Justia Health Law Opinion Summaries

The case involves a billing dispute between a group of emergency room physicians (plaintiff) and an insurance company (defendant). The dispute centers on the interpretation of Connecticut’s surprise billing law, which aims to protect insured individuals from high medical bills when they receive emergency care from out-of-network providers. The plaintiff contends that the law requires the defendant to fully reimburse them for emergency services and then collect any applicable cost-sharing amounts (deductibles, copayments) from the insured. The defendant argues that it can deduct the insured’s cost-sharing amounts from the reimbursement it pays to the plaintiff.The United States District Court for the District of Connecticut dismissed the plaintiff’s stand-alone claims under the surprise billing law, concluding that the law does not create a private right of action. The court then certified three questions to the Connecticut Supreme Court: (1) whether a CUTPA claim can be maintained for conduct that violates the surprise billing law but not CUIPA, (2) whether the surprise billing law requires insurers to fully reimburse providers and then collect cost-sharing amounts from insureds, and (3) whether the defendant’s practice of deducting cost-sharing amounts from reimbursements violates the surprise billing law.The Connecticut Supreme Court held that Connecticut law does not recognize a cause of action under CUTPA for conduct that violates the surprise billing law but is not identified as an unfair insurance practice under CUIPA. The court also held that the surprise billing law does not require insurers to fully reimburse providers and then collect cost-sharing amounts from insureds. Instead, insurers can deduct the insured’s cost-sharing amounts from the reimbursement paid to the provider. Finally, the court concluded that the defendant’s practice of deducting cost-sharing amounts from reimbursements does not violate the surprise billing law. View "NEMS, PLLC v. Harvard Pilgrim Health Care of Connecticut, Inc." on Justia Law

The case involves a dispute over the taxability of personal property used by a hospital at an outpatient rehabilitation facility. The plaintiff, a hospital owned by a health system, operates a rehabilitation facility in a leased suite. The plaintiff claimed that the personal property used at this facility was exempt from taxation under Connecticut General Statutes § 12-81 (7) or (16), which provide tax exemptions for charitable and hospital property, respectively. The town's assessor denied the tax exemption, and the town's board of assessment appeals upheld this denial.The trial court reviewed the case and sided with the plaintiff, granting its motion for summary judgment. The court reasoned that although the plaintiff is part of a health system, the personal property was located at a leased facility, not owned by the health system, and therefore did not fall under the purview of General Statutes § 12-66a. The court concluded that the personal property was exempt from taxation under § 12-81 (7) and (16).The Connecticut Supreme Court reviewed the case and reversed the trial court's decision. The Supreme Court held that the personal property used at the rehabilitation facility is taxable under § 12-66a, even if it would otherwise be exempt under § 12-81 (7) or (16). The Court determined that the term "acquired" in § 12-66a includes leased property, not just purchased property. The Court emphasized that the statute aims to protect municipalities from losing tax revenue due to health systems acquiring tax-exempt status for properties they use, whether owned or leased. The Court also clarified that the plaintiff, as part of a health system, falls under the statute's provisions, making the personal property taxable.The Supreme Court reversed the trial court's judgment and remanded the case with directions to deny the plaintiff's motion for summary judgment and for further proceedings. View "William W. Backus Hospital v. Stonington" on Justia Law

In this case determining the scope of immunity afforded by Executive Order No. 7V, as it related to acts or omissions undertaken in good faith by health care professionals and health care facilities because of an alleged lack of resources attributable to the COVID-19 pandemic the Supreme Court upheld the judgment of the trial court concluding that Defendants failed to establish that the immunity afforded by the order applied in this case.Governor Ned Lamont issued Executive Order No. 7V providing immunity from suit and liability to health care providers under certain circumstances relating to COVID-19. Plaintiff in this case filed wrongful death claims against Defendants, Regency House of Walling ford, Inc. and National Health Care Associates, Inc., alleging twelve counts of wrongful death based on medical negligence and medical recklessness. Defendants moved to dismiss the complaint, claiming immunity under Executive Order No. 7V. The trial court denied the motion to dismiss. The Supreme Court affirmed, holding that the trial court too narrowly construed the language of the order but nevertheless did not err in denying Defendants' motion to dismiss. View "Manginelli v. Regency House of Wallingford, Inc." on Justia Law

The Supreme Court affirmed in part and reversed in part the judgment of the trial court in his wrongful death action filed by the daughter of the decedent and the executor of her estate, holding that the trial court erred in dismissing counts five, six, and seven of the complaint.At issue was Executive Order No. 7V, which conferred immunity on health care providers in connection with the governor's March, 2020 declaration of a public health emergency caused by the COVID-19 pandemic. Plaintiff brought this action against several physicians and a hospital, but Defendants moved to dismiss the complaint on the ground that they were immune under the federal Public Readiness and Emergency Preparedness Act (PREP Act) for allegedly grossly negligent acts and omissions undertaken before the receipt of the decedent's negative COVID-19 test result. The court granted the motions to dismiss as to certain physicians. The Supreme Court affirmed in part and reversed in part and remanded the case for further proceedings, holding that the trial court erred in concluding that Defendants were entitled to immunity under the PREP Act. View "Mills v. Hartford HealthCare Corp." on Justia Law

The Supreme Court reversed in part the judgment of the trial court awarding Plaintiff $200,309 in damages for Defendants' breach of a lease agreement, holding that the trial court improperly allocated the burden of proof as to mitigation in determining the damages award.At issue in this appeal was how the executive orders issued by Governor Ned Lamont during the earliest months of the COVID-19 pandemic affected the enforceability of a commercial lease agreement for premises that Defendants leased from Plaintiff. Both parties appealed from the judgment of the trial court awarding Plaintiff damages. The Supreme Court reversed in part, holding that the trial court (1) did not err in determining that the economic effects of the executive orders did not relieve Defendants of their obligations under the lease agreement; but (2) improperly relieved Defendants of their burden of proving that Plaintiff's efforts were commercially unreasonable under the circumstances, thus necessitating a new damages hearing. View "AGW Sono Partners, LLC v. Downtown Soho, LLC" on Justia Law

The Supreme Court affirmed the judgment of the trial court in favor of Defendants in this action alleging that Boston Scientific Corporation's sale of its Obtryx Transobturator Mid-Urethral Sling System (Obtryx) violated the Connecticut Product Liability Act, Conn. Gen. Stat. 52-572m et seq., holding that there was no error.The named plaintiff alleged that the Obtryx, a transvaginal mesh sling implanted in women to treat stress urinary incontinence, injured her in various ways after it was implanted in her. Plaintiffs brought claims against Boston Scientific and the named plaintiff's gynecologist and medical practice, alleging violations of the Act, negligence sounding in informed consent, and misrepresentation. The trial court granted the medical defendants' motion for summary judgment. The case proceeded to trial against Boston Scientific, and the jury returned a verdict in its favor. The Supreme Court affirmed, holding that the trial court (1) did not err in granting summary judgment for the medical defendants on the informed consent and misrepresentation claims; and (2) properly declined to instruct the jury on the reasonable alternative design prong of the risk-utility test. View "Fajardo v. Boston Scientific Corp." on Justia Law

The Supreme Court held that Conn. Gen. Stat. 28-9 provided authority for Governor Ned Lamont to issue executive orders during the civil preparedness emergency he declared pursuant to the statute in response to the COVID-19 pandemic and that the statute passes constitutional muster.In response to the pandemic, Governor Lamont issued certain executive orders that limited various commercial activities at the State's bars and restaurants. At issue in this case was whether the COVID-19 pandemic constituted a "serious disaster" pursuant to section 28-9 and whether that statute conferred authority on the governor to issue the challenged executive orders. The Supreme Court held (1) Governor Lamont did not exceed his statutory authority when he issued the challenged orders; and (2) section 28-9 is not an unconstitutional delegation of the General Assembly's legislative powers to the governor. View "Casey v. Lamont" on Justia Law

The Supreme Court affirmed the judgment of the trial court in favor of Defendant, Denise Merrill, Secretary of the State, intros action seeking declaratory and injunctive relief with respect to Defendant's change of the absentee ballot application for the August 11, 2020 primary election to add COVID-19 as a new reason for requesting an absentee ballot pursuant to Executive Order No. 7QQ, holding that the trial court did not err.At issue in this public interest appeal was whether Governor Ned Lamont's executive order, which was later ratified by the legislature and which modified Conn. Gen. Stat. 9-135 by adding COVID-19 as a permissible reason for absentee voting violates Conn. Const. art. VI, 7. The trial court granted jumtgnet for Defendant. The Supreme Court affirmed, holding that Executive Order No. 7QQ does not violate Article 6, Section 7. View "Fay v. Merrill" on Justia Law

The Supreme Court affirmed in part and reversed in part the judgment of the trial court insofar as it rendered judgment in Defendant's favor on counts alleging fraudulent transfer under the Connecticut Uniform Fraudulent Transfer Act (CUFTA), Conn. Gen. Stat. 52-552a through 52-552l, and unjust enrichment, holding that the trial court erred in rejecting Plaintiff's CUFTA claim but did not err in rejecting Plaintiff's unjust enrichment claim.Defendant Stephen McGee used a power of attorney granted to him by his elderly mother, Helen McGee, to transfer to himself funds from Helen's checking account. As a consequence of the transfers, Helen had insufficient assets to pay her debt to Plaintiff Geriatrics, Inc. Plaintiff brought this action, and the trial court rendered judgment in Defendant's favor on Plaintiff's CUFTA and unjust enrichment claims. The Supreme Court reversed in part, holding (1) in rejecting the CUFTA claim the trial court improperly failed to consider and apply agency principles; and (2) in light of the unrequited evidence, the trial court did not abuse its discretion in rejecting Plaintiff's unjust enrichment claim. View "Geriatrics, Inc. v. McGee" on Justia Law

The Supreme Court reversed the judgment of the trial court granting the motions to dismiss filed by Defendants, healthcare providers, on the ground that Plaintiffs failed to commence their action within the five-year repose period of Conn. Gen. Stat. 52-555, the wrongful death statute, holding that, under the facts of this case, the trial court improperly resolved disputed jurisdictional facts without providing Plaintiffs an opportunity either to engage in limited discovery or to present evidence in connection with their argument that the repose period had been tolled by the continuing course of conduct doctrine. The Court remanded the case for further proceedings consistent with this opinion. View "Angersola v. Radiologic Associates of Middletown, P.C." on Justia Law