv11271, NOS: Medicare Act - Contract, Categories: Civil Procedure, Insurance, Medicare
J. Sullivan denies an individual's motion for clarification of the district court's previous opinion, which denied the Secretary of the Department of Health and Human Services' motion to dismiss the individual's challenge to a denial of Medicare coverage. Contrary to the individual's arguments, the court only previously decided it had subject matter jurisdiction due to conflicts regarding certain therapy trial requirements, while it did not decide whether other conflicts exist.
Court: USDC District of Columbia, Judge: Sullivan, Filed On: May 24, 2023, Case #: 1:17cv797, NOS: Medicare Act - Contract, Categories: Civil Procedure, Jurisdiction, Medicare