The California Supreme Court has revived a long-standing lawsuit between the California Medical Association (CMA) and Aetna over the insurance company’s alleged retaliation against physicians who referred their patients to out-of-network providers. The trial court judge and a state appellate court both dismissed the suit, which CMA originally filed in 2012, finding that CMA had no standing to bring the Read More
District Court Allows Mental Health Parity Claim Based on As-Applied Disparity to Proceed
A self-insured health plan participant sued the plan and plan administrator after receiving denials of his claims for his child’s residential mental health treatment. The participant claimed that Anthem Blue Cross and Blue Shield violated the Mental Health Parity and Addiction Equity Act (MHPAEA) for imposing a treatment limitation on mental health/substance use disorder (MH/SUD) benefits that it did not impose on Read More
U.S. Supreme Court to Consider Whether Mandatory Job Transfer Constitutes Discriminatory Employment Action
The U.S. Supreme Court has agreed to hear an appeal from the Eighth Circuit entitled Muldrow v. City of St. Louis. The issue in Muldrow involves whether Title VII of the Civil Rights Act of 1964 prohibits discrimination in job transfer decisions, absent evidence that the transfer caused the plaintiff a material disadvantage. As a result, the high Court will consider whether Title VII applies to all terms, conditions, Read More
DC Circuit Upholds $1.1M ACA Penalty as Tax
The U.S. Court of Appeals for the D.C. Circuit recently ruled that $1.1 million in penalties that the Internal Revenue Service (IRS) assessed against a wireless phone company for failing to provide health insurance coverage for its employees in violation of the Affordable Care Act (ACA) is a tax. Therefore, the company could not challenge the penalty due to the Anti-Injunction Act, which prohibits lawsuits Read More
Scorching Temperatures Spurn Feds to Call for Increased Worker Protections
Late July and early August brought about record-breaking heat waves nationwide, and many saw temperatures hit triple digits. In response, President Biden called for the U.S. Department of Labor (DOL) to issue its first-ever heat-related Hazard Alert. DOL’s Occupational and Safety Health Administration (OSHA) issued the Hazard Alert on July 27, 2023, affirming protections for workers from excessive heat under federal Read More
Mental Health Parity: Agencies Report to Congress on Continued Compliance Issues and Highlight Enforcement Activity
The U.S. Department of Labor (DOL), the U.S. Department of Health and Human Services (HHS), and the U.S. Department of Treasury have issued their second MHPAEA Comparative Analysis Report to Congress. This report is a requirement of the Consolidated Appropriations Act, 2021 (CAA, 2021) and the Mental Health Parity and Addiction Equity Act (MHPAEA). Under the CAA, 2021, health plans and insurers imposing Read More
Aetna and MLB Face ERISA Suit Over Denied Mental Health Claims
A Major League Baseball Players (MLB) Benefit Plan participant recently filed an ERISA lawsuit against Aetna Health and Life Insurance Co. (Aetna) and the MLB Benefits Plan. The suit challenges the denial of inpatient mental health treatment claims for the participant’s daughter. MLB offers mental health benefits to employees and their beneficiaries, including inpatient and outpatient treatment of mental health Read More
U.S. Supreme Court Eases Standard for Employees to Sue Employers Concerning Denied Religious Accommodations in the Workplace
The U.S. Supreme Court recently issued its decision in Groff v. DeJoy, Postmaster General, making it easier for employees to sue employers that fail to offer religious workplace accommodations. In its ruling, the Court revived a Title VII lawsuit that former U.S. Postal Service (USPS) employee and Evangelical Christian Gerald Groff had filed after the USPS would not accommodate his religious practices. When the Read More
PBM Reform Legislation Advances in Senate and House Committees
Committees in both houses of Congress recently voted to advance legislation reforming pharmacy benefit managers (PBMs). In recent months, PBMs, which manage prescription drug benefits on behalf of health insurers, Medicare Part D drug plans, and large employers, have come under fire for allegedly anticompetitive practices and inflated consumer drug prices. The Senate Finance Committee, which handles matters Read More
September 2023 | HBL Celebrates a Decade of Excellence
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