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Compounding Pharmacy’s Group Boycott Claim Survives Motion to Dismiss

On August 23, 2016, the District Court for the Eastern District of Missouri allowed claims by a compounding pharmacy to proceed, denying a motion to dismiss filed by the defendant pharmacy benefit manager (“PBM”). In...more

DOJ Challenges Health Insurance Merger

On July 21, 2016, the Department of Justice, Antitrust Division (the “DOJ”) announced that it, along with several state attorneys general, would sue to block two multi-billion dollar health insurance mergers between Aetna and...more

When Settlement and Secrecy Do Not Mix

Non-disclosure and confidentiality provisions can be an important aspect of resolving a case through settlement. But when one of the parties is a purported class, and the allegation is an antitrust violation, settlement and...more

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

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

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

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

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

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

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

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

Blog: Part VII Transfers – When Is The Independent Expert Obliged To Disclose The Documents He Relies On, As He Prepares His...

In Excess Insurance Company Limited & others, the Court was asked to sanction the transfer of an insurance business from three different insurers to a fourth. The Prudential Regulation Authority and Financial Conduct...more

Congress Takes Long Look at Proposed Health Insurance Mergers

While the Department of Justice Antitrust Division is responsible for reviewing the proposed Anthem/Cigna and Aetna/Humana mergers for any potential competitive concerns, Congress jumped into the process with both feet in...more

Strike Three: Antitrust Claims in Florida Auto Insurer Proceeding Dismissed With Prejudice

On September 23, District Court Judge Gregory Presnell (Middle District of Florida) dismissed the antitrust claims asserted by a class of auto body shops in A&E Auto Body v. 21st Century Centennial Insurance, this time with...more

5th Circuit Affirms the Dismissal of Federal Antitrust Claims Against Insurance Broker on McCarran-Ferguson Act Grounds While...

On September 23, the Fifth Circuit Court of Appeals issued its opinion in Sanger Insurance Agency v. HUB International, affirming the dismissal of plaintiff's federal antitrust claims based upon the McCarran-Ferguson Act (15...more

Health Care Mergers Come Under Scrutiny

In July, 2015, Aetna struck a deal to buy Humana for $37 billion, which would cover 33 million members. Merging with Humana would give Aetna more than one-quarter of the total Medicare Advantage market, analysts say. In...more

Property & Casualty Personal Lines Insurers Doing Business In Rhode Island Have Until November To Remove Non-Risk Factors In Price...

Rhode Island’s Rhode Island Department of Business Regulation (“DBR”) has joined the growing list of state insurance regulators to issue a bulletin on the practice of price optimization. On September 18, 2015, the DBR issued...more

FTC Announces Increase in Merger Filings by Insurers and Overall

On August 12, the Federal Trade Commission (FTC) and DOJ released the agencies' 37th Annual Hart-Scott-Rodino Act (HSR) Report, highlighting the 33 merger enforcement actions brought by the agencies over the federal...more

Auto Insurers Score Another Victory in the Auto Body Shop Antitrust Litigation

On August 17, United States District Judge Greg Presnell (M.D. Fla.) handed the auto insurer defendants in the In re Auto Body Antitrust Litigation another significant victory, confirming a "Report and Recommendation" by...more

[Webinar] Find Out How Your Approach to Compliance Training Compares To Hundreds of Your Peers - July 22, 10:00am PT/ 1:00pm ET

Join us for this free webinar as we reveal the results of our 2015 Ethics & Compliance Training Benchmark Report. Find out how your program compares to the 600+ training professionals who weighed in this year. You’ll find...more

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