CA Federal Judge Orders Billing Contractor to Produce Docs in Surprise-Billing Claim

U.S. Magistrate Joseph C. Spero granted a motion to compel from a proposed class of patients, alleging that their insurer, United Behavioral Health, had underpaid their out-of-network reimbursement claims. The judge found that third-party billing contractor, MultiPlan, had waived all claimed protections in its privilege log and failed to follow an October order concerning the discovery dispute. As a result, MultiPlan Read More

EBSA Issues Final Rule on ESG Factors for Retirement Plans

The Employee Benefits Security Administration (EBSA) of the U.S. Department of Labor (DOL) has issued a final rule adopting amendments to the Investment Duties regulation under Title I of the Employee Retirement Income Security Act (ERISA). These amendments, which become effective on January 30, 2023, change certain amendments to the Investment Duties regulation adopted in 2020 and are part of the Biden Read More

Prohibited Transaction Exemption 2002-51 to Permit Certain Transactions Identified in the Voluntary Fiduciary Correction Program

The Employee Benefits Security Administration (EBSA) has published a proposed amendment to Prohibited Transaction Exemption (PTE) 2002-51. In conjunction with the proposed amendment, the U.S. Department of Labor (DOL) published an amendment statement of its Voluntary Fiduciary Correction Program (VFCP). Comments on the proposed rule are due by January 20, 2023.  PTE 2002-51 exempts certain transactions identified Read More

HHS Issues Proposed Rule Changing HIPAA Standards for Certain Electronic Pharmacy-Related Transactions

The U.S. Department of Health and Human Services (HHS) has issued a proposed rule that would update HIPAA’s electronic transaction standards regarding some retail pharmacy transactions related to healthcare claims. The affected retail pharmacy transactions include health care claims or equivalent encounter information, eligibility for a health plan, referral certification and authorization, and coordination of Read More

10th Circ. Appears Unreceptive to UnitedHealth Arguments in ERISA Mental Health Benefits Claim

A panel of the U.S. Court of Appeals for the Tenth Circuit recently heard oral arguments in the case of K. et al. v. United Behavioral Health et al., case number 21-4088. The judges appeared skeptical of United Behavioral Health’s challenge to the district court's 2021 ruling. That court found that United and an Alcatel-Lucent employee medical plan violated the ERISA by denying inpatient mental health treatment Read More

Employers Face Legal Risks in Protecting Abortion Access for Workers

After the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health, which allows states to ban abortion, many employers vowed to protect abortion access for their workers. Some employers took action to adjust their health plans, and others promised workers that they would still be able to obtain abortions, even in states where it is illegal, by providing financial support for out-of-state travel or other Read More

OCR Announces Dental Practice Settlements Under HIPAA Individual Access Provision

The Office of Civil Rights (OCR) of the U.S. Department of Health and Human Services (“HHS”) has announced three more settlements with dental practices as part of its enforcement initiative of the individual access provision of HIPAA. Under this provision of the privacy rule, individuals have the right to access their protected health information (PHI), in most cases, within 30 days. These settlements bring the total Read More

Court Hearings for Benefits Attorneys to Watch

AT&T Workers Appeal Dismissal of 401(k) Excessive Fees Suit to Ninth Circuit The U.S. Court of Appeals for the Ninth Circuit recently heard oral arguments in Robert Bugielski et al. v. AT&T Services Inc. et al., case number 21-56196. A class of almost 250,000 AT&T workers appealed after a federal district court judge granted summary judgment in favor of AT&T in their ERISA lawsuit. The workers Read More

Proactive Steps that 401(k) Plan Sponsors Can Take to Avoid Litigation

Small and mid-size 401(k) plan fiduciaries progressively have become the target of plaintiffs’ law firms filing suits based on alleged breaches in fiduciary duty. In most of these lawsuits, participants claim that plan sponsors have breached their fiduciary duty by charging excessive fees, making poor investment choices, or failing to monitor investments properly. Due to plaintiffs using detailed benchmark data to Read More

Wells Fargo Settles Multimillion Dollar 401(k) Suit with DOL

Wells Fargo has settled with the U.S. Department of Labor (DOL) after an investigation revealed that the fund overpaid for company stock purchased for the plan during specific years. The settlement requires Wells Fargo to pay almost $132 million to its 401(k) plan participants and a penalty of nearly $13.2 million. The lawsuit involves Wells Fargo and Company, Wells Fargo Bank, and GreatBanc Trust Company, a trustee Read More