Whistleblower Sarah Benke recently testified in a False Claims Act bench trial that Caremark, which is a pharmacy benefits manager (PBM) for Aetna Life Insurance Co., overbilled Medicare Part D for sponsored prescription drugs. She estimated that the CVS-owned PBM caused $240 to $330 million in damages by billing Medicare for reimbursement amounts that were higher than it paid pharmacies
Employee Benefits
Episode 2: From Navy SEAL to Nonprofit GC: A Mission-Driven Legal Journey
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Episode Summary:
In this episode of In-House Counsel and HR Perspectives, host David Hall welcomes Tim Phillips, Chief Legal Officer at Habitat for Humanity International and General Counsel for the Navy SEALS Foundation. With a background that spans Naval Special Warfare, big law, and executive legal leadership at major nonprofits like the American…
Hospitals Increasingly Filing Antitrust Suits Against Blue Cross and Blue Shield Carriers
Large hospitals and health systems have filed a spate of antitrust suits against various Blue Cross and Blue Shield (BCBS) carriers, including Elevance Health and Health Care Service Corp. These plaintiffs in the recent lawsuits are those health system giants that opted out of the $2.8 billion antitrust settlement that BCBS agreed to last fall. They had until March 29,…
HHS Issues Memo Rescinding 2022 Guidance on Gender Affirming Care
The U.S. Department of Health & Human Services (HHS) has issued a memorandum rescinding its 2022 guidance entitled “Rescission of ‘HHS Notice and Guidance on Gender Affirming Care, Civil Rights, and Patient Privacy’.” The rescission cites Section 5(b) of Executive Order 14187, “Protecting Children from Chemical and Surgical Mutilation,” as justification. The rescission of the 2022 HHS guidance is effective…
Federal 340B Drug Pricing Program Failing Patients, Increasing Drug Costs
The American Benefits Council has released a new white paper calling for reforms to the federal 340B drug pricing program. According to the paper, the 340B program is failing to meet the needs of the patients that it was designed to help. At the same time, the program is driving up healthcare expenses for employer-sponsored health plans by $5.2 billion…
DOL’s New Retirement Security Rule Remains on Hold as Agency Pauses Appeals
The U.S. Department of Labor (DOL) has filed a motion with the U.S. Court of Appeals for the Fifth Circuit to pause its appeals of two federal court cases challenging its new Retirement Security Rule. This move follows two July 2024 federal court orders staying the implementation of the rule, which was supposed to go into effect in September 2024.…
Liability for Employers Handling Discrimination Complaints Without DEI
More and more companies are explicitly moving away from diversity, equity, and inclusion (DEI) policies in the wake of the White House’s January executive order addressing the issue. In the aftermath of this exodus, employers now must grapple with how to handle discrimination complaints. Abandoning DEI policies also results in rejecting in-house dispute resolution processes for discrimination complaints.
Dismantling of…
IRS Begins Implementation of Biden-Era Paperwork Burden Reduction Act
The Internal Revenue Service (IRS) has begun the process of implementing the Paperwork Burden Reduction Act, a law from the Biden administration that is already in effect. To assist employers, the IRS has issued Notice 2025-15, which no longer requires employers to send coverage statements to all full-time employees.
Instead of sending out complex, personalized statements to full-time employees,…
Federal Judge Refuses to Dismiss Retaliation Claims Over Sephora’s Hiring Practices
A U.S. District Court judge in Georgia has declined to partially dismiss a former store manager’s discrimination and retaliation claims against Sephora. Nixaliz Mestre, who is Latina, was terminated from the high-end beauty chain after refusing to prioritize white job applicants over applicants of other races. The judge ruled that Mestre’s allegations were sufficiently detailed to avoid dismissal prior to…
HHS Settles HIPAA Security Breach Stemming from Phishing Cyberattack for $3 Million
The Office for Civil Rights (OCR), a division of the U.S. Department of Health and Human Services (HHS), has announced a $3 million settlement with Solara Medical Supplies, LLC, a covered entity under the Health Insurance Portability and Accountability Act (HIPAA). The unauthorized disclosures stemmed from a cyberattack that resulted in violations of the HIPAA security and breach notification rules.…