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DOJ and North Carolina Challenge Anti-Steering and Tiering Provisions in Managed Care Contracts

The Department of Justice’s antitrust division (the “DOJ”)and the State of North Carolina (“NC”) jointly sued, on June 9, 2016, Carolinas HealthCare System (“CHS”), the largest healthcare system in North Carolina, over...more

Contractual Prohibitions on Health Insurers Steering Policyholders to Lower Cost Providers Draws Antitrust Challenge

The United States Department of Justice has filed an action seeking to enjoin a hospital from enforcing provisions in its contracts with health insurers that prohibit the insurers from steering policyholders to lower cost...more

U.S. Department of Justice Sues North Carolina Hospital System for Insisting on Anti-Steering Provisions in Insurance...

On June 9, 2016, the Antitrust Division of the United States Department of Justice (“DoJ”) filed a complaint against the Charlotte-Mecklenburg Hospital Authority, d/b/a Carolinas Health Care System (“CHS”) in the United...more

Manatt on Health Reform: Weekly Highlights - June 2016#3

CMS targets short-term insurance plans in efforts to stabilize the individual market risk pool; Illinois mandates Medicaid coverage for opioid addiction treatment; and Michigan seeks to restructure State Medicaid financing....more

DOJ and NC File Antitrust Suit Challenging Anti-Steering Restrictions in Payor Contracts

A popular weapon used to contain health care expenditures is the creation by payors and employers of tiered provider networks, which by differentiated co-pays attempt to steer insureds to less expensive choices. In...more

Health Update - May 2016

Actions to Advance Infant and Early Childhood Mental Health - Editor's Note: Children's earliest experiences—both positive and negative—impact their brain formation and in turn their social and emotional, physical,...more

Insurers Gain Additional Dismissals in the Florida Auto Body Action

In early 2014, a group of Florida auto body shops sued the leading auto insurers in their state, alleging that the insurers had conspired to suppress the amounts the auto body shops received in reimbursement rates. The case,...more

Insurer Antitrust Exemption in Europe in Jeopardy

In the United States, the McCarran Ferguson Act provides insurers with an exemption from the federal antitrust laws. Enacted in 1945, the Act provides that conduct that constitutes the "business of insurance" is outside the...more

Insurance Antitrust Newsletter - May 2016

Insurer Antitrust Exemption in Europe in Jeopardy - In the United States, the McCarran Ferguson Act provides insurers with an exemption from the federal antitrust laws. Enacted in 1945, the Act provides that conduct that...more

Insurer Actions Cut the Heart Out of Out-of-Network Providers

Aetna Life Insurance Company recently won a $37 million verdict against a group of Northern California surgical centers, Bay Area Surgical Management, LLC and its affiliates (collectively, Bay Area), for an alleged...more

Aetna vs. BASM: Pigs Get Fat and Hogs Get Slaughtered

On April 13, 2016, a jury in Santa Clara, California awarded Aetna, Inc. $37.4 million from Bay Area Surgical Management, LLC (“BASM”), six of its affiliated surgery centers and its three principals. Aetna had accused the...more

Misuse of market power: How proposed changes to the law will affect the private health insurance sector

The Turnbull Government recently announced that it will adopt the Harper Review's recommendation to amend section 46 of the Competition and Consumer Act. The Government expects to introduce the relevant legislation into...more

European Commission Proposes Non-renewal of the Insurance Block Exemption Regulation

The European Commission has recently issued a Report announcing its preliminary view that the Insurance Block Exemption Regulation (“IBER”) should not be renewed when it expires on March 31, 2017. The IBER provides an...more

Commission set to say goodbye to the insurance block exemption

The insurance industry currently benefits from the Insurance Block Exemption Regulation (Regulation 267/2010) (IBER), which is due to expire on 31 March 2017. IBER exempts from the competition rules, subject to certain...more

Sixth Circuit Finds Possibility of Conspiracy Among Hospital Network Members

The Sixth Circuit on Tuesday voted 2 to 1 to reverse a district court’s grant of summary judgment under which a defendant hospital network had been found to be a single entity incapable of conspiring with itself in an...more

Individual Accountability and the SEC [Video]

From the 2016 PLUS D&O Symposium session “The DOJ, SEC and the New Era of Individual Accountability,” Helen Cantwell (Debevoise & Plimpton) and Stephanie Avakian, Esq. (U.S. Securities & Exchange Commission) discuss...more

Securities Regulation and Class Action Trends in Canada [Video]

From the 2016 PLUS D&O Symposium session “Shareholder Activism and Litigation in Canada,” David Conklin (Goodmans LLP), Orestes Pasparakis (Norton Rose Fulbright Canada), Paul Emerson (Berkshire Hathaway Specialty Insurance)...more

UnitedHealth Settles NY Attorney General Antitrust Probe

In early January, the New York Attorney General's Office announced that it had reached an agreement with UnitedHealth that would conclude the AG Office's investigation into UnitedHealth's marketing of elder care and nursing...more

Will 2016 Be the Year for McCarran Repeal?

As the second session of the 114th Congress begins to pick up steam, five bills are currently pending in the House that, if enacted, would repeal the McCarran-Ferguson Act’s antitrust exemption for at least some insurers....more

California Insurance Department Holds Hearing on Centene/Health Net Merger

Since the summer of 2015, a great deal of attention has focused on whether the proposed Anthem/Cigna and Aetna/Humana mergers will be approved by federal and state antitrust regulators. These transactions have been the...more

Proposed Aetna-Humana Merger Passes Another Hurdle in Antitrust Review

The proposed merger between major health insurers Aetna Inc. and Humana Inc. continues to inch closer to finalization. In a recent press release, Aetna announced that 10 states have now signed off on its proposed acquisition...more

OIG Issues (Another) Favorable Advisory Opinion Regarding Medigap/Preferred Hospital Network Arrangement in Advisory Opinion 16-01

On January 7, 2016, the Department of Health and Human Services, Office of Inspector General (OIG) issued Advisory Opinion 16-01, approving yet another insurer’s proposed contract with a preferred hospital network. The...more

FTC's Big Data Report Provides Road Map for Insurers Using Big Data

On January 6, the Federal Trade Commission ("FTC") released a report entitled "Big Data: A Tool for Inclusion or Exclusion? Understanding the Issues" ("Report") that follows the FTC's September 15, 2014 workshop on "the...more

Where in the World are the D&O Claims? [Video]

From the 2015 PLUS Conference session “Where in the World are the (D&O) Claims?,” moderator Jennifer O’Neill (Allianz Global & Corporate Specialty) and panelist Stephen Shepherd (Zurich Insurance Company) discuss D&O trends...more

States Launch Hearings on Major Insurance Company Mergers

This summer, in the space of only a few weeks, Aetna announced an intention to acquire Humana, followed by an announcement by Anthem that it was planning to merge with Cigna. As was widely reported at the time, if...more

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