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District Court Upholds Pension Reductions Under MPRA

"This decision confirms that the government may authorize reductions in multiemployer pension benefits under ERISA in response to plan insolvency risks, without triggering takings liability." [King v. U.S., No. 23-1956 (Fed. Cir. Aug. 18, 2025)]

OCR's Risk Analysis Initiative: Lessons from Recent HIPAA Enforcement Actions

"The latest enforcement actions involve settlements ranging from $25,000 to $350,000 and breaches affecting between 4,304 and 585,621 individuals' ePHI.... [U]nlike the prior Risk Analysis Initiative cases that were publicized during the Biden Administration, which all stemmed from ransomware attacks, these more recent cases reflect a broader range of security failures."

BCBSGA Sues Providers for Alleged Misuse of NSA Arbitration Process

"BCBSGA accuses Sound Physicians (a large, multistate physician group) and its subsidiaries, together with HaloMD, Inc., of systematically submitting thousands of ineligible disputes to the NSA's IDR process. BCBSGA alleges the scheme involved falsely attesting to claim eligibility, overwhelming the IDR process, and inflating offers, resulting in millions of dollars being improperly awarded to Sound Physicians on those claims." [Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. v. HaloMD, Inc., No. 25-2919 (N.D. Ga. complaint filed May 27, 2025)]

Maryland Further Delays Implementation of FAMLI Program

"House Bill 102 marks the third consecutive year that the launch of Maryland's FAMLI program has been delayed. In addition to the new timeline, the legislation revises several key aspects of the program, including definitions, contribution rates, reporting requirements, and introduces new provisions for self-employed individuals."

District Court Twice Rejects United’s Efforts to Kick Behavioral Health Class Actions

"Beach confirms that breach of fiduciary duty and wrongful denial theories grounded in restrictive clinical criteria remain viable post-Wit, while Jones demonstrates how plaintiffs can tailor class definitions to navigate the Ninth Circuit's reprocessing limitations. Collectively, the decisions signal sustained judicial scrutiny of behavioral health guidelines and underscore the importance of robust, GASC-compliant medical necessity criteria and transparent claims communications." [Beach v. United Behavioral Health, No. 21-8612 (N.D. Calif. May 5, 2025); Jones v. United Behavioral Health, No. 19-6999 (N.D. Calif. Apr. 14, 2025)]

District Court Dismisses Manufacturer Challenge to Colorado Law Limiting Prescription Drug Prices

"There are currently six states with active Prescription Drug Affordability Boards (PDABs)  ... As PDABs march toward declaring the price of certain drugs to be unaffordable for state residents and establishing a maximum price or reimbursement for certain drugs in their states, some pharmaceutical manufacturers have begun to challenge the constitutionality of PDABs in court. In March, a federal court in Colorado tossed out one of these suits on the basis that the manufacturer lacked the requisite standing." [Amgen Inc. v. Colorado Prescription Drug Affordability Review Bd., No. 24-0810 (D. Colo. Mar. 28, 2025)]

Anthem Set to Settle Five-Year Long Mental Health Coverage Class Action

"[P]laintiffs alleged that the internal guidelines for deciding when to cover residential mental health treatments are misaligned with the medical community and focus too much on short-term crisis intervention while minimizing the importance of chronic and persistent symptoms that require different types of care. These actions were alleged to be in violation of [ERISA] and the [MHPAEA]." [Collins v. Anthem, Inc., No. 20-1969 (E.D.N.Y. status report filed Apr. 15, 2025)]

As Healthcare AI Expands, States Are Passing Laws to Protect Consumers

"States are beginning to regulate the use of AI as a patient care support tool, for both healthcare payers and providers.... At the same time, private class action litigation and state attorneys general are challenging AI practices in the healthcare sector.... In this climate, governing boards should ensure that these evolving state law developments are being monitored and, as applicable, adjustments to operations are made."

Texas District Court Cites Loper Bright in Upholding Biden-Era ESG 401(k) Investing Rule

"The opinion explained that ERISA's fiduciary provisions require that 'a fiduciary must always discharge his duties in the interest of the beneficiary alone and only for the purpose of gaining financial benefit.' However, the provisions do not explicitly limit what a fiduciary may consider while discharging his or her duty.... While narrow, the decision acts as a considerable example of a court approving the use of ESG principals and stands as a potential case study for the limited impact Loper Bright may have on agency deference decisions." [Utah v. Micone, No. 23-0016 (N.D. Tex. Feb. 14, 2025]

Massachusetts Enacts Drug Pricing Legislation: PBM Licensure, Mandatory Cost Reporting, and Consumer Cost-Sharing Limits

"The key elements of the Act: [1] impose on certain health plans targeted consumer cost-sharing limitations for selected pharmaceuticals used to treat delineated chronic conditions; [2] impose mandatory licensing and regulation of PBMs, including constraints on to-be-defined PBM conflicts of interest; and [3] require PBMs and pharmaceutical manufacturers to comply with detailed cost and pricing data reporting requirements[.]"