In mid-April 2022, the U.S. Department for Health and Human Services (HHS) officially opened its out-of-network payment dispute resolution portal under the No Surprises Act. This portal is the mechanism that many providers and payers must use to settle cases in certain circumstances. Some states have set up their own dispute resolution processes, and self-insured plans in those states must
The U.S. Department of Labor (DOL) recently issued a warning about its intention to launch an investigative program into those plans that offer cryptocurrency and related products as investment options. The DOL’s investigative program would include those products offered through brokerage windows, implying that plan fiduciaries might be responsible for those investments. Therefore, plan fiduciaries need to carefully consider their
On April 22, 2022, the U.S. Court of Appeals for the Sixth Circuit issued its decision in Hawkins v. Cintas Corporation, No. 21-3156, holding that ERISA claims for breach of fiduciary duty belong to the plan. As a result, plan members alleging harm to their individual retirement accounts in defined contribution plans, cannot be forced to arbitrate their claims
On April 19, 2022, the U.S. Department of Labor (DOL), U.S. Department of Health and Human Services (HHS), and the U.S. Treasury issued joint guidance concerning the 2020 Transparency in Coverage Final Rules. The primary subject of this guidance, entitled FAQs About Affordable Care Act Implementation Part 53, involves the provision of a safe harbor for health plans to
Tenet Healthcare and nineteen of its hospitals filed a complaint against Cigna Health and Life Insurance Company in Connecticut Superior Court, alleging that Cigna had reimbursed its claims at unfair and unreasonable rates. The plaintiffs also allege that Cigna wrongfully denied claims for emergency medical services, although they are legally obligated to provide Cigna plan members with emergency medical care.
The Russian invasion of Ukraine has led to a wave of public pension funds making divestment pledges from Russian investments. These public pension funds included some of the largest in the country, such as the state pension funds of New York and California. Private employers managing pension plans subject to ERISA should not follow divestment trends without solid financial reasons.
A Texas federal district court has granted Blue Cross and Blue Shield of Texas, Inc.’s motion to dismiss the state law claims, including a negligence per se claim filed by Brandon Walters, a group health plan participant, concerning a HIPAA violation. The case is Walters v. Blue Cross Blue Shield of Tex., Inc., 2022 WL 902735 (N.D. Tex. 2022).
Blue Cross
The city of Chicago has asked an Illinois federal district court judge to dismiss a suit filed by six city employees, challenging a wellness program within the city’s health insurance plan. The employees have argued against the dismissal, saying that the city’s argument for dismissal is based on a dispute over voluntariness, which is an issue that is unresolvable on
President Biden recently released his FY 2023 budget, which includes new and drastically increased funds to enforce the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).
From a financial perspective, Biden calls for a $125 million budgetary allotment to the states to assist with MHPAEA enforcement. State regulators can approve plan designs of fully insured group and
After a Minnesota federal district court judge denied its motion to dismiss a proposed ERISA class action suit in May, Wells Fargo & Co. has agreed to settle the case by paying $32.5 million. The employees claimed that Wells Fargo had violated ERISA by mismanaging their 401(k) plan. More specifically, the workers alleged that Wells Fargo had breached its fiduciary