Managed Care Litigation Update Volume 204: July 15, 2022

• Publication year: 2022

NEWSWORTHY

Seventh Circuit holds that hospital has cause of action against state Medicaid agency under §1983 for violations of Medicaid Act for alleged failure to require timely payment by MCOs. Saint Anthony Hosp. v. Eagleson, USAC 7^th Cir., No. 21-2325, 2022 WL 2437844 (Doc. 60, filed Jul. 5, 2022).

Seventh Circuit affirms dismissal of antitrust claims against insurer by outpatient surgery clinic complaining about preferred provider contract between insurer and hospital system. Marion Healthcare, LLC v. [ ], Health Care Service Corp., USAC 7^th Cir. No. 20-1581, 2022 WL 2763502 (Doc. 65, filed Jul. 15, 2022).

District court dismisses claim of surgery center where Cigna had allegedly withheld payment for $5.6 million in ERISA benefits following the determination by Cigna that provider was engaging in fee forgiveness, and the plan terms provided Cigna the discretion to deny benefits if it determines provider engaged in fee forgiveness. Physicians Surgery Center of Chandler v. Cigna Healthcare Inc., USDC D. AZ, No. 20-cv-2007-PHX-MTL, 2022 WL 2390948 (Doc. 52, filed Jul. 1, 2022). Previously reported at MCLU Vol. 163.

District court dismisses without prejudice claims of substance abuse and mental health treatment provider on the basis of plan defenses, including anti-assignment provisions. Dual Diagnosis Treatment Center, Inc. v. Health Care Service Corp., USDC ND IL, No. 22-cv-846, 2022 WL 2528060, (Doc. 23, filed Jul. 7, 2022). Previously reported in MCLU Vol. 195.

RECENTLY FILED ACTIONS

Tiara Yachts, Inc. v. Blue Cross Blue Shield of Michigan, U.S.D.C. W.D. MI, Doc. No. 1:22-cv-603-RJJ-RSK, (filed Jul. 1, 2022). Plan sponsor sues administrator and alleges flaws in the claims processing system caused administrator to overpay claims and that the flaws were hidden from sponsor and never fixed.

Prime Healthcare Foundation - East Liverpool, LLC v. Aetna Health Inc., U.S.D.C. N.D. OH, Doc. No. 4:22-cv-1173-BYP, (filed Jul. 1, 2022). Removed action in which network hospital seeks over $6 million in benefits for "emergency care and other medical services." Hospital asserts hundreds of claims were wrongfully denied or underpaid.

RECENTLY FILED ACTIONS

Mark D. Herbert v. Aetna Life Insurance Company, et al., U.S.D.C. C.D. CA, Doc. No. 5:22-cv-1097-JGB-KK, (filed Jul. 1, 2022). Removed action in which member seeks $40,000 in ERISA benefits for "cervical disc arthroplasty" for treatment of persistent neck pain. Plaintiff asserts that the California Department of Insurance determined on external review that the procedure was medically necessary.

Robin Givens, et al. v. Blue Cross and Blue Shield of Florida, Inc., U.S.D.C. M.D. FL, Doc. No. 3:22-cv-733-TJC-MCR, (filed Jul. 5, 2022). Member...