Health Insurance

News & Analysis as of

Class Certification Improper in Data Breach Case, PA Appellate Court Finds

The Pennsylvania Superior Court has affirmed a trial court's decision denying class certification in a data breach case against two health plans, reversing its own earlier ruling in the same case that the plaintiff did not...more

Health Alert (Australia) - May 2, 2016

In This Issue: - Judgments; Legislation; and Reports. - Excerpts from Judgments: Inquest into the death of Chris Pravin Prasad Mr Prasad was a 51-year-old involuntary inpatient at a psychiatric...more

California Insurance Commissioner Approves 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

DOL Issues Guidance Regarding Interaction Between Affordable Care Act And Fringe Benefit Requirements Under Service Contract,...

The Davis Bacon Act and the Davis Bacon Related Acts (collectively “DBRA”) and the Service Contract Act (“SCA”) impose additional obligations related to fringe benefits and wages on covered contractors. With the passing of...more

L.A. hospital under fire for ‘dumping’ poor patient after emergency treatment

Is this any way to treat the most needy? Los Angeles prosecutors have announced a $450,000 settlement with yet another of the city’s hospitals accused of “patient dumping,” the practice of hustling individuals, particularly...more

Cadillac Tax: A Levy in Limbo

The future of the Cadillac tax, a key cost-control mechanism and federal revenue source enacted as part of the Patient Protection and Affordable Care Act (ACA), is unclear. Though initially set to take effect in 2018,...more

Are retirement ages in PHI schemes age discriminatory?

Mistakes by employers in relation to an employee's entitlement to PHI can be very costly. In one leading High Court case, Aspden v. Webbs Poultry & Meat Group (Holdings) Limited [1996] I.R.L.R. 521, an employee was awarded...more

Section 1557 of the ACA: The Legal Side of Health Equity

This week marks the end of National Minority Health Month and its 2016 theme of “Accelerating Health Equity for the Nation.” This month, the HHS Office of Minority Health’s goal was to “raise awareness of the health...more

New ACA, et. al. FAQs Cover Items From “Top” to “Bottom”

On April 20, the “Big Three” agencies (DOL, Treasury/IRS, and HHS) released another set of FAQs (the 31st, for those of you counting at home). Consistent with earlier FAQs, the new FAQs cover a broad range of items under the...more

Newly Released FAQs Address Health Plan Compliance Issues

The questions address a wide range of issues, including preventive care, coverage for clinical trials, required disclosures, the Women’s Health and Cancer Rights Act, rescissions, reference pricing and mental health parity...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

Health Law Insights Newsletter - Issue 8 - April 2016

McCarter & English, LLP’s Health Care Group presents Issue 8 of the Health Law Insights, which discusses the latest legal issues in the health care industry. NATIONAL - New Payment Model for Part B Drugs Proposed -...more

Health Net Deepens Investigation of Addiction Treatment Centers

As noted in a blog posted earlier this year, addiction treatment providers have been receiving an increased number of requests from payors seeking a range of medical and billing records and other documentation concerning the...more

A&B Healthcare Week in Review

I. REGULATIONS, NOTICES, & GUIDANCE - On April 15, 2016, the Food and Drug Administration (FDA) issued a proposed rule entitled, “Applications for Approval and Combinations of Active Ingredients Under Consideration for...more

Summary of Benefits and Coverage Templates Finalized

On April 6, 2016, the US Department of Labor posted final versions of the updated summary of benefits and coverage (SBC) template and instructions, updated uniform glossary and other associated materials. In previous...more

Technological and Information Concerns Highlight NAIC Spring 2016 National Meeting

The National Association of Insurance Commissioners (NAIC) Spring 2016 National Meeting, which was held from April 3 – 6 in New Orleans, offered insight into numerous issues being considered by state commissioners nationwide....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

IREG Update - Exemptions of health care sharing ministries from insurance laws and regulations

Exemptions of health care sharing ministries from insurance laws and regulations - Whether because of the cost of the policies, or their religious and political principles, many Americans are looking to avoid enrolling...more

Health Alert (Australia) - April 11, 2016

In This Issue: - Judgments; Legislation; and Reports. - Excerpts from Judgments: South Australia 11 April 2016 - Inquest into the death of Roswitha Maria Osang Mrs Osang presented to the Tanunda...more

Good News for Corporate Policy Holders: Court Finds Cyber Coverage Under Standard Liability Policy

Corporate policy holders received good news on April 11 when the U.S. Court of Appeals for the Fourth Circuit issued its opinion in the case captioned: The Travelers Indemnity Company of America v. Portal Healthcare...more

Feds identify security vulnerabilities in state healthcare exchange websites

A Government Accountability Office (GAO) examination of the state-run health insurance exchanges for California, Kentucky and Vermont identified inadequate security measures in place to protect consumers’ personal...more

Bad COBRA Notices Can Cost You

Sun Trust Bank was sued in a class action challenging its COBRA notice. The plaintiffs who brought the lawsuit claimed that the COBRA notice was materially deficient in that it failed to provide the name and address of the...more

SCOTUS ERISA Cases, Part Two: Preemption of State Healthcare Claims Database

This is the second article of a three part series summarizing employee benefit issues that are being argued in front of the U.S. Supreme Court during the current October 2015 term. Part One provided an outline of Montanile v....more

What’s In a Name? Not Much, Says Colo. Federal Court

On March 31 a federal court in Colorado threw out a suit by 80 chiropractors against several national health insurers. The chiropractors alleged that the insurers violated Colorado law by paying them less than physicians and...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

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