News & Analysis as of

Health Insurance

Aetna and its Vendor Face Class Action Lawsuit over HIV Disclosure

A Pennsylvania man has filed a class action lawsuit against Aetna Inc., accusing it of violating his privacy rights when the insurer mailed him prescription information in an envelope with a large, clear window that disclosed...more

Ripeness: A Question of Subject Matter Jurisdiction - Allied World Surplus Lines Insurance Company v. Blue Cross and Blue Shield...

by Nexsen Pruet, PLLC on

Addressing a contractual requirement to exhaust Alternative Dispute Resolution (ADR) prior to commencing litigation, the United States District Court for the District of South Carolina chose to forge its own path, rejecting...more

Healthcare Insurer Rebuked for Exposing Policyholders’ HIV Status

Two legal advocacy groups have accused Aetna Inc. – the Hartford-based healthcare company – of “gross” breaches of privacy and confidentiality including violations of federal healthcare law when a third-party vendor...more

IRS Reminder that ACA Employer and Individual Tax Penalties Are Not Waived

by Dickinson Wright on

With all the heated rhetoric surrounding the Affordable Care Act ("ACA"), including the President's Executive Order issued on January 20, 2017 and the recent efforts to repeal and replace the law, employers and individuals...more

Under the Dome: Inside the Maine State House

by Pierce Atwood LLP on

Under the Dome: Inside the Maine State House provides a high-level overview of recent activity at the Maine State House. Republicans Challenge Wording of Medicaid Expansion Question on Fall Ballot - Question 2 on...more

ACA Cost-Sharing Reductions– A Momentary Reprieve and Ongoing Doubts

The Future of CSRs – A Tale Told in Tweets. In follow-up to our May 5, 2017 blog post, “ACA Cost-Sharing Reductions: An Uncertain Future,” on August 16, 2017, the Trump Administration made an announcement (Announcement) that...more

DOL Releases Draft Model Form for Mental Health Parity Disclosure Requests

by Ballard Spahr LLP on

The U.S. Department of Labor (DOL) recently released a draft model form for plan participants to request disclosures from group health plans and insurers about restrictions on mental health coverage. The form is designed to...more

IRS Reaffirms ACA's Employer Mandate

by Barley Snyder on

While the long-term future of the Affordable Care Act may be in doubt, the law’s application to employers remains largely unaffected by recent political developments....more

Many Lessons Still Need to be Learned regarding Patient Access to Health Care Information

by McDermott Will & Emery on

The Office of the National Coordinator for Health Information Technology recently released a report (the Report) detailing user experience research on patient access to health data. The Report sought to examine the...more

Update on Cost-Sharing Reduction (CSR) Payments and Graham-Cassidy-Heller Proposal

by King & Spalding on

According to multiple media reports, the Trump administration will make CSR payments for August. President Trump has previously called these expenditures, which help insurers fund coverage for low income individuals,...more

Health Alert (Australia) 22 August 2017

by DLA Piper on

In This Issue: - Judgments; Legislation; and Reports. - Excerpts from Judgments: 11 August 2017 - South Western Sydney Local Health District v Sorbello [2017] NSWCA 201 - NEGLIGENCE – assessment of damages...more

Lessons Learned from 2017 OCR HIPAA Enforcement Actions

by Foley & Lardner LLP on

So far 2017 is proving to be an active year for Health Insurance Portability and Accountability Act (HIPAA) enforcement. This comes on the heels of 2016, which saw an unprecedented level of enforcement actions, with 13 total...more

Beltway Buzz - August 18, 2017

EEO-1 News . . . Maybe. Rumors are rampant that the White House’s Office of Management and Budget (OMB) may soon take action on the Equal Employment Opportunity Commission’s (EEOC) changes to its EEO-1 form, which will...more

Physicians Maintain High Standards

by Burr & Forman on

By the time this article goes to print, a lot could change, so there’s no apparent use in guessing what will come of the next Repeal and Replace efforts or what’s happening at Main Justice. Nobody knows. The only certainties...more

Uncertainty Surrounds Low Income Pool (LIP) Funding

The Centers for Medicare and Medicaid Services (CMS), in an August 3, 2017 letter to Florida’s Medicaid Director, approved a five-year extension of the State’s 1115 demonstration project, the Managed Medical Assistance...more

Recent 11th Circuit Decision Is a Victory for Health Care Providers Challenging Insurer Reimbursement Decisions and a Reminder of...

by K&L Gates LLP on

The existence and scope of assignments of benefits from patients to health care providers continues to be critically important to a provider’s ability to challenge an insurer’s reimbursement decision under the Employee...more

Massachusetts Employers Face $200 Million Increase in Health Care Costs under MassHealth Amendments

On August 1, Massachusetts Governor Charlie Baker signed into law H. 3822, “An Act Further Regulating Employer Contributions to Health Care” (the “Act”). The purpose of the Act is to shore up the finances of the...more

Medicare Secondary Payer Act Class Actions

There have been a substantial number of putative class actions filed recently against insurers involving the Medicare Secondary Payer Act (MSPA). These cases are typically filed by assignees of Medicare advantage...more

Alphabet Soup — Changes to the Affordable Care Act

by LeClairRyan on

With the new Trump administration and Republican control of Congress, there has been a lot of discussion about eliminating the Affordable Care Act and replacing it with a different set of rules. Legislation has passed the...more

New Guidance on Coverage for Eating Disorders

by Tucker Arensberg, P.C. on

The Departments of Labor, Treasury, and Health and Human Services recently released a frequently asked question (“FAQ”) regarding the implementation of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction...more

Recess Update on the Affordable Care Act and Its Repeal and Replacement

by Ballard Spahr LLP on

The momentary lull in congressional activity on health care provides an opportune time for an update on the efforts to repeal and replace the Affordable Care Act (ACA)....more

D.C. Circuit Finds that Theft of Health Insurance Subscriber ID Numbers Is a Cognizable Injury in Identity Theft Litigation

by Moore & Van Allen PLLC on

Recently, the D.C. Circuit Court of Appeals ruled in Attias v. CareFirst, Inc., No. 16-7108, that customers had standing to sue a health insurer for a 2014 data breach in which the customers’ information was stolen. ...more

How Medicare and Employer Coverage Coordinate

Medicare benefits start at age 65, but many people continue working past that age, either by choice or need. It is important to understand how Medicare and employer coverage work together....more

Health Alert (Australia) 14 August 2017

by DLA Piper on

In This Issue: - Judgments; Legislation; and Reports. - Excerpts from Judgments: 10 August 2017 - Inquest into the Death of Stephen Herczeg 57/2016 (1808/2016) - The said Court finds that Stephen Herczeg aged 72...more

The DC Circuit Opens the Door to Data Breach Plaintiffs Alleging Substantial Risk of Future ID Theft

by Fenwick & West LLP on

The U.S. Court of Appeals for the D.C. Circuit has held that allegations of a heightened risk of future identity theft resulting from a data breach established a concrete injury at the pleading stage....more

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