Court Says Insurer Doesn’t Have To Reconsider Thousands Of Claims
United Behavioral Health had been required to reconsider tens of thousands of denied claims for mental health, drug and alcohol care but an appeals court has now overturned the earlier rulings. Mount Sinai, the American Hospital Association, the NIH, and more are also in the news.
San Francisco Chronicle:
Ninth Circuit Overturns Behavioral Health Care Rulings That Required Insurer To Reconsider Thousands Of Claims
A federal appeals court has overturned rulings that would have required an insurer to reconsider its denials of tens of thousands of claims for mental health, drug and alcohol care. In decisions in 2019 and 2020, Chief U.S. Magistrate Judge Joseph Spero of San Francisco said United Behavioral Health, which manages mental health services for insurance giant UnitedHealthcare, had acted “to protect its bottom line” by using its own restrictive criteria to deny claims in multiple states from 2011 to 2017. He said the company then “lied to state regulators” and made misleading statements during a nonjury trial in his court. (Egelko, 3/23)
Modern Healthcare:
United Behavioral Health Beats Landmark Coverage Class-Action
A federal appeals court on Tuesday reversed a landmark decision that required the nation's largest behavioral health insurer to adopt more stringent standards for mental health and substance abuse treatment and reprocess tens of thousands of claims. The 9th U.S. Circuit Court of Appeals ruled that United Behavioral Health adequately followed plan terms when it denied coverage by self-insured and fully insured employer health plans for residential and outpatient treatment from 2011 to 2017. (Tepper, 3/23)
In other health care industry news —
Modern Healthcare:
Mount Sinai Opens Clinic To Support Pregnant Women And Prevent Stillbirth
Mount Sinai Health System will launch a multidisciplinary clinic this month, focused on reducing stillbirths and supporting women and families who have experienced this pregnancy loss, the health system said Tuesday. The Rainbow Clinic at Mount Sinai is a collaboration with the organization PUSH for Empowered Pregnancy and will provide sensitivity training for clinicians and devise strategies for better pregnancy outcomes. It will offer clinical care and psychological support in post-stillbirth pregnancies as a way to prevent fear, anxiety and future perinatal losses. (Devereaux, 3/23)
Modern Healthcare:
American Hospital Association's Latest Investments Emphasize Health Equity
The American Hospital Association is taking a direct approach to facilitating health equity by providing capital and support to investment outfits emphasizing personalized healthcare startups led by women and people from racial and ethnic minority communities. The AHA has invested in SteelSky Ventures, a women-led fund with a portfolio focused on maternal health, telehealth and in-home care services and artificial intelligence tools for managing chronic health conditions, the trade group announced Tuesday. (Hartnett, 3/23)
Stat:
NIH Grapples With An Identity Crisis, After Covid And Collins’ Departure
Under the reign of Francis Collins, the National Institutes of Health was untouchable. From virtually the moment President Obama appointed him in 2009, prominent figures in government and science have been enchanted by Collins, the Harley-riding, guitar-playing geneticist who brought newfound attention to the nation’s medical research agency. In less than a decade, his agency’s budget ballooned from $29 billion to $42 billion. In an era when Democrats and Republicans agreed on nothing, the NIH’s popularity served as a rare unifier under three presidents. (Facher, 3/24)
Also —
Salt Lake Tribune:
50 Women Sue Provo OB-GYN, Alleging Sexual Battery And Abuse
Dozens more women have come forward in a lawsuit filed against a Provo OB-GYN who they say sexually assaulted them while he was their doctor. One woman said she “felt like she was not in control of her own body — that she was just a piece of meat on the exam table,” according to an amended complaint filed this month in 4th District Court. Another woman, who was nervous about getting a Pap test, remembers asking Dr. David H. Broadbent “to wait a minute so she could relax her body.” “Broadbent chuckled and said, ‘Oh, you need a minute to get ready to get assaulted?’” the complaint alleges. (Jacobs, 3/23)
KHN:
In Nurse’s Trial, Investigator Says Hospital Bears ‘Heavy’ Responsibility For Patient Death
A lead investigator in the criminal case against former Tennessee nurse RaDonda Vaught testified Wednesday that state investigators found Vanderbilt University Medical Center had a “heavy burden of responsibility” for a grievous drug error that killed a patient in 2017, but pursued penalties and criminal charges only against the nurse and not the hospital itself. Vaught, 38, was stripped of her nursing license and is now on trial in Nashville for charges of reckless homicide and abuse of an impaired adult. If convicted, she faces as much as 12 years in prison. Vanderbilt received no punishment for the fatal drug error. (Kelman, 3/24)
