Justin Liby

Justin Liby

Polsinelli

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California Division of Workers’ Compensation Takes Action Against TPAs and Will Increase Audits of TPAs in 2016

The Audit and Enforcement Unit of the California Division of Workers’ Compensation (DWC) issued a press release recently indicating it will be conducting more target audits in 2016 to address utilization review (UR)...more

3/31/2016 - Audits Independent Medical Review Medical Records Penalties Policies and Procedures TPAs Workers Compensation Board

New Legislation To Register and Regulate TPAs Proposed in Washington State

Legislation was recently introduced in the Washington State House of Representatives (HB 2445) and the Washington State Senate (SB 6447) that would require third party administrators to register with the Washington Office of...more

3/14/2016 - Insurance Commissioners Insurance Industry Proposed Legislation Registration Requirement Third-Party Agents TPAs

Third Party Administrator Update: TPA Regulatory and Legislative Developments - December 2015

Polsinelli is pleased to share the December 2015 Third Party Administrator Newsletter. This newsletter covers topics throughout the year that effect TPAs. Items discussed in this report include: - State Insurance...more

12/15/2015 - Confidential Communications Cybersecurity Data Breach Information Requests Insurance Industry Licensing Rules Third-Party Agents

State Insurance Regulators Take Action Against Unlicensed Third Party Administrators

Recently, two state insurance departments took action against third party administrators operating in their respective states based on their failure to be properly licensed as a TPA. These regulatory actions against...more

11/17/2015 - Compliance Insurance Industry Professional License Regulatory Oversight TPAs

New Licensing and Regulatory Requirements for Pharmacy Benefit Managers in Ohio

House Bill 64 recently amended Ohio Revised Code Chapter (ORC) 3959. The relevant code sections amended by House Bill 64 are ORC 3959.111 and ORC 3959.12 and these changes took effect on September 29, 2015. Pursuant to...more

10/8/2015 - Compliance Healthcare Pharmacies

Missouri Department of Insurance Enters into $1.25 Million Settlement with Nine Affiliated Insurers

Missouri insurance regulators recently announced a $1.25 million settlement with nine affiliated insurance companies as a result of a market conduct examination into their handling of workers’ compensation insurance. ...more

4/17/2015 - Department of Insurance Insurance Industry Settlement Agreements

Missouri Insurance Department Reaches $7.8 Million Settlement with Anthem

The Missouri Department of Insurance, Financial Institutions and Professional Registration (DIFP) recently announced that it has entered into a $7.8 million regulatory settlement with Healthy Alliance Life Insurance Co. and...more

8/7/2014 - Blue Cross Blue Shield Health Insurance Insurance Industry Settlement

New Washington Rule Clarifies Authority to Issue Penalties Against TPAs

The Washington State Department of Health has promulgated a new rule clarifying the Department's authority to issue civil penalties against health carriers and third-party administrators. This rule, which is outside the...more

7/24/2014 - Civil Monetary Penalty Department of Health Health Insurance Healthcare Insurance Industry Licenses Licensing Rules Third-Party Service Provider

New Laws Regulating Pharmacy Benefit Managers In New Mexico, Utah And Washington

This past legislative session, several state legislatures enacted legislative regulating pharmacy benefit managers ("PBMs"). New Mexico, Utah, and Washington all adopted laws requiring licensure or registration of PBMs, in...more

5/16/2014 - Employee Benefits Pharmacies Prescription Drugs

New York Department Of Financial Services Fines Metlife Subsidiaries $60 Million

On March 31, 2014, Benjamin M. Lawsky, Superintendent of the New York Department of Financial Services ("NYDFS") announced an Agreement under which MetLife will pay $60 million for insurance licensing violations by two of its...more

4/14/2014 - Department of Financial Services MetLife

Market Conduct Examination Penalties On The Rise In Missouri

Our firm's Summer 2012 Insurance Business & Regulatory newsletter discussed a recent increase in market conduct examination activity by the Missouri Department of Insurance, Financial Institutions and Professional...more

2/6/2014 - Compliance Investigations

Third Party Administrator Update - Volume 2, 2013

In This Issue: - Nevada Begins Audits of TPAs - Insurers Challenge Requirement to Use Social Security Death Master File - ACLI Files Lawsuit Regarding Prohibition on Offshoring - Tennessee Modifies...more

10/18/2013 - Audits Insurance Industry Licensing Rules Offshoring Social Security Third-Party TPAs Workers' Compensation Defense

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