Managed Care Litigation Update Volume 218: February 15, 2023

• Jurisdiction: United States,Federal
• Publication year: 2023
• Citation: Vol. 218

NEWSWORTHY

District court grants summary judgment to TPA of ERISA plans where members alleged putative class action challenging UMR's level of care guidelines for residential treatment of mental health and substance abuse disorders, holding that the adoption of the guidelines was consistent with the plans' terms and that the denials of plaintiff's specific claims were a proper exercise of discretion. Luciana Berceanu, et al. v. UMR, Inc., USDC WD WI, No. 3:19-cv-568-wmc, 2023 WL 1927693, (Doc. 169, filed Feb. 10, 2023).

District court vacates revised rule implementing the No Surprises Act on the grounds that "[a]lthough the Departments have abandoned the 'rebuttable presumption' term, they have not relinquished their goal of privileging the QPA, tilting arbitrations in favor of insurers, and thereby lowering payments to providers." Texas Medical Ass'n, et al. v. United States Dep't of Health and Human Svcs, et al., USDC ED TX, No. 6:22-cv-372-JDK, 2023 WL 1781801, (Doc. 99, filed Feb. 6, 2023).

District court dismisses underpayment claims of laboratory challenging reimbursement amounts for COVID testing, permitting leave to amend only a single state law claim. The court held plaintiff did not have ERISA standing as it did not possess assignments. Saloojas, Inc. v. Aetna Health of California, Inc., USDC ND CA, No. 3:22-cv-2887-JSC, 2023 WL 1975248, (Doc. 54, filed Feb. 13, 2023). Previously reported at MCLU Vol. 201.

RECENTLY FILED ACTIONS

Dual Diagnosis Treatment Center, Inc., et al. v. [ ], Optum Services, Inc., U.S.D.C. C.D. CA, Doc. No. 2:23-cv-742, (filed Feb. 1, 2023). OON mental health treatment facilities and laboratories allege RICO conspiracy to force plaintiffs out of business and avoid "paying over $65 million in legitimate mental health claims." Plaintiffs allege defendants misused the special investigations unit to deny legitimate claims. Other actions by these providers reported at MCLU Vol. 152, 163, 192, 195, 197.

RECENTLY FILED ACTIONS

OptumRX, Inc. v. Paducah Pharmacy Inc., U.S.D.C. D. MN, Doc. No. 0:23-cv-257-SVN-LIB, (filed Feb. 1, 2023). PBM seeks arbitration with participating pharmacy regarding disputed reimbursements for prescription drugs pursuant to arbitration provision in provider manual.

SEE ALSO:
• OptumRX, Inc. v. Elk River Pharmacy Inc., U.S.D.C. D. MN, Doc. No. 0:23-cv-258-WMW-ECW, (filed Feb. 1, 2023).

Brittany Fritsch v. Blue Shield of California, U.S.D.C. D. CO, Doc. No. 1:23-cv-333-NRN, (filed Feb. 3, 2023). Member...