Managed Care Litigation Update Volume 220: March 15, 2023

• Publication year: 2023

NEWSWORTHY

Fifth Circuit affirms dismissal of claims associated with proton beam therapy against Office of Personnel Management, finding FEHBA preemption. Gonzalez v. Blue Cross Blue Shield Assoc., USAC 5^th Cir., No. 22-10062, 2023 WL 2473296 (Doc. 65, filed Mar. 13, 2023). Previously reported at MCLU Vol. 158.

District court grants plan's motion to dismiss claims of OON provider seeking reimbursement for Covid testing, finding there is no private right of action under the CARES Act, the Families First Coronavirus Response Act, or the ACA section 300gg-19a. Murphy Medical Associates, LLC v. Centene Corp., USDC D Conn., No. 3:22-CV-504-VLB, 2023 WL 2384143 (Doc. 47, filed Mar. 6, 2023).

District court dismisses without prejudice OON provider's state law claims related to health plan after finding ERISA complete preemption. Park Avenue Podiatric v. Cigna Health & Life Ins. Co., USDC SD NY, No. 1:22-cv-10312-AKH, 2023 WL 2478642, (Doc. 19, filed Mar. 13, 2023). Previously reported at MCLU Vol. 214.

District court grants plan's motion to dismiss patient's claim for coverage of wilderness therapy, finding patient failed to state a claim under the Mental Health Parity and Addiction Equity Act. L.L.., individually and on behalf of J.L., a minor, v. Anthem Blue Cross Life & Health Ins., DLA Welfare Benefit Plan, USDC D UT, No. 2:22-cv-208-DAK, 2023 WL 2480053 (Doc. 34, filed Mar. 13, 2023). Previously reported at MCLU Vol. 197.

RECENTLY FILED ACTIONS

Felix Brizuela v. Highmark Blue Cross Blue Shield of Pennsylvania, U.S.D.C. W.D. PA, Doc. No. 2:23-cv-337, (filed Mar. 1, 2023). Pro se clinical neurologist asserts civil rights violations in response to FWA investigation involving suspected kickbacks associated with intravenous gamma globulin (IVIG).

Jeffrey M. Folland, et al. v. [ ], Blue Cross Blue Shield of Illinois, U.S.D.C. E.D. MI, Doc. No. 2:23-cv-10511-LJM-APP, (filed Mar. 2, 2023). Member challenges $81,194.45 ERISA subrogation lien and asserts Michigan No-Fault Act to shield recovery from the benefits paid by the automobile liability policy, which is asserting that it will coordinate benefits.

RECENTLY FILED ACTIONS

Christy Vacondios v. Blue Cross and Blue Shield of Florida, Inc., et al., U.S.D.C. M.D. FL, Doc. No. 8:23-cv-476-SDM-MRM, (filed Mar. 2, 2023). Member seeks ERISA benefits from self-funded plan associated with air ambulance transportation from Lakewood Medical Ranch Medical Center to Johns Hopkins All Children's Hospital to treat Diabetic Ketoacidosis. The claim was denied as not medically necessary.

East Coast Aesthetic Surgery NJ v. Cigna Health and Life...