Managed Care Litigation Update Volume 208: September 15, 2022

• Publication year: 2022

NEWSWORTHY

District court grants 12(b)(1) motion to dismiss on basis of the enforceability of ERISA plans' anti-assignment clauses. Superior Biologics NY, Inc. v. Aetna, Inc., et al., USDC SD NY, No. 20-cv-5291-KMK, 2022 WL 4110784 (Doc. 69, filed Sep. 8, 2022). Previously reported at MCLU Vol. 156.

District court grants motion to dismiss Section 1557 claim alleging impermissible discrimination based on member's gender, holding that complaint failed to allege that the health policy was associated with a health program or activity that receives federal assistance and that plaintiff's allegation that the basis of the denial was due to plaintiff's gender was conclusory. Tinsley Ariana Taylor Makayla Saramosing v. Health Care Service Corp., USDC WD OK, No. 21 -cv-669, 2022 WL 4086565 (Doc. 17, filed Sep. 6, 2022). Previously reported at MCLU Vol. 180.

District court dismisses for lack of personal jurisdiction claims of pharmacy against plans where the plans' PBM terminated the pharmacy from the network, determining that the termination from the PBM network had nothing to do with the defendants' contacts with the forum state. CZ Services, Inc., et al. v. Anthem Insurance Companies, Inc., et al., USDC ND CA, No. 19-cv-4453-JD, 2022 WL 4126281 (Doc. 124, filed Sep. 9, 2022).

State court of appeals, in reversal of trial court, determined Kentucky's 2020 Medicaid Managed Care RFP was valid and rejects bid protest of Anthem, while remanding for dissolution of temporary injunction awarding Anthem an MCO contract. Molina Healthcare of Kentucky, Inc. v. Anthem Kentucky Managed Care Plan, Inc., et al., KY App. Ct., No. 2021 -CA-0806, 2022 WL 4112393, (filed Sep. 9, 2022).

RECENTLY FILED ACTIONS

Vanguard Plastic Surgery, PLLC v. Aetna Life Insurance Company, U.S.D.C. S.D. FL, Doc. No. 0:22-cv-61639-RS, (filed Sep. 1, 2022). OON plastic surgeon seeks benefits and alleges underpayment associated with alleged emergency surgery. Billed charges were $97,651 and the amount paid was $1,704.89. Other actions filed by this provider are reported in MCLU Vol. 159, 161, 163, 168, 171, 178, 189, 191, 192, 197, 202, 207.

O.C. Multispecialty Surgery Center v. Aetna Life Insurance Co., et al., U.S.D.C. C.D. CA, Doc. No. 2:22-cv-6236-MWF-KS, (filed Sep. 1, 2022).

Removed action in which OON facility and alleged assignee seeks ERISA benefits and alleges underpayment associated with treatment of 5 members. Other actions filed by this provider are reported in MCLU Vol. 179, 183, 184.

RECENTLY FILED ACTIONS

Nick Ingertson v. Aetna Health Inc., et al., U.S.D.C. D. AZ, Doc. No. 4:22-cv-395-JAS, (filed Sep. 2, 2022). Removed action in which member seeks...