Tag Archives: lawsuits

Health plans win some, lose some in challenges to Trump ACA changes

Image by SalFlako via Flickr

Think the only big lawsuit pending on the Affordable Care Act is the Texas fight over whether the whole law is unconstitutional? Think again.

Several lawsuits are still working their way through the courts involving the unpaid cost-sharing reduction (CSR) subsidies, and risk corridor payments. Potentially, the Trump administration could be forced to pay insurers billions of dollars. (Paul Demko has reported on this extensively for Politico, and this post cribs shamelessly — but gratefully — from his knowledge.) Continue reading

New report on Big Pharma settlements highlights need for tougher enforcement

In honor of Sunshine Week, AHCJ invited organizations devoted to government transparency to write about how their work can help health care reporters. Here is the second of four.

Public Citizen’s Health Research Group today released an updated report cataloging all major financial settlements that the pharmaceutical industry has been forced to sign with federal and state governments from 1991 through 2017 for illegal activities.

The report shows a dramatic decrease since 2013 in both the total amount paid and the average penalty. Additionally, it found that state governments have virtually stopped prosecuting pharmaceutical manufacturers on their own initiative and with their own resources. Continue reading

Calif. dental board allows complaints to accumulate outside public view

Photo by courtney0609 via Flickr.

Photo by courtney0609 via Flickr.

Reporter Rachel Cook took a long and detailed look at the career of one Bakersfield, Calif., dentist and ended up with a series called “Dental Dangers,” recently published in The Bakersfield Californian.

The stories examine a history of complaints and lawsuits against Robert Tupac, who, as a board-certified prosthodontist, specializes in the restoration and replacement of teeth. Over three decades, more than a dozen of Tupac’s patients claimed his shoddy work left them with troubles ranging from bone loss to drooling, Cook wrote, and some patients reported that it would take thousands of dollars worth of corrective work to undo the harm.

In her reporting – done as a 2013 California Health Journalism Fellow – Cook described a state dental board system that allowed the alleged problems with the dentist to pile up outside public view. “A potential patient searching for competent dental care would never know about many of Tupac’s alleged professional shortcomings — or those of any other California dentist — without undertaking extensive and often difficult research,” Cook wrote. Continue reading

Watch funding, implementation and court cases as health reform moves forward

The election is over. Obamacare survived.

So what’s the story in your state or community?

Implementation. Or lack thereof.

Joanne KenenJoanne Kenen (@JoanneKenen) is AHCJ’s health reform topic leader. If you have questions or suggestions for future resources, please send them to joanne@healthjournalism.org.

So here’s an overview of where things stand in D.C. – and what it means for the health beat.

(Soon we will post a short separate item on the new state insurance exchange deadlines. If your state wants to run its own exchange, the deadline is still Nov. 16. They have more time to fill in the details though.)

The Affordable Care Act will not be repealed. Maybe the House will still hold a few symbolic repeal votes, but it’s not going to be repealed. That does not mean that critics of the law won’t try to dismantle parts of it. Some likely targets include the Medicare Independent Payment Advisory Board and some of the industry taxes, particularly the medical device tax. Watch your own legislators to see where they go on this—if you are in a state or district with a medical device industry, watch the Democrats as well as the Republicans (and the medical device businesses themselves). Ask them how they want to offset the funding; if they eliminate one of the taxes that paid for the coverage expansion, where do they want to get that money instead? Adding to the deficit isn’t going to go over as a solution.

The law’s funding is vulnerable. How vulnerable and which parts? Hard to say yet. But for what it’s worth, #DEFUND is the new Twitter rallying cry for opponents of the law (some of whom do not seem to realize that the Republican House can’t act unilaterally … but I digress). There will be ample opportunities for Republicans to try to take a whack at this, not just through the annual budget and appropriations process but through the lame duck session of Congress getting under way this week that will try to find a way of averting, at least temporarily, the fiscal cliff. Continue reading

Group tackles shady practices of Calif. insurers

In California Lawyer, Jeanette Borzo tells the story of how Los Angeles city attorneys and a private law firm teamed up to take on California insurance giants with allegations that the insurers are using intentionally obtuse forms to create excuses to rescind health coverage rather than pay for major claims.

Borzo reports that lawyer William Shernoff “argued that Blue Shield’s policy applications were designed to confuse, so that misstatements would provide an excuse for rescission should a policyholder ever require expensive treatment.” Shernoff wrote that “at a time when the policyholders are seriously ill, the insurance company walks away, leaving them uninsured, uninsurable and buried in debt.”

The lawsuits attracted the attention of California regulators and health providers alike. Doctors and hospitals, often stuck with the bills when coverage is rescinded for possibly bogus reasons, joined the class action against companies like Blue Cross of California.

“‘… it appears to have evolved into a cost-savings method,’ [Los Angeles Chief Assistant City Attorney Jeffrey] Isaacs says. ‘It’s a systematic, institutional process to flag and pull anything that looks costly to the company.’ Some insurers, he notes, even have a list of ‘rescission diagnostic codes’—a group of medical conditions that, when reported on claims, trigger an investigation into potential falsehoods on a policyholder’s application that might justify rescission.”

Three of California’s biggest insurers, Blue Cross, Blue Shield, and Health Net, have already been fined $18.3 million, but the attorneys and advocates continue to bring cases to court and push for legislative reforms.