Compliance
This section focuses on health care compliance and regulations – both national and state – including the ACA. It includes changes in health care law, regulation, and court decisions and their impact on health insurance professionals, employers, and individuals.
The Internal Revenue Service (IRS) has recently been ramping up its enforcement of employer requirements related to the Affordable Care Act (ACA), and the penalties for non-compliance can sometimes be severe. Employers with at least 50 full-time employees, considered an Applicable Large Employer (ALE), are subject to Employer Shared Responsibility Provisions of the ACA. These provisions require organizations considered ...
The US Supreme Court has again overturned longstanding precedent, this time getting rid of a 40-year- old standard for decision making that required federal courts to defer to reasonable agency decisions where federal law is silent or unclear.
Recent Supreme Court decisions curbing the power of federal agencies will hobble government efforts to protect public health, legal experts warn. The rulings will make it harder for some federal agencies to bring enforcement actions.
A report from a conservative think tank found that as many as 5 million people are wrongfully receiving Affordable Care Act insurance subsidies, prompting House Republican leaders to call for an investigation into possible enrollment fraud.
A provision of Biden’s Inflation Reduction Act requires drugmakers to pay rebates to Medicare if they hike the price of a medication faster than the rate of inflation.
After the Supreme Court struck down a controversial bankruptcy plan from Purdue Pharma, the maker of OxyContin, those who sued the drug company were left uncertain about when promised funds would be available to combat addiction and other damage from the ongoing drug epidemic. The ruling upended a carefully-crafted settlement worth roughly $8 billion, and involving the Sackler family, ...
An appeals court affirmed a lower court's ruling that HHS could not force Braidwood and other firms who challenged the ACA mandate to cover PrEP drugs for HIV, however, the nationwide ACA coverage mandate is still in effect.
A federal appeals court in California has shielded a health insurer against a state-law breach-of-contract claims and other state-law claims. A three judge panel at the 9th U.S. Circuit Court of Appeals recently found that the state-law claims had a “connection with” a benefit plan governed by the Employee Retirement Income Security Act. Congress passed ERISA in ...
Sutter Health was absolved this week from a California whistleblower lawsuit alleging the nonprofit system owed $519 million for double-billing patients. After a seven-week trial, Alameda County Superior Court Judge Stephen Kaus ruled Monday retired surgeon Dr. Gregory Duncan and patient Gary Hulbert failed to show that Sutter’s billing practices for surgical patients were fraudulent. Duncan and ...
The US Department of Labor has announced separate settlements with Unum Life Insurance Co. of America and the Lincoln National Life Insurance Co. that relate to their practices on evidence of insurability.