Health Insurance

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One Step Closer to the Supreme Court: The Fate of Obamacare Premium Tax Credits in the Face of the Circuit Split

Last month, two federal courts of appeals issued opposing decisions on whether the Patient Protection and Affordable Care Act (the “ACA”) permitted subsidies, in the form of premium tax credits, to health coverage bought...more

Federal Health Insurance Marketplace Sends Notices Regarding Citizenship and Immigration Data Inconsistencies

The Centers for Medicare & Medicaid Services (“CMS”) announced that the Federal Health Insurance Marketplace (“Marketplace”) began sending follow-up notices to consumers with citizenship or immigration data inconsistencies...more

Indian Health Service Recovery Efforts Against Commercial Health Plans

Health plans across the country are increasingly receiving demands for payment from the Indian Health Service (“IHS”), tribal health programs (collectively “Indian Organizations”) and the U.S. Department of the Treasury for...more

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

The Affordable Care Act—Countdown to Compliance for Employers, Week 21: Self-Funded Group Health Plans, the Affordable Care Act...

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) ushered in broad national standards aimed at improving the efficiency and effectiveness of the U.S. health care system. Referred to generically as...more

Health Care Update - August 2014

In This Issue: - Sovaldi Pricing Lower in Canada - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives - Other Congressional and State Initiatives - Other Health...more

Affordable Care Act Update: Courts Divided on who is Eligible for Subsidies on the Exchange

On July 22, 2014, within 2 hours of each other, two U.S. Courts of Appeal issued conflicting rulings on whether subsidies may be offered in states that use the federal insurance exchange. Background. The...more

Circuit Court Split on ACA Could Impact Employer Penalties

In conflicting opinions released on July 22nd, two federal circuits split on whether Affordable Care Act subsidies are available under a federally operated health insurance exchange. “Pay or play” penalties apply only if...more

Captive Insurance: Feds Promote Tax Benefits, but Pay Attention to the Details

Recent IRS rulings and a U.S. Tax Court decision continue to lay a solid foundation for captive insurance companies. However, the tax requirements must be strictly followed. Below we provide an update to assist captives in...more

No delay of game – Affordable Care Act (ACA) compliance efforts should continue, despite court rulings

Perhaps you have put your compliance efforts on the back burner, hoping the ACA will just go away. We have heard many reasons for this procrastination, including the constitutional challenge to the individual mandate, the...more

CHI Takes the Plunge into the Insurance Business

For several years now hospital systems have been tip-toeing around the business of health insurance. They’ve been signing up for Medicare Advantage plans, taking on more and more risk, managing care and raiding health...more

Los Angeles County Sues Hospital Owner for False Surgical Implant Claims to County Workers’ Compensation Program

On July 18, 2014, the County of Los Angeles (“the County”) filed a lawsuit in Los Angeles Superior Court again Michael D. Drobot, Sr., his son Michael R. Drobot, Jr. and their controlled entities, Pacific Hospital of Long...more

New ACA Rules Could Require Broader Provider Networks

"If you like your doctor, you can keep your doctor." President Obama repeated this assurance to the American public numerous times, and the statement was prominently featured on the White House web site prior to and after...more

ERISA (8th Circuit): Over-The-Counter Vitamin Supplements Trigger Pre-Existing Condition Exclusion

What sort of “medical treatment” triggers the pre-existing condition exclusion in an ERISA-governed disability policy?...more

HEAL Advisory: How Big Is Halbig? The Potential Effects of This Major Ruling Are Numerous and Significant

On July 22, 2014, the U.S. Court of Appeals for the D.C. Circuit and the U.S. Court of Appeals for the Fourth Circuit issued conflicting opinions on a key aspect of the Affordable Care Act ("ACA"). The cases are Halbig v....more

Highmark and UPMC Consent Decree

Highmark and UPMC took a major step toward resolving network participation issues June 27, 2014, by executing a Consent Decree with the Commonwealth of Pennsylvania Departments of Insurance and Health. The Consent...more

Draft Forms Released for the Affordable Care Act's Health Coverage Reporting Requirements

The Affordable Care Act (ACA) imposes new reporting requirements on employers and insurance companies offering health coverage. Last week, the IRS released drafts of the four forms that will be used by employers and insurers...more

Circuit Courts Split on ACA Subsidies

On July 22, 2014, United States Circuit Courts of Appeals from two different circuits issued opposing rulings on the legality of the Federal government providing subsidies to eligible buyers of health insurance products from...more

Favorable Ruling: Taxability of HMOs Under New York City General Corporation Tax

A New York City Tax Appeals Tribunal Administrative Law Judge (ALJ) recently ruled in favor of Aetna, Inc. (Aetna) on whether a health maintenance organization (HMO) was “doing an insurance business” in New York State,...more

The Affordable Care Act—Countdown to Compliance for Employers, Week 22: Charting the Future of the Premium Subsidies (and Employer...

On July 22, 2014, two federal appellate courts issued conflicting decisions, within hours of each other, regarding the IRS final rule published on May 23, 2012 (the “IRS Rule”), intended to implement the exchange-related tax...more

Conflicting Rulings on Health Insurance Subsidies Raise Concerns Among Insurers and Providers

On Tuesday, July 23rd 2014, separate federal circuit court panels issued conflicting rulings regarding whether the government could subsidize health insurance premiums for Americans enrolled in federally-run health exchanges....more

Joint Employment Finding Leads to Unexpected $3 Million Liability in Hospital Malpractice Case

When Washington Hospital obtained an insurance policy in 2003 to cover medical claims arising from acts by its employees, its insurer probably did not consider whether hospital employees included workers supplied by a...more

Of Mice and Elephants: Halbig and King and The Struggle of Two Federal Appeals Courts to Find Meaning in Words That May or May Not...

At issue in Halbig v. Burwell and King v. Burwell is whether or not subsidies to buy insurance on an exchange are available in both state and federal exchanges. On its face the Affordable Care Act (“ACA”) provides for...more

Circuit Court Split Casts Doubt on PPACA Subsidies for Individuals and Employer Penalties in 36 States

Two federal appeals courts issued conflicting rulings on July 22 on whether individual premium subsidies under the Patient Protection and Affordable Care Act (PPACA) are available in 36 states that have federally run...more

Federal Courts Make Conflicting Rulings on Premium Assistance for Federal Exchange Plan Participants

Does the Affordable Care Act (ACA) authorize the payment of premium and copayment subsidies, or “premium assistance subsidies,” to individuals enrolled in a federally established Exchange? On July 22, 2014, two federal courts...more

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