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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…

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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…

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,…

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…

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…

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,…

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…

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.…