Health Insurance

News & Analysis as of

HHS OIG Finalizes New Exclusion Rules as Administration Exits

With just a week left before a new administration takes office, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) finalized changes to the regulations authorizing OIG to exclude...more

Health Reform Outlook for 2017: A Year of Major Uncertainty

Fulfilling their promises, Congressional Republicans moved to repeal the Affordable Care Act (ACA) on the first day of the new Congress when Senate Budget Committee Chair Michael Enzi (R-WY) introduced “reconciliation...more

Congress to Vote on Budget Resolution to Start Process of Repealing the Affordable Care Act; Vice President-Elect Pence Promises...

This week, the Senate and the House are expected to approve an FY 2017 budget resolution instructing congressional committees to write legislation, known as budget reconciliation bills, to rescind many key components of the...more

The New “Price” of U.S. Health Care: The Future of Value-based Reimbursement Under President-elect Trump and Tom Price

The total U.S. health care expenditure was $3.2 trillion in 2015, and is projected to grow to nearly $5.6 trillion by 2025. As our nation’s cost of care rises, both Democrats and Republicans recognize the overwhelming need to...more

The AHA’s Letter to Santa Claus

The American Hospital Association, after having been “nice” all year, penned its letter to Santa Claus with its wish list for Christmas. Its four page letter (actually addressed to President-Elect Donald Trump at 1717...more

What Does a Trump Presidency Mean for the Affordable Care Act?

President-elect Trump has stated repeatedly that one of his initial goals is to repeal and replace the Affordable Care Act (the "ACA"). Because the Republicans control both houses of Congress, it seems likely that a repeal...more

Researchers see ways Obamacare helped to cut costs, improve patient care

As the already known complications to its demise have increased by the minute, there may be some detectable pauses in the partisan zeal to give the Affordable Care Act, aka Obamacare, the bum’s rush. That’s because the...more

A Liar and A Cheat? 3 Ways to Pay...

Seyfarth Synopsis: Insurer gets to pick its remedy when hospital engages in dishonest billing and illegal kickbacks…to the tune of $41 million. Judge Lynn Hughes of the U.S. District Court for the Southern District of...more

Protecting Large, National Customers in Merger Enforcement—A Temporary Trend?

The past year has seen some significant and interesting challenges brought by the federal antitrust agencies in the merger space. There has been evidence for years of the agencies’ aggressive willingness to litigate. And...more

What inspectors (pretending to be patients) of social health insurance are (not) allowed to do

Against severe resistance of the medical profession, the social insurance agencies may send out inspectors pretending to be patients (in other industries also described as "mystery shoppers") to doctors' offices and hospitals...more

Honeywell Defeats Retirees’ Class Action Suit for Lifetime Health Benefits

A federal district court in Ohio dismissed retirees’ claims for lifetime healthcare benefits from Honeywell.  Honeywell provided healthcare benefits to plaintiffs through a series of collective bargaining agreements and,...more

Germany – Rise of Minimum Wage and New Ceilings for Social Security Contributions

Rise of Minimum Wage as of January 1st 2017: As of January 1st 2017 the statutory Minimum Wage in Germany rises from € 8.50 to € 8.84 gross per hour. It is the first increase, since the Minimum Wage Act...more

Anthem and Aetna Merger Trials Begin

While the election of Donald Trump as the nation's next president is clearly the biggest news in Washington over the last two months, for the insurance industry, big news has also been made at the federal district courthouse....more

Big Ten Update: End-of-Year Changes to Top Insurance Regulators

While Ohio made all the holiday bowl news, its Big Ten counterparts of Illinois, Indiana and Iowa have been making all the holiday news on leadership of insurance regulation. Since December 5, 2016, three Midwest states have...more

UPDATE: District Court Denies Preliminary Injunction in AARP Suit to Block Final Rules on Employee Wellness Programs

The U.S. District Court for the District of Columbia (Judge Bates) has denied AARP’s request to block the implementation of the EEOC’s final wellness regulations pending a decision on the merits. As we have discussed...more

Employment Law 2016 Review

Preparing for Medical Marijuana in Pennsylvania - Marijuana legalization reached Pennsylvania in 2016, bringing with it a host of new questions employers are going to have to answer. Signed into law on April 17, the...more

Employee Benefits Developments - December 2016

The Employee Benefits practice group is pleased to present the Benefits Developments Newsletter for the month of December, 2016. Certain Captive Arrangements Are No Longer Under the Radar - Notice 2016-66, released...more

QSEHRAs: End-of-Year Legislation Provides a New Health Care Option for Small Employers

Tucked at the end of the recently enacted 300-plus-page 21st Century Cures Act (Cures Act) is a provision that offers certain small employers a new opportunity to help employees purchase individual market major medical...more

CT Hospitals Have New Patient Disclosure Requirements Beginning in 2017

Beginning January 28, 2017, Connecticut hospitals must start notifying patients who schedule certain non-emergency diagnoses or procedures of their right to request related cost and quality information. This new requirement...more

District Court Rejects Retirees’ Claim for Lifetime Healthcare Benefits

A federal district court in Michigan dismissed retirees’ claims for lifetime, unalterable healthcare benefits from BorgWarner. BorgWarner provided healthcare benefits to Plaintiffs through a series of collective bargaining...more

New ACA FAQs - Special Enrollment, Women’s Preventive Care and a Cure for the HRA that Ails You (If You’re Small Enough)

In the latest round of FAQs on ACA implementation (now up to 35 if you’re keeping track), the DOL, HHS and Treasury Department addressed questions regarding HIPAA special enrollment rights, ACA coverage for preventive...more

Health Reimbursement Accounts for Small Employers

A new law allows small employers to provide a stand-alone employer-paid health reimbursement account plan to employees without incurring a tax penalty. This plan would help employees pay for insurance offered on an exchange...more

Medicaid 1115 Waivers Re-Approved for New York Managed Care and HIV Enrollees, Arkansas Works Cost-Sharing and Mandatory Job...

CMS has recently approved five-year extensions for Medicaid Demonstration Waivers under Section 1115 of the Social Security Act in New York and Arkansas. Both extensions allow each state to continue innovative pilot...more

Small Employers Have New Health Reimbursement Option Under Cures Act

The 21st Century Cures Act (Cures) signed by President Barack Obama on Dec. 13, 2016, contains a smorgasbord of health-related provisions, from reforming federal mental health policies to increasing funding for medical...more

Saudi Arabia Update - December 2016

Legal developments - New Regulations Published - The Minister of Commerce and Investment approved the Regulations for Unlisted Joint Stock Companies (Regulations). The Regulations cover many topics, including the...more

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