Managed Care Litigation Update Volume 214: December 15, 2022

• Publication year: 2022

NEWSWORTHY

Ninth Circuit issues unpublished opinion affirming enforcement of anti-assignment provision, finding that unlike in Beverly Oaks, provider did not engage in the administrative claims process or otherwise indicate it was acting as an assignee. Brand Tarzana Surgical Institute, Inc. v. Int'l Longshore & Warehouse Union-Pacific Maritime Ass'n. Welfare Plan, et al., USAC 9^th Cir., No. 22-55211, 2022 WL 17538750, (Doc. 44, filed Dec. 8, 2022).

Eight Circuit affirms decision granting permanent injunction in favor of plaintiffs objecting to coverage of gender-transition procedures, holding that the HHS implementation of Section 1557 and Title VII violate the Religious Freedom Restoration Act of 1993. The Religious Sisters of Mercy, et al. v. Becerra, et al., USAC 8^th Cir., No. 21-1890, 2022 WL 17544669, (Doc. 5225412, filed Dec. 9, 2022).

New York state court dismisses claim of plastic surgeon and holds that letter issued to beneficiary granting an in-network exception did not defeat ERISA preemption, nor could it be the basis of a breach of contract claim or claim for promissory estoppel. Norman Maurice Rowe, M.D., M.H.A., LLC v. Oxford Health Insurance Company, Inc., et al., NY Sup. Ct., No. 713556/21, 2022 WL 17411567, (filed Nov. 30, 2022).

District court dismisses claim of Medicare Advantage beneficiary who challenged the denial of certain dental treatment, holding that plaintiff failed to demonstrate he exhausted administrative remedies and therefore could not establish subject matter jurisdiction. Rong Zhang v. UnitedHealthCare, USDC D. AZ, No. 20-cv-2064-PHX-GMS, 2022 WL 17537985, (Doc. 38, filed Dec. 8, 2022). Previously reported in MCLU Vol. 163.

RECENTLY FILED ACTIONS

Walkyra Hernandez, et al. v. Cigna Health and Life Insurance Company, U.S.D.C. S.D. FL, Doc. No. 1:22-cv-23926-BB, (filed Dec. 1, 2022). Two members seek ERISA benefits and allege underpayment associated with separate back surgeries for which plaintiffs allege they are being balance billed. Billed charges on the first plaintiff for both the surgeon and the Physician Assistant were $157,934, and the amounts paid were $3,723.39, and $14,000, respectively. Billed charges on the first plaintiff for both the surgeon and the Physician Assistant were $157,934, and nothing was paid on either claim.

Prime Healthcare Services - Garden City, LLC v. Aetna Life Insurance Company, U.S.D.C. E.D. MI, Doc. No. 2:22-cv-12915-LJM-APP, (filed Dec. 1, 2022). Removed action in which hospital seeks over $4 million in alleged underpayments associated with...