There were several recent court decisions that have addressed the right of medical providers, acting under assignments of ERISA plan benefits from patients, to seek plan documents and summary plan descriptions, and to sue plan fiduciaries.

In one case, the district court dismissed the action, holding that the patients had not assigned their rights to sue the plan for statutory penalties. The provider attempted to obtain a retroactive assignment, but the Eleventh Circuit court of appeals held that the provider was not a participant nor a beneficiary in the plan and thus had no standing to bring a claim. Continue Reading Recent Case Law Regarding Health Plan Assignment of Benefits

Exercising Office WorkerHusch Blackwell was recently named a finalist for the St. Louis Business Journal’s Healthiest Employers 2016 competition. The Business Journal’s profile of Husch Blackwell highlights the firm’s effective use of wellness challenges in the workplace and praises Chris Smith, a partner in our St. Louis office, for his dedicated participation in the wellness initiatives.

Given our firm’s success with health and wellness initiatives, we decided to take this opportunity to discuss and reflect on just a few (of the many) legal requirements relevant to employer wellness programs. Continue Reading EEOC’s targeting of wellness programs and what that means for your company

white collarAs most are aware, on May 18, 2016, the U.S. Department of Labor (DOL) released its much anticipated final rule, drastically increasing the salary requirements to qualify as an exempt executive, administrative or professional employee. The DOL estimates that the final rule will extend overtime protections to 4.2 million workers in the first year of implementation and boost wages by $12 billion over the next 10 years. The rule is set to become effective Dec. 1, 2016. Continue Reading Challenge to the doubling of the white collar salary exemption under FLSA

dollar-signiStock_000013001848_LargeThe DOL’s self-imposed February deadline for announcing new FLSA regulations redefining “white collar” exemptions has come and gone with without any action from the DOL. No new deadline has been announced; however, the DOL’s website suggests that it still hopes to release the new regulations soon. Stayed tuned, and we will report back when the regulations are released or when any other information is given.

rings-iStock_000007928926_LargeThe Department of Labor (“DOL”) published its final rule on Feb. 24, 2015, relating to the definition of “spouse” under the Family and Medical Leave Act  (“FMLA”) Regulations. Beginning March 27, 2015, when the final rule becomes effective, the definition of “spouse” for purpose of FMLA leave will include eligible employees in legal same-sex marriages. Prior to this rule change, same-sex partners were only considered spouses if their marriage was recognized in the state where they lived. Under the new rule, the focus shifts to where the marriage was “celebrated.” Accordingly, if the marriage is legal under the law of the state where the marriage was performed or “celebrated,” the same-sex marriage is legal for purposes of the FMLA regardless of state law where the employee lives. Continue Reading DOL issues final rule expanding FMLA leave rights to legal same-sex marriages

dollar-signiStock_000013001848_LargeIn March 2014, President Obama directed the Secretary of Labor to prepare and propose new FLSA regulations. These new rules were to be announced late last year, but have been repeatedly delayed. Now it appears the new rules will be announced later this month. While the scope of the changes is unknown, it is anticipated the changes will reduce the number of employees who qualify for exempt status. Continue Reading Changes coming to FLSA regulations – Time to get ready

Husch Blackwell attorney Joe Geraci was recently quoted in an AIS Health Reform Week article titled HHS’s Statements on Exchange QHPs Stir Confusion, Complicate Copay Assistance.  The article reports that the Obama administration is sending mixed messages on whether Qualified Health Plans (QHPs) on the insurance exchanges will be considered federal health programs.  A recent statement in a CMS Q & A document appears to contradict a statement in a letter from HHS Secretary Kathleen Sebelius.  If QHPs are federal health programs, insurers will be required to provide certain patient-assistance programs such as copayment waivers from providers.  Additionally, current assistance programs available through commercial plans are prohibited in federal programs.

To read the full AIS’s Health Reform Week article, click here.

Employers should be aware of important year-end action items relating to qualified retirement plans and health and welfare plans.  Husch Blackwell attorney Uche A. Enemchukwu detailed a number of these obligations in an e-alert and noted that some require immediate attention to satisfy the December 2, 2013 deadline.  Other items must be addressed before the end of calendar year 2013, and some by early in 2014.

To read the full e-alert, click here.

Husch Blackwell attorney Joe Geraci weighed in on recent guidance provided by HHS related to whether the federal anti-kickback statute applies to patients who purchase subsidized health insurance products on the new state or federal healthcare exchanges.  Specifically, the anti-kickback regulations apply to “federal healthcare programs” that are defined to include the following:

Any plan or program that provides health benefits, whether directly through insurance, or otherwise, which is funded directly, in whole or in part, by the United States Government …

(emphasis added)

Given this broad definition, many believed the HHS would classify subsidized healthcare exchange products as “federal healthcare programs.” Such a decision would, in effect, make the federal anti-kickback statute apply to commercial insurance because providers would have had no way of knowing whether a patient’s insurance from, for instance, Blue Cross or another commercial payor was purchased and subsidized through a PPACA exchange.

On Wednesday some clarity was provided. In a letter dated Oct. 30, 2013, to Rep. Jim McDermott, HHS Secretary Kathleen Sebelius stated that her department:

Does not consider qualified health plans (QHPs), other programs related to the federally facilitated marketplace, and other programs under Title I of the Affordable Care Act to be federal healthcare programs.

Consequently, subsidized health insurance products under PPACA are not “federal healthcare programs.” And since they are not federal healthcare programs, the anti-kickback statute will not apply to payments that providers receive from subsidized insurance products.

To read the full e-alert, and to learn about why a note of caution is in order, click here.



Some employers may have rejoiced when IRS Notice 2013-45 delayed until 2015 the implementation of the employer shared-responsibility penalties mandated by the Patient Protection and Affordable Care Act (ACA). Certainly, this delay is a win for employers; however, other healthcare reforms will demand the attention of health plan sponsors before January 1, 2014.  Husch Blackwell attorney Scott Behrens recently summarized the requirements, which include a Notice of Exchange Availability, Limits on Overall Cost Sharing and Transitional Reinsurance Fee.

Despite the delay for employer shared-responsibility penalties, other penalties apply for failing to comply with ACA provisions that demand plan sponsor’s attention prior to January 1, 2014. Accordingly, plan sponsors should closely review their plans and make any necessary amendments to ensure compliance and avoid penalties.

Click here to read the alert.