Administrative Agency Insurance

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How Big Is Halbig? The Viability of the ACA’s Employer Mandate Hangs in the Balance

For employers with employees in the 36 states with a federally facilitated exchange, the question arises how the Halbig decision impacts their decision and strategy to provide health coverage to their employees when the...more

A Tale of Two Circuits: D.C. Circuit, Fourth Circuit Split on ACA Subsidies

It was the best of times for ACA subsidies, it was the worst of times for ACA subsidies. On Tuesday, the Court of Appeals for the D.C. Circuit (“D.C. Circuit”) and the Court of Appeals for the Fourth Circuit (“Fourth...more

Harsh Justice

Concerned that its own decision might have "the potential to conflict" with that of the Pennsylvania Insurance Department, a Pennsylvania federal court relied on the primary jurisdiction doctrine to dismiss a putative class...more

High Court allows application for permission to bring judicial review proceedings relating to the jurisdiction of the Financial...

In this case report, Sarah Hitchins, an associate in Allen & Overy LLP’s Banking, Finance and Regulatory Litigation Group, considers the High Court’s decision to allow an application for permission to bring judicial review...more

Proposed Expansion of OIG’s Exclusion Authority

In May, the Office of Inspector General of the Department of Health and Human Services (OIG) proposed a new rule (Rule) that would implement changes included in the ACA. The Rule would expand OIG’s authority to exclude...more

I Can’t Get No SATISFACTION-- In the Eleventh Circuit, Is Discretionary Language Still "Satisfactory to Us"?

Ever since the United States Supreme Court addressed the question of whether a wholesale adoption of the "arbitrary and capricious" standard of review would be appropriate for judicial review of denial of benefit...more

Employee Benefit Plan is Governmental Plan, Even Though Employees are Not, says District Court in 11th Circuit.

It is a deceptively simple statement: Governmental employee benefit plans are exempt from ERISA. 29 U.S.C. § 1003(b)(1). But what about an employee benefit plan of an entity affiliated with a governmental entity, but whose...more

CMS Releases Proposed IPPS and LTCH Rule

On April 30, 2014, CMS released the much anticipated proposed Hospital Inpatient Prospective Payment System rule (“Proposed IPPS Rule”), which would apply to FY 2015 Medicare payments. For inpatient acute care hospitals, CMS...more

Unclaimed Property Round Up

The battle over unclaimed property continues to spawn increased litigation and regulatory activity. Litigation Highlights - In December 2013, a West Virginia court dismissed 63 lawsuits brought by the Treasurer...more

Securing Public Deposits Under Pennsylvania's Act 72

A governmental entity in Pennsylvania may deposit its moneys in a financial institution only if the financial institution pledges collateral for the deposit to the extent the deposit exceeds the FDIC insurance limits. This...more

New York Trial Court Holds that Administrative Orders Do Not Constitute "Final Adjudications"

New York Trial Court Holds that Administrative Orders Do Not Constitute “Final Adjudications” For Purposes of Applying Fraud/Dishonesty Exclusion in Professional Liability Policy - A recent New York trial court...more

Market Conduct Examinations: Are You Prepared?

Market analysis and market conduct examinations provide insurance regulators with information to assess how the insurance marketplace as a whole, and the individual insurance entities that make up that market, are in...more

Legal Alert: NCOIL Unclaimed Property Task Force Springs Into Action; Co-Chair Keiser Seeks Proposed Changes to Model Unclaimed...

On Friday, March 7, 2014, the National Conference of Insurance Legislators’ (NCOIL) Unclaimed Property Task Force (Task Force) met in-person at NCOIL’s spring meeting. Led by the Task Force’s Co-Chair George Keiser (ND), the...more

CFPB Initiates Administrative Proceeding Against Mortgage Lender

Subsequent to its denial of a mortgage lender’s petition to set aside a civil investigative demand in 2012, the CFPB publicly announced that it had served Notice of Charges, initiating an administrative proceeding against the...more

Capital Thinking: General Legislative

The Senate will convene today, Monday, January 27, at 2:00 pm. After any leader remarks, the Senate will resume consideration of the motion to proceed to S. 1926, the Homeowner Flood Insurance Affordability Act of 2014. At...more

Washington's Unprecedented Bid to Supplant State Insurance Regulators

In mid-October, Prudential Financial Inc. dropped its fight against being designated as a systemically important financial institution (SIFI) by the Treasury Department's Financial Stability Oversight Council. When the...more

Australia’s High Court Denies Employee Worker’s Compensation Claim For Sex Injury

Ruling in a 4-2 decision[1], the Australian High Court denied a government employee worker’s compensation claim for an injury the employee sustained while having sex in a motel room during a business trip. The female...more

NC Medicaid Providers, Are You Required to Seek an Informal Appeal Prior to Filing a Contested Case at OAH?

Recently, numerous clients have come to me asking whether they have the right to appeal straight to the Office of Administrative Appeals or whether they have to attend informal appeals first, whether the informal appeal is...more

Legal Alert: Florida Announces DMF Search Requirement and Date-of-Death Dormancy Trigger

In an administrative declaratory ruling, the Florida Department of Financial Services (DFS) announced that Florida’s unclaimed property statute requires life insurers to search the Social Security Administration Death Master...more

OIG Reports on The First Level of the Medicare Appeals Process

The HHS Office of Inspector General (OIG) recently published the results of a study regarding the first level of the Medicare Parts A and B appeals process, or redeterminations, for years 2008 through 2012. The report...more

Attention: All Medicaid Providers Whose Services Require Prior Authorization

A Way to Increase Revenue and Help Medicaid Recipients - Have you heard the cliché: “Killing two birds with one stone….?” The phrase is thought to have originated in the early 1600s when slingshots were primarily...more

Protests Of The Medicaid Managed Assistance ITN Recommended Awards

Pursuant to Section 409.966, Florida Statutes, traditional Medicaid services are to be provided to Florida recipients through a limited number of Managed Care Organizations ("MCOs") in the 11 Regions of the state. The Agency...more

The Government Shut Down and Its Impact on Public Health

In the early morning of October 1, 2013, the U.S. federal government officially went dark. The shutdown came in the aftermath of the Senate’s decisive vote to reject a House plan that would have kept the government funded for...more

Health Alert (Australia) - September 23 2013

In This Issue: - Judgments - Legislation - Reports - Excerpt from Reports: ..Australia. Health Practitioner Regulation Agency (AHPRA) and the boards 16 September 2013 - The national Boards have...more

The Affordable Care Act & the Impact on the C-Suite – Interview with Alden Bianchi, Member, Mintz Levin [Video]

Attorney Alden Bianchi, Practice Group Leader of Mintz Levin's Employee Benefits & Executive Compensation Practice, discusses why the Affordable Care Act makes health care benefits something that should be top-of-mind to...more

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