Cigna Health and Life Insurance Co. is facing an ERISA class action lawsuit in Connecticut District Court, in which proposed class members alleged that the insurance company is overcharging for medical services. Although Cigna claims that it negotiates with in-network providers for lower rates to help their insureds save money, the proposed class members claim that Cigna engaged in a fraudulent scheme and that they Read More

The DOL, IRS, and HHS have issued joint FAQs About Affordable Care Act and Consolidated Appropriations Act, 2021 Implementation Part 57. These FAQs address certain provisions of the Consolidated Appropriations Act, 2021 (CAA, 2021) that ban so-called "gag clauses" or any provisions in group health plan agreements that preclude certain disclosures of provider-specific cost or quality-of-care information. Previously, Read More

The Centers for Medicare & Medicaid Services (CMS) has pushed back the deadline by one year for issuing final regulations concerning the imposition of civil penalties for violations of Medicare Secondary Payer (MSP) reporting requirements. Responsible reporting entities (RREs) for group health plans, typically insurers or third-party administrators, must report certain information to CMS about individuals with Read More

Two recent federal court decisions, one in Florida and one in New York, have cast significant doubt on the ability of the U.S. Department of Labor (DOL) to issue and enforce formal regulations defining who qualifies as a fiduciary under federal benefits law. In its latest regulatory agenda, the DOL’s Employee Benefits Security Administration (EBSA) indicated that it intended to issue a new proposed rule explaining Read More

After a Texas federal court vacated a portion of the final regulations on the surprise billing independent dispute resolution (IDR) process, the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) ordered certified IDR entities to stop issuing new IDR payment determination pending further agency guidance. In addition, as per the Court's order, CMS also recalled Read More

A three-judge panel of the U.S. Court of Appeals for the Ninth Circuit recently heard oral arguments in an architecture firm’s appeal of a district court judge’s order denying its attorney fees. Bowers + Kubota Consulting Inc. sought attorney fees against the U.S. Department of Labor (DOL) in an ERISA suit in which it prevailed. The case is Martin Walsh v. Brian Bowers et al., case number 22-15378, U.S. Court of Read More

A Florida federal district court judge partially granted a securities industry group’s motion for summary judgment, in which it sought to invalidate certain ERISA guidance from the U.S. Department of Labor (DOL). The case is American Securities Association v. U.S. Department of Labor et al., case number 8:22-cv-00330, U.S. District Court for the Middle District of Florida. In her ruling, the judge found that FAQ 7 Read More

The 2020 Consolidated Appropriations Act (CAA) laid out new transparency responsibilities for hospitals and payers, including removing all gag clauses limiting data access and utilization. Benefits advisors should prepare, plan, and take all steps necessary to ready their plan sponsor clients for these major changes in the healthcare landscape. The newly available hospital and payer transparency (HPT) will allow plan Read More

A three-judge panel of the U.S. Court of Appeals has rejected an appeal from Envision Management Holding and employee stock ownership plan (ESOP) trustee Argent Trust Co., seeking to compel arbitration of an Employee Retirement Income Security Act (ERISA) lawsuit. The court found that an agreement in the ESOP plan documents directly contradicted plan participants’ remedies under ERISA, which triggered the effective Read More

The Trump administration declared both a COVID-19 national emergency and a public health emergency (PHE) in 2020. The national emergency is set to expire on March 1, 2023, and the PHE is set to expire on April 11, 2023. The Biden administration now has issued a statement of administrative policy stating its intention to extend both emergencies and end them on May 11, 2023. Its announcement is consistent with its Read More