The U.S. Department of Health and Human Services’ Centers for Medicare & Medicaid Services (CMS), the Office of Personnel Management (OPM), the Department of Treasury’s Internal Revenue Service (IRS), and the U.S. Department of Labor’s (DOL) Employee Benefits Security Administration (EBSA) have issued a proposed rule on the federal Independent Dispute Resolution (IDR) process under the No Surprises Act (NSA). The Read More

An Illinois judge has denied a motion by Blue Cross Blue Shield to dismiss a same-sex discrimination lawsuit concerning coverage for couples undergoing fertility treatments. In denying the insurance company’s motion to dismiss, the judge found that the company may have denied the woman coverage under a policy that unlawfully discriminates against LGBTQ couples. The case is Murphy v. Health Care Service Corp., Case Read More

Three federal agencies – the U.S. Department of Labor (DOL), the U.S. Department of Health and Human Services (HHS), and the Internal Revenue Service (IRS) – recently issued FAQs (Part 62) on the “qualified payment amount” (QPA) under the No Surprises Act. The agencies also published guidance on the phased reopening of the independent dispute resolution (IDR) portal. FAQs on Surprise Billing QPA The issues in Read More

A panel of the U.S. Court of Appeals for the Fifth Circuit has reversed a district court decision awarding former NFL running back Michael Cloud higher disability benefits and back pay. Nonetheless, the panel agreed with many of the lower court’s findings, noting the NFL retirement plan’s “disturbing” and aggressively unfair treatment of former players who had suffered severely incapacitating on-the-field injuries Read More

A Massachusetts federal court has given preliminary approval to a $61 million settlement in a pending lawsuit concerning General Electric’s (GE) alleged mismanagement of retirement savings invested in a proprietary fund. The settlement would partially reimburse about 200,000 current and former participants in GE’s 401(k) plan for losses incurred since September 2011 because of GE Asset Management’s comparatively poor Read More

A federal court has invalidated a 2021 U.S. Department of Health and Human Services (HHS) regulation as arbitrary and capricious. The regulation changed the relationship between direct financial support from drug manufacturers and the Affordable Care Act (ACA) annual limits on cost-sharing. The case is HIV and Hepatitis Policy Inst. v. HHS, 2023 WL 6388932 (D.D.C. 2023). Drug manufacturers often provide direct Read More

A Texas federal judge recently upheld a U.S. Department of Labor (DOL) final rule concerning environmental, social, and governance (ESG) considerations in investment decisions by plan fiduciaries. Judge Matthew J. Kacmaryk found that the DOL’s ESG investing rule did not violate the Employment Retirement Income Security Act (ERISA). The ruling was unanticipated, as Judge Kacmaryk historically has struck down many Read More

A federal court judge in North Carolina dismissed a lawsuit in which a former employee alleged that Old Dominion Freight Line had violated its fiduciary duty under ERISA by mismanaging its workers’ 401(k) plan. Specifically, ex-employee Harvey Davis claimed that Old Dominion failed to substitute cheaper investment funds for more expensive options, thus violating the duty of prudence under ERISA and failing to monitor Read More

In L.D. v. United Healthcare Insurance, 2023 WL 4847421 (D. Utah 2023), a group health plan participant sued the plan and its insurer after receiving a denial of coverage for her child’s residential treatment as not medically necessary. The plan participant claimed that the denial of her claim violated the Mental Health Parity and Addiction Equity Act (MHPAEA) in that the plan applied the "medically necessary" Read More

The U.S. Court of Appeals for the Tenth Circuit recently issued a decision in Pharmaceutical Care Management Association (PCMA) v. Mulready, which many see as a significant win for pharmacy benefit managers (PBMs) and self-funded health plans. In its decision, the Tenth Circuit held that PBMs are subject to ERISA, thus preempting state law restrictions on PBMs. PCMA filed suit to challenge certain provisions of Read More