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

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

FTC Withdraws Prior Health Care Antitrust Policy Statements as It Continues to Investigate PBM Market

The Federal Trade Commission (FTC) recently unanimously voted to withdraw its previously issued policy statement that opposed state legislation increasing transparency over pharmacy benefit managers (PBMs). Consistent with heightened scrutiny of PBMs by federal agencies, the FTC issued a statement cautioning against reliance on prior advocacy statements regarding PBMs that no longer may be valid. The FTC stated Read More

A Look at the Proposed Joint Regulations to Implement MHPAEA and NQTL Requirements

Three federal agencies – the Department of Labor (DOL), the Department of Treasury (Treasury), and the Department of Health & Human Services (HHS) – released joint proposed rules designed to amend existing rules under the Mental Health Parity and Addiction Equity Act (MHPAEA). The proposed rules also fulfill the mandate of the Consolidated Appropriations Act, 2021 (CAA, 2021) to implement nonquantitative Read More

Musk Pleads No Personal Liability in Former Employee Severance Claims

A Delaware federal judge heard arguments recently on Elon Musk’s motion to dismiss all claims against him personally in a lawsuit filed by former Twitter employees over severance benefits. The case is Arnold et al. v. X Corp. et al., case number 1:23-cv-00528, the U.S. District Court for the District of Delaware. Musk argued that he did not sign off on the provisions of the 2022 Twitter takeover deal concerning Read More

Takeaways from Biden Administration’s Proposed Rules on Mental Health Parity

The U.S. Department of Labor (DOL), U.S. Department of the Treasury (Treasury), and the U.S. Department of Health and Human Services (HHS) recently issued 395 pages of proposed rules designed to guide group health plans on compliance with mental health parity laws. These rules clarify that the Biden administration intends to restrict plans’ use of nonquantitative limits on mental health and substance use disorder Read More

DOL Announces DST Systems to Pay Over $124M to Settle 401(k) Plan Mismanagement

The U.S. Department of Labor (DOL) has announced the settlement of a class action Employee Retirement Income Security Act (ERISA) lawsuit for more than $124.6 million on behalf of the more than 9,000 participants in the DST Systems Inc. 401(k) plan. The DOL and private plaintiffs alleged that DST and other defendants, including New York City investment management firm Ruane, Cunniff, & Goldfarb Inc., had failed Read More

FAQs (Part 60) Address Interaction of Surprise Billing Rules with ACA Cost-Sharing and Transparency Requirements

The U.S. Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury recently issued joint FAQs (Part 60) concerning the implementation of specific provisions of the Affordable Care Act (ACA) and Title I of Division BB of the Consolidated Appropriations Act, 2021 (the No Surprises Act). The purpose of these FAQs is to address overlap in some areas of the ACA and the No Surprises Act. The first Read More

Kraft Heinz Sues Aetna for Violating Fiduciary Duty, Improperly Paying Providers for Medical Services

Kraft Heinz Co. has filed an ERISA lawsuit against Aetna Inc. in a Texas federal court. Aetna provides claims processing and adjudication services for Kraft Heinz, which self-funds its employees’ and retirees’ medical expenses. Under ERISA, Aetna has a fiduciary duty to properly identify, deny, and prevent the payment of any provider claims that are false or improperly submitted. Kraft Heinz claims that Aetna Read More

Laid-Off Employees File ERISA Suit Against Twitter for Failure to Pay $500 Million in Severance

A group of former Twitter employees laid off after Elon Musk took over the company recently filed a proposed class action lawsuit in a California federal court. The former employees allege that Twitter failed to pay laid-off employees more than $500 million in severance according to the company's ERISA-governed severance plan, which Musk promised would remain in effect. The Twitter severance plan provided Read More