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Hospitals Accused of Violating the False Claims Act Through Ownership of the PPO For Their Self-Funded Employee Health Plans

On August 27, 2015, following notification by the government that it had decided not to intervene, the United States District Court for the Middle District of North Carolina, ordered that a qui tam complaint charging...more

Employee Benefits Alert - August 2015

Retirement Plans - IRS Issues Guidance on Benefit Suspension Voting under MPRA - As we have written in prior alerts, the Multiemployer Pension Reform Act of 2014 (MPRA) permits trustees of financially troubled...more

Will Increased Consolidation in the Insurance Industry Yield Opportunities or Challenges for Investors?

A recent flurry of activity in the health insurance industry would seem to indicate that investors can expect significant consolidation in the managed care sector....more

New York Governor Andrew Cuomo names Anthony Albanese Acting Superintendent of Financial Services

Bloomberg reported last week that Anthony Albanese, Chief of Staff to Departing Superintendent Ben Lawsky, has been named to head the New York Department of Financial Services on an acting basis. He will lead the Department...more

Cybercrime on the Rise: Targeting Banking Institutions and Insurance Companies

Security experts are warning that 2015 is the “Year of the Healthcare Hack” as media outlets continue to report on a number of high-profile companies that have recently experienced attacks by cybercriminals seeking valuable...more

Trademarks in Cuba, Successful Whistleblowers, Big Data, Health Care Encryption, Jury Instruction Tips [Expect Focus – Vol. 1,...

IN THE SPOTLIGHT · Is your Company Ready to Comply with Encryption of Individually Identifiable Health Information? LIFE INSURANCE · STOLI Schemers Must Make Good on Damages Caused · At the State Level, Is a Fixed-Index...more

Manhattan U.S. Attorney Prevails in Securities Fraud, RICO Case

The SEC has brought a series of investment fund fraud and Ponzi schemes. Indeed, the Commission has brought so many of these cases in recent years they have become a staple....more

A Look Back: NetDiligence 2014 Cyber Claims Study

The NetDiligence 2014 Cyber Claims Study relies on data voluntarily provided by insurers about amounts paid out on cyber claims occurring from 2011 through 2013. Since the Study only accounts cyber claims reported to larger...more

World Economic Forum – Release of the Global Risks Report

Each year the World Economic Forum (WEF) is held in January in Davos, Switzerland. The WEF has released its Global Risks Report. The report is prepared by the WEF with its strategic partners Marsh & McLennan Companies and...more

Proposal on Voluntary Health Insurance Scheme in Hong Kong

Since 2008, the Hong Kong government has conducted two public consultations on healthcare service reforms and possible supplementary healthcare financing options. On 15 December 2014, the Hong Kong government initiated a...more

Health protection scheme in Hong Kong

Background of Health Protection Scheme in Hong Kong - In 2008, the Hong Kong government conducted the first stage public consultation on healthcare service reforms and six possible supplementary healthcare financing...more

Effects of the New Federal Spending Package on the Health Sector

In mid-December, President Obama signed into law a $1.1 trillion spending bill known as the “Consolidated and Further Continuing Appropriations Act, 2015” or “Cromnibus.”[1] This post explores provisions that relate to the...more

Second Circuit: Class-Wide Reformation Is Appropriate Equitable Relief

In the latest chapter of the Amara saga, the Second Circuit recently affirmed the district court’s class-wide order to reform CIGNA’s cash balance plan, as a means to remedy what the district court previously found to be...more

The Unique Risks Of Investing In Out-Of-Network Providers

For several years, industry observers have been predicting the demise of out-of-network business models, yet they still survive. For some providers in certain specialties and certain geographies, a predominantly...more

View From McDermott: A New Type of ERISA-Based Hold-Up—The Rise of Out-of-Network Provider Suits Against Self-Funded Health Care...

Over the past decade, there has been a significant increase in the number of physicians who have dropped out of Preferred Provider Organization (‘‘PPO’’) and Health Maintenance Organization (‘‘HMO’’) networks and attempted to...more

OFAC Settlement Extends Violations to “Support Service” Providers

OFAC stated that an insurance company and its affiliates violated OFAC regulations by providing insurance support services for policies that were issued to, or provided coverage for, persons designated on the OFAC Specially...more

Rating Agency Developments

On October 13, Moody’s released is rating methodology for U.S. Health Insurance Companies. On October 10, DBRS published its methodologies regarding the following...more

HRAs Under the Affordable Care Act

Analysis: HRAs are employer-funded accounts designed to reimburse employees for out-of-pocket medical expenses. Employees are not permitted to contribute their own funds, so they are unlike flexible spending accounts or...more

Summary of HUD’s LEAN 232 Program E-Mail Blast: Office of Residential Care Facilities (ORCF), June 26, 2014

In an effort to summarize the highlights of the U.S. Department of Housing and Urban Development (HUD) LEAN E-mail Blasts that we receive, and rarely have time to review in a timely fashion, we at Pepper are providing this...more

Recent Cases of Note

District of New Jersey Denies Class Certification in Title Insurance Case on Grounds of Ascertainability - In the latest in a series of decisions from courts in the Third Circuit regarding ascertainability of a...more

Changing Financial Landscape for Medical Debts of the Uninsured

The implementation of the ACA has afforded many with the opportunity to obtain insurance coverage. Despite the opportunity, a large number of individuals have either chosen not to enroll in a health plan or have been unable...more

HUD Issues New Handbook for Long Term Care Financing Under Section 232

On May 22, 2014, HUD published a new Handbook covering its Section 232 Healthcare Insurance Mortgage Program, which insures HUD-approved lenders against financial loss from mortgage loan defaults in loans to qualifying long...more

Potential Risks of Healthcare Joint Ventures Between Insurance Companies and Hospitals

Healthcare joint ventures are nothing new. Since the mid-2000’s, physician-hospital ventures have been resurgent, notwithstanding the Office of Inspector General’s skepticism regarding the risk of fraud and abuse when...more

Employee Benefits Developments - March 2014

On January 9, 2014, the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (collectively, the “Departments”) issued additional health care reform guidance in the form of Frequently Asked Questions...more

Insurance Topics We Will Be Watching in 2014

With the first month of the year behind us, this report outlines major insurance topics that we will be watching throughout 2014. Forces, trends and events that we believe will affect regulation, transactions and...more

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