Health Insurance

News & Analysis as of

Healthcare Litigation - October 2016

Recently, California Governor Jerry Brown signed into law “surprise medical bill legislation,” seeking to curb out-of-network medical bills. This law, designated AB 72, amends California’s Health and Safety Code to limit the...more

DOJ-AmEx Case Could Have Ramifications for Health Care Providers

The U.S. Department of Justice's loss to American Express sends a message to health care providers: Steering, tiering, exclusive dealing and other contractual arrangements that appear to suppress competition in one part of...more

Employer Obligations Under New Nondiscrimination Rules: ACA Section 1557 and Requirements for Federal Contractors

Two new regulations require some employers to make health plan design and administrative changes. While not all employers are subject to these requirements, those who are will need to review their plans and be aware of other...more

Affordable Care Act Whistleblower Complaint Procedures

On October 11, 2016, the Occupational Safety and Health Administration published a final rule that establishes procedures and time frames for handling whistleblower complaints under the Affordable Care Act (ACA); for hearings...more

New Non-Discrimination Notice Requirements Go Into Effect October 17, 2016

In May of this year, the Office for Civil Rights (OCR) of the Department of Health and Human Services (HHS) finalized its rulemaking implementing certain non-discrimination requirements under Section 1557 of the Affordable...more

Continuing Assaults on Surprise Out-of-Network Bills

California struck the most recent blow against surprise out-of-network medical bills. Surprise bills are different from the bills you get when you knowingly choose an out-of-network provider. Those are painful, but they...more

Reminder: Employers Must Use Extreme Caution When Considering Reimbursing an Employee’s Individual Health Insurance Premium

In follow up to IRS Notices 2013-54 and 2015-17, the IRS Office of Chief Counsel has issued 4 information letters thus far in 2016 regarding employer reimbursement of employee individual health insurance premiums and related...more

Watching SCOTUS – ERISA Church-Plan Exemption Revisited

Seyfarth Synopsis: Currently before the Supreme Court are two petitions regarding the thorny legal question of which organizations can qualify for ERISA’s Church-plan exemption. If the Supreme Court grants certiorari and...more

Manatt on Health Reform: Weekly Highlights - October 2016 #2

Kentucky receives final approval from CMS to transition its Marketplace to the platform; Ohio puts a prescription drug price ceiling on its November 2017 ballot; and a new study links Medicaid expansion to...more

As Obamacare draws fire, millions more struggle with employer coverage

The Affordable Care Act aka Obamacare has been a vital path into health insurance coverage for millions of Americans. But the Houston Chronicle and other media deserve credit for reminding that most people in this country...more

The Road to Higher Out-of-Pocket Medical Costs is Paved with Good Intentions: The Unintended Consequences of High Deductible...

High-deductible health plans (HDHPs) are among the fastest growing health plans in both the individual and group markets. For calendar year 2017, the IRS defines an HDHP as any health plan with a minimum deductible of $1300...more

Manatt on Health Reform: Weekly Highlights - October 2016

Vermont moves closer to launching the country’s first all-payer ACO; CMS approves Arizona’s 1115 waiver extension but rejects the State’s proposed work requirement and premiums for those earning below the FPL; and CMS issues...more

Big Summary Judgment Win for Hospital Defending $300M Exclusive Dealing Antitrust Suit

After fending off a motion for judgment on the pleadings in March 2015, a small hospital in Peoria, Illinois lost on summary judgment in its $300 million antitrust suit alleging illegal exclusive dealing and attempted...more

Red Notice Newsletter - Chinese

LATAM Airlines Agrees to Pay $22 Million to Settle FCPA Cases - Last month, LATAM Airlines (“LATAM”), based in Santiago, Chile, agreed to pay $22 million to settle parallel civil and criminal proceedings involving...more

Employee Benefits Developments - September 2016

Final IRS Regulations Eliminate Requirement to File 83(b) Election with Tax Return - Under Section 83(a) of the Internal Revenue Code (the “Code”), if property is transferred in connection with the performance of...more

Red Notice Newsletter - August 2016

LATAM Airlines Agrees to Pay $22 Million to Settle FCPA Cases - Last month, LATAM Airlines (“LATAM”), based in Santiago, Chile, agreed to pay $22 million to settle parallel civil and criminal proceedings involving...more

California Clamps Down On Surprise Out-Of-Network Bills

On September 23, 2016, Governor Brown signed AB 72, California’s surprise out-of-network law. The bill protects patients who seek care at an in-network facility from balance billing by individual health care providers who are...more

California Targets Surprise Medical Bills, Follows on the Heels of New York and Florida

Governor Brown approved a new law last Friday that limits patient exposure to so-called surprise medical bills. AB 72 caps the cost-sharing obligations of patients who unexpectedly receive care from non-contracted providers...more

Hot Topics in Employer Health Benefits

As we start looking forward to 2017, and as many employers head into annual enrollment periods this fall, employers need to be aware of recent changes in the law that have a significant impact on health benefit plans. This...more

Health Alert (Australia) 26 September 2016

In This Issue: - Judgments; Legislation; and Reports. - Excerpts from Judgments: Queensland - 10 September 2016 - Inquest into the death of C - C was a 14 year old girl with multiple physical and...more

District Court Decision Upholds Employer’s Wellness Program But Signals Support for EEOC Positions Going Forward

In EEOC v. Orion Energy Systems, Inc., the Eastern District of Wisconsin rejected the EEOC’s claims that Orion Energy’s wellness program violated the Americans with Disabilities Act (“ADA”). Although the court upheld the...more

Half a Loaf: Court Rejects ADA "Safe Harbor" But Approves Pre-Regulations Wellness Program as "Voluntary"

The EEOC’s attack on employee wellness programs as unlawful under the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA) that began in 2014 with three lawsuits, and continued with...more

UnitedHealth Plan Holders Win Class Certification in ERISA Lawsuit

The District Court for the Northern District of California recently granted certain members of UnitedHealth health plans class certification in their suit alleging improper denial of benefits. Plaintiffs in the putative...more

Antitrust-Related Recent Developments: FTC/DOJ Aggressive Merger Enforcement Continues

The Federal Trade Commission and Department of Justice have continued their aggressive stance against proposed mergers that the antitrust agencies perceive as harmful to competition. So far this year, the FTC obtained a...more

3 ways to save millions & improve access in the costly U.S. health care system

Yes, the good news is that the number of Americans without health insurance has fallen to new lows. But it’s also true that employers, who still provide the bulk of health care coverage in this country, have shifted...more

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