Managed Care Litigation Update Volume 196: March 15, 2022

• Jurisdiction: United States,Federal
• Publication year: 2022
• Citation: Vol. 196

NEWSWORTHY

District court concludes FFCRA and CARES acts do not create a private right of action in case brought by laboratories claiming underpayment and wrongful denials associated with COVID-19 testing. Murphy Medical Associates, LLC, et al. v. Cigna Health and Life Ins. Co., et al., USDC D. CT, No. 3:20-cv-1675-JBA, 2022 WL 743088, (Doc. 48, filed Mar. 11, 2022).

District court denies summary judgment of PBM where employee plan alleges PBM breached the administrator contract by failing to meet the fraud detection and response requirements of the parties' contract, resulting in significant increases in compound drug prescription costs. New York City Transit Authority v. Express Scripts, Inc., USDC SD NY, No. 1:19-cv-5196-JMF, 2022 WL 603937, (Doc. 144, filed Mar. 1, 2022).

District court determined the administrative record was incomplete and demonstrated procedural irregularities and accordingly remanded ERISA claim for breast reconstruction to plan administrator for reprocessing. Edith Evans v. United Healthcare of Oklahoma, Inc., USDC ND OK, No. 4:20-cv-670-CVE-SH, (Doc. 72, filed Feb. 2, 2022). Previously reported in MCLU Vol. 167.

RECENTLY FILED ACTIONS

BCBSM, Inc., et al. v. GS Labs, LLC, U.S.D.C. D. MN, Doc. No. 022-cv-513-ECT-DTS, (filed Mar. 1, 2022). Plan asserts overpayment and seeks recoupment associated with COVID-19 lab tests where plan asserts "GS Labs systematically subjects insured patients seeking COVID screening to expensive and wasteful testing (including testing for non-COVID diagnoses)." Similar claims against this provider reported in MCLU Vol. 181, 186.

RECENTLY FILED ACTIONS

Olaoluwa O. Ilelaboye v. Humana Wisconsin Health Organization Insurance Corporation, U.S.D.C. W.D. WI, Doc. No. 3:22-cv-108-jdp, (filed Mar. 1, 2022). Removed action in which member seeks ERISA benefits associated with OON emergency services and asserts plan should pay more than just the maximum allowable fees.

Michigan Spine & Brain Surgeons, PLLC, et al. v. [ ], Aetna Life Insurance Company, U.S.D.C. E.D. MI, Doc. No. 2:22-cv-10448-NGE-EAS, (filed Mar. 1, 2022). Surgeon and alleged assignee seeks ERISA benefits associated with minimally invasive laminectomy, left transpedicular decompression, and fusion from L3 to S1. Both the facility fee and the professional services fee were denied on the grounds plaintiff was not current with premiums due to retroactive increase in cost that erased a credit balance.

The Discovery House, LLC, et al. v. Cigna...