When the same health plan administrator both administers a benefit plan and pays the benefits due under the plan, it is considered by courts to have a structural conflict of interest.  That conflict of interest is not problematic on its own – it is perfectly legal, and it is not a breach of fiduciary duty.  However, when a plan member files a lawsuit challenging the administrator’s denial of the member’s benefits, a court can consider the conflict of interest as a factor in whether the administrator’s denial was arbitrary and capricious.

Over the last several years, courts have provided administrators and their attorneys with guidance on how to limit the impact of this common structural conflict of interest.  When defending against denial of benefits claims under ERISA, 29 U.S.C. § 1132(a)(1)(B), defendant plan administrators should be aware of whether the conflict of interest exists and address it proactively to avoid negative inferences.Continue Reading When the Payor is Also the Decisionmaker in ERISA Benefits Lawsuits Under 29 U.S.C. § 1132(a)(1)(B)

On April 2, 2021, the Departments of Labor (DOL), Health and Human Services (HHS) and Treasury (collectively the “Departments”) jointly released nine (9) questions and answers (“FAQs Part 45”) related to recent changes made to the Mental Health Parity and Addiction Equity Act (“MHPAEA”) by the Consolidated Appropriations Act of 2021 (the “Appropriations Act”).

FAQs

Please join Husch Blackwell as we go virtual with our Health Law Conference. The series will include a range of important topics relevant to the healthcare industry and will be moderated by Curt Chase, leader of the firm’s Healthcare, Life Sciences and Education team; Hal Katz, American Bar Association, Health Law Section, Chair; and Tom Shorter, American Health Law Association, President-Elect Designate. The webinar programs will be offered every Thursday through November 19.

Deal activity among hospitals, physicians and health plans will continue at a swift pace into 2021. In our fifth session, hear from industry thought leaders on how the pandemic is impacting private equity and strategic investments in the healthcare space.
Continue Reading Health Law & Innovation Virtual Series – Strategic Acquisitions and Investment Opportunities During a Pandemic

gavel-scales2013%20052[On Wednesday, July 20, 2016, the U.S. Department of Justice (DOJ) filed two lawsuits in the U.S. District Court for the District of Columbia, one, Cause 1:16-cv-01494, seeking to stop the proposed merger between Aetna and Humana (valued at $37 billion) and the other, Cause 1:16-cv-01493, seeking to stop the acquisition of Cigna by Anthem (valued at $54 billion).
Continue Reading U.S. DOJ sues to stop health plan mergers