HHS recently announced inflation-adjusted penalty amounts related to violations of Summary of Benefits and Coverage (SBC), Medicare Secondary Payer (MSP), and HIPAA privacy and security rule requirements. These new penalty amounts are calculated based on a cost-of-living increase of 1.03241% and are applied to penalties assessed on or after August 8, 2024, for violations occurring on or after November 2, 2015.

On August 5, 2024, the Seventh Circuit Court of Appeals (Seventh Circuit) affirmed the district court’s ruling in favor of insurer Group Health Cooperative (the defendant) when they denied claims for therapy treatment brought by parents on behalf of their autistic child (plaintiffs) based upon then-current medical literature. The plaintiffs asked the defendant health insurer to pay for certain treatments for their autistic child that occurred  between 2017 and 2019. The defendant refused to pay since the medical literature at the time did not support speech therapy as a treatment for autism for...

On August 20, 2024, representatives Robert Scott and Mark DeSaulnier, ranking members, respectively, of the House Committee on Education and the Workforce and the Subcommittee on Health, Education, Labor, and Pensions, sent a letter to the DOL’s Employee Benefits Security Administration (EBSA) assistant secretary Lisa Gomez asking for increased oversight on group health plan service providers. In part, the letter stems from a springtime New York Times (NYT) investigation into a data analytics company, which alleged the company engaged in harmful...

On July 29, 2024, in Mullins v. CONSOL Energy Inc. Long Term Disability Plan, the Third Circuit Court of Appeals (Third Circuit) held that the termination of a coal miner’s ERISA long-term disability benefits by the claims administrator, Lincoln Financial Group (Lincoln), was not based on substantial evidence in the record and was therefore an abuse of discretion. The Third Circuit vacated the prior district court judgment upholding Lincoln’s termination decision and remanded the case back to the district court for reinstatement of the miner’s benefits.

On August 2, 2024, the Fifth Circuit Court of Appeals (Fifth Circuit) affirmed the district court’s decision to vacate regulations promulgated by three federal agencies: the DOL, HHS, and IRS (the agencies). The regulations established priorities for independent arbitrators appointed to resolve disputes between healthcare providers and payors through an Independent Dispute Resolution (IDR) process established under the No Surprises Act (NSA).

On May 30, 2024, the federal district court in the Northern District of Texas issued an order granting Health Care Service Corporation's (HCSC) motion to dismiss the claims of plaintiffs Guardian Flight LLC and Med-Trans Corporation against HCSC. Plaintiffs are air ambulance providers who provided services out-of-network and went through the Independent Dispute Resolution (IDR) process with the defendant to settle a payment dispute. 

Recently, in Tanner v. Stryker Corp. of Michigan, the US Court of Appeals for the Eleventh Circuit (Eleventh Circuit) affirmed a lower court’s ruling that a non-birthing parent does not have a right to protection under the FMLA prior to the birth of a child. As background, the plaintiff was expecting a child with his former girlfriend who lived out of state. The plaintiff requested leave under FMLA to travel and await the birth of the child. 

On July 3, 2024, the US District Court for the Southern District of Mississippi issued a stay on the effective date of parts of the final rule issued by HHS on May 6, 2024 (the May 2024 Rule), that applies the ACA Section 1557 nondiscrimination provisions to discrimination on the basis of gender identity. The May 2024 Rule was scheduled to take effect on July 5, 2024. On May 30, 2024, the states of Tennessee and Mississippi joined with...

On June 27, 2024, HHS updated its “HIPAA and Reproductive Health” web page with resources to help covered entities, including group health plans, and business associates comply with the 2024 final HIPAA Privacy Rule to Support Reproductive Health Care Privacy (the 2024 Final Rule). On April 26, 2024, HHS published the 2024 Final Rule, which modifies the existing HIPAA Privacy Rule. 

On July 1, 2024, the OCR announced that it settled an investigation into Heritage Valley Health System (HVHS), a healthcare provider, following a ransomware attack that resulted in a breach of PHI. OCR alleged that HVHS failed to take necessary steps required by HIPAA to reduce the risk of a ransomware attack. OCR began an investigation into HVHS on October 31, 2017, after media reports of the provider experiencing a data breach.