DICEROS BLOG
Cultivate & Motivate
“The beautiful thing about learning is that nobody can take it away from you.”
- B.B. King
Court Strikes Key Arbitration Provision of the No Surprises Act
A federal judge in Texas has struck down a key provision of the No Surprises Act’s (NSA). Independent dispute resolution process (IDR) established to determine the final payment amount beyond allowable patient cost-sharing for out-of-network health care services in situations where the NSA prohibits surprise billing…
Mercer: Employer-Sponsored Health Plan Costs Shot Up in 2021
Mercer Consulting’s 2021 National Survey of Employer-Sponsored Health Plans reveals that the average cost of employer-sponsored health insurance rose by 6.3% in 2021…
New Reporting Requirements on Prescription Drug Spending
On November 17, 2021, the Department of Health and Human Services, the Department of Labor, and the Treasury Department (the Departments) issued an interim final rule under the No Surprises Act requiring group health plans and health insurance issuers to annually submit key data…
Court: Use of ‘Dummy Code’ on Health Plan Claims Violated ERISA
The Fourth Circuit Court of Appeals has ruled that a claims administrator’s practice of encouraging the use of a “dummy” medical procedure code on health insurance claim forms to disguise ineligible administrative fees as legitimate health care expenses violated ERISA.
Group Health Plans Must Cover At-Home COVID-19 Tests Without Cost-Sharing
Beginning January 15, 2022, individuals with employer-sponsored health insurance who purchase an at-home over-the-counter (OTC) COVID-19 diagnostic test authorized, cleared, or approved by the U.S. Food and Drug Administration (FDA)…
Health Insurer Sues Emergency Room Doctors Over ‘Upcoding’
Health insurance giant UnitedHealthcare (UHC) has filed a lawsuit in federal district court against TeamHealth, one of the nation’s largest hospital emergency room (ER) staffing and billing companies, alleging that it fraudulently and deliberately “upcoded” tens of thousands of claims for ER services…
Doctors Challenge Arbitration Provision of the No Surprises Act
On September 30, 2021, the Department of Labor, the Department of Health and Human Services, and the Treasury Department (the Departments) issued an interim final rule under the No Surprises Act (NSA) that establishes the federal independent dispute resolution (IDR) process…
State Law Claims Against Health Plan Survive ERISA Preemption
The patient suffered from a serious medical condition and sought long-term acute care in a New Jersey hospital. Prior to the patient’s admission, the hospital called the patient’s group health plan to confirm…
Bipartisan Bill Would Expand and Strengthen Coverage for Telehealth Services
House Representatives Dean Phillips (D-MN) and Steve Chabot (R-OH) introduced the bipartisan Telehealth Coverage and Payment Equity Act (H.R. 4480), a bill that would expand and make permanent the temporary coverage of telehealth services currently provided under Medicare.
New Guidance on COVID-19 Vaccine Incentives and Surcharges
On October 4, 2021, the Department of Labor (DOL), the Department of Health and Human Services (HHS), and the Treasury Department (Treasury) issued new guidance…
Denial of ‘Wilderness’ Mental Health Claim did not Violate MHPAEA
A federal judge has ruled that a health plan’s denial of a claim for inpatient mental health “wilderness” treatment did not violate the Mental Health Parity and Addiction Equity Act (MHPAEA)…
New Guidance Clarifies, Delays Key Health Plan Reforms
The Treasury Department, the Department of Labor, and the Department of Health and Human Services (the agencies) have jointly issued frequently asked questions (FAQs) guidance that clarifies or delays certain provisions of the Affordable Care Act (ACA)
Health Plan Hit with Big Penalty for Failing to Provide Plan-Related Documents
A federal judge ruled that a group health plan violated ERISA by failing to provide plan-related documents to a plan participant who requested them following the denial of a claim
Transgender Health Care Lawsuit Moves Forward
A federal judge found that a blanket exclusion for “gender-confirming health care” and related services in the state of West Virginia’s Medicaid program…
Limited Waiver of HIPAA Sanctions and Penalties as a Result of Hurricane Ida
The Secretary of the Department of Health and Human Services (HHS) Xavier Becerra has declared a public health emergency as a result of the consequences of Hurricane Ida in Louisiana and Mississippi.
Court: TPA’s Cross-Plan Offsetting Scheme Violated ERISA
A federal district court has ruled that a third-party administrator’s (TPA) practice of conducting “cross-plan offsets,” the withholding of amounts overpaid…
Proposal Would Bypass Health Insurance ‘Birthday Rule’ for Newborns
On July 22, 2021, House Representative Sharice Davids (D-KS) introduced the “Empowering Parents’ Health Care Choices Act” (H.R. 4636)…
DOL Says Audio Recording May Be Relevant to Benefits Claim
A recent Department of Labor (DOL) Information Letter says that ERISA Section 503 and the DOL’s implementing claims procedure regulations require…
PrEP Must Be Covered with No Cost-Sharing
On July 19, 2021, The Department of Labor (DOL), The Department of Health and Human Services (HHS), and The Treasury Department issued a set of…
Feds Target Health Care Fraud, COVID-19 Schemes
The Department of Health and Human Services (HHS) and The Department of Justice (DOJ) have released their jointly prepared annual report on…