Arizona Healthnet Fines 2010

Arizona Aetna Fines 2009

Increase Predicted For 2010 Workplace Litigation

2/17/2010: Health Insurers Break Profit Records as 2.7 Million Americans Lose Coverage

01-06-10 Healthcare Reform Legislation Finalizes ERISA as Mandatory for All Group Health Plans and All Healthcare Providers Appeals Procedures

11-19-09 New Healthcare Overpayment Recoupment Embezzlement Recovery Service Announced In Wake Of Launch of New Federal Task Force To Combat Healthcare Fraud Crisis

11-10-09 - The New Healthcare Reform Bill Passed by Congress Prompts Expansion of Claims Recovery Company (CRC)

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Arizona Department of Insurance Fines Two Major insurers for Appeal Violations

This month and a few months ago, the Arizona Department of insurance took the important step of imposing stinging fines on two major insurers for what had come to the departments attention regarding the insurers consistent violation of both State law as well as federal ERISA law of patients rights in the appeal process.

CRC has filed thousands of appeals on behalf of patients in Arizona and has spoken on numerous occasions to the State Department of Insurance regarding these state laws and the numerous examples of the violations we have seen.

Holding the insurance companies accountable for their compliance with state and federal law is an ongoing effort at CRC.

New Guidance on Department of Labor Enforcement Priorities for Employee Benefits

Legal Alert examining the new enforcement priorities of the US Labor Department’s Employee Benefits Security Administration, which include an initiative to pursue criminal charges against serious violators of ERISA — In a September 14, 2009 speech, Assistant Secretary of Labor Phyllis C. Borzi announced that EBSA has initiated a criminal project to prosecute what she referred to as “the most egregious and persistent violations” of ERISA, and also plans to focus enforcement efforts on several key civil areas. All plan sponsors, administrators and other fiduciaries should be aware of these enforcement priorities.
Full Article:
9/17/2009
In a September 14, 2009 speech, the Assistant Secretary of the US Labor Department’s Employee Benefits Security Administration (EBSA), Phyllis C. Borzi, laid out some of EBSA’s enforcement priorities in the new Administration.  She also described a new initiative to pursue criminal charges against serious violators of ERISA.  All plan sponsors, administrators and other fiduciaries should be aware of these enforcement priorities.
Assistant Secretary Borzi announced that EBSA has initiated a criminal project to prosecute what she referred to as “the most egregious and persistent violations” of ERISA.  As an example, Borzi identified embezzlement of plan assets, such as amounts withhold from employees’ paychecks and intended as contributions to 401(k) plans or as payment for health insurance premiums, which never reach their intended destination.  She also identified individuals who knowingly file false 5500 forms – the annual reports that all plans are required to file with the government – as targets for possible criminal prosecution.  This new focus on criminal charges, which could be brought against individuals as well as corporations, is in addition to the Labor Department’s ongoing efforts to address delinquent participant contributions, which Borzi said continues to be a priority.
Borzi also announced that EBSA will focus its enforcement efforts on several additional initiatives covering a wide range of issues.  These include:

• fees of pension consultants and service providers.  An existing project focused on the propriety and disclosure of these fees will be expanded to address situations in which the service providers use their fiduciary status to increase their compensation;
• ESOPs (employee stock ownership plans).  This initiative will include issues of valuation – whether ESOPs and their participants are being overcharged for the stock acquired by the plan – as well as fiduciary self-dealing and conflicts of interest;
• bankrupt and financially distressed plan sponsors.  Through its “REACT” project, the Labor Department will focus on taking legal action on to protect the interests of these participants; and
• multiple employer welfare arrangements (MEWAs). These arrangements sometimes involve health care fraud and are often put together by individuals not qualified to establish them.

Borzi noted that other regulatory activities were also underway.  She said the Labor Department is working on the investment advice rule-making begun during the previous Administration, and hoped to issue a new proposed rule, with a short comment period, soon.  EBSA also plans to complete its review of two plan fee/expense disclosure rulemakings in the “near future,” and by the end of 2009, to decide what action it should take with respect to target date funds.

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10/19/2009: Health Reform Bills May Not Protect Consumers from Treatment Denials (Kaiser Family Foundation)

Excerpt: "'Experts said the legislation under consideration does not significantly enhance patient protections against insurers refusing to cover requests for treatment. Most people currently have no right to challenge health insurers' treatment decisions by suing them for damages.' The Employee Retirement Income and Security Act (ERISA) 'bars suits for damages over health benefit decisions' for the 132 million people who get insurance through employers. Current health care bills do not remove the barrier (Girion, 10/19)."

10/19/2009: A Call for Repeal of Health Care Insurers' Antitrust Exemption (Workforce Management; free registration required)