The U.S. Department of Health and Human Services (HHS) has extended the effective date of its final rule updating electronic transaction standards for retail pharmacy transactions under the Health Insurance Portability and Accountability Act (HIPAA). The final rule also modifies the Medicaid pharmacy subrogation standard. These final rules were scheduled to go into effect on February 11, 2025. The new effective date Read More

UMR, which is UnitedHealth-owned third party administrator (TPA), agreed to pay $20.25 million in a U.S. Department of Labor (DOL) suit over their process for review of emergency room (ER) claims. Vincent Micone III, acting DOL secretary, has asked the U.S. District Court for the Western District of Wisconsin to approve a consent order and judgment to resolve the pending court case. In July 2023, the DOL filed a Read More

Republican state finance officials from 18 states have urged the acting heads of the U.S. Securities and Exchange Commission (SEC) and U.S. Department of Labor (DOL) to adopt regulations for asset managers and retirement plan sponsors banning the use of environmental, social and governance (ESG) or diversity, equity and inclusion (DEI) factors. The officials pointed to a recent legal loss by American Airlines as Read More

The U.S. Department of Labor (DOL), U.S. Department of Health and Human Services (HHS), and the Internal Revenue Service (IRS) recently released their 2024 Mental Health Parity and Addiction Equity Act (MHPAEA) Report to Congress. DOL also released its FY 2023 MHPAEA Enforcement Fact Sheet. The Consolidated Appropriations Act, 2021, provides for an annual report specific to nonquantitative treatment limitation (NQTL) Read More

A New Jersey federal district court has dismissed the plaintiff’s breach of fiduciary claims in Lewandowski v. Johnson & Johnson, et al. No 3:24-cv-00671 (D.N.J. January 24, 2025) without prejudice and with leave to amend the complaint, based on standing. In her lawsuit against Johnson & Johnson and its Pension & Benefits Committee, Ann Lewandowski alleged that the defendants collectively breached their Read More

The Seventh Circuit has reinstated a lawsuit by an auto parts corporation seeking a clawback of the proceeds a former plant manager received from selling his stock shares. The Court reversed the lower court’s grant of summary judgment in favor of the former manager, stating that it should not have considered the reasonableness of the noncompete clause in the stock agreement. The case is LKQ Corporation v. Robert Read More

The U.S. Department of Labor (DOL), U.S. Department of Health and Human Services (HHS), and the Internal Revenue Service (IRS) have issued FAQs About Consolidated Appropriations Act, 2021 Implementation Part 69. The FAQs provide guidance on the calculation of the qualifying payment amount (QPA) used in the independent dispute resolution (IDR) process under the No Surprises Act. The FAQs also extended enforcement Read More

Employers are facing multiple challenges this year in providing competitive and quality health care benefits for employees. Skyrocketing costs, increased fiduciary risk, and a constantly evolving legal and political landscape all are impacting the ability of employers to effectively provide healthcare benefits. Nonetheless, employers appear dedicated to continuing to provide these benefits, with an estimated 43% Read More

The U.S. Department of Treasury and the Internal Revenue Service (IRS) has proposed regulations concerning SECURE Act 2.0 changes to retirement plan catch-up contributions. The changes include increased catch-up contributions for plan participants between ages 60 and 63 and mandatory Roth tax treatment for catch-up contributions made by certain 401(k) plan participants. Increased Catch-Up Contributions for Certain Read More

The Health Resources and Service Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) approved updated preventive services guidelines for women on December 20, 2024. Under the Affordable Care Act (ACA), group health plans and insurers, with the exception of non-grandfathered plans[1], must cover certain preventive health services without cost-sharing. The updated HRSA guidelines apply to Read More