Managed Care Litigation Update Volume 210: October 15, 2022

• Publication year: 2022

NEWSWORTHY

District court denies motion to dismiss by MA plans challenging theory of false claims action in with "the Government alleges that Defendant has knowingly disregarded its duty to ensure the accuracy of the risk adjustment data that it submitted to [CMS] under the Part C plans operated by Anthem." United States v. Anthem Inc., USDC SD NY, No. 20-cv-2593-ALC, 2022 WL 4815978 (Doc. 60, filed Sep. 30, 2022).

District court grants motions to stay pending arbitration pursuant to various provider agreements where the Chickasaw Nation alleges violations of the Recovery Act against various PBMs. Chickasaw Nation v. Caremark PHC, LLC, USDC ED OK, No. 6:20-cv-488-PRW, 2022 WL 4624694, (Doc. 119, filed Sep. 30, 2022).

District court grants plan's motion to dismiss putative class action asserting violations of the FFCRA and CARES Acts, holding that the "overwhelming majority of district courts have addressed the issue have found [neither of these statutes] creates a private right of action." Saloojas, Inc. v. Blue Shield of California Life and Health Insurance Company, USDC ND CA, No. 3:22-cv-3267-MMC, 2022 WL 4843071, (Doc. 27, filed Oct. 3, 2022). Previously reported in MCLU Vol. 202.

RECENTLY FILED ACTIONS

Jordan P. Farkas, MD v. Aetna Life Insurance Company, et al., U.S.D.C. D. NJ, Doc. No. 2:22-cv-5858-JMV-AME, (filed Oct. 3, 2022).

Removed action in which OON provider and alleged attorney in fact seeks benefits and alleges underpayment associated with "emergency services to the patient to treat the injuries to his left knee." Billed charges were $9,921 and no payment was made.

Nakul Karkare, M.D. v. Oxford Health Insurance, Inc., U.S.D.C. E.D. NY, Doc. No. 2:22-cv-5886-JMA-JMW, (filed Oct. 3, 2022). OON physician and alleged attorney in fact seek ERISA benefits and assert underpayment associated with emergency orthopedic surgery. Billed charges were $210,808 and the amount paid was $8,057.32.

Vanguard Plastic Surgery, PLLC v. Aetna Life Insurance Company, U.S.D.C. S.D. FL, Doc. No. 0:22-cv-61853-WPD, (filed Oct. 4, 2022). OON provider group seeks benefits from county school plan and alleges underpayment associated with treatment of 3 patients involving mastectomies and breast reconstruction services. The asserted difference between billed charges and amounts paid are $702,346.33, $632,390.42, and $21,293.92, respectively. Other actions filed by this provider are reported in MCLU Vol. 159, 161, 163, 168, 171, 178, 189, 191, 192, 197, 202, 207, 208,...