Search the News Archive

The Fifth Circuit Calls Into Question Its Standard of Review in ERISA Denial of Benefits Cases

"The Plan ... did not provide deference to the decisions of Plan Administrator. However ... the Court applied the abuse of discretion standard to examine the plan administrator's factual determinations.... [T]he Court noted that it is the only circuit that would apply deference to factual determinations made by a plan administrator when the plan does not vest them with that discretion, and also pointed to the growing number of state laws prohibiting discretionary clauses in insurance contracts." [Ariana M. v. Humana Health Plan of Texas, Inc., No. 16-20174 (5th Cir. Apr. 21, 2017)]

National Review of HIPAA Compliance Finds Rampant Confusion and Mistakes

Excerpt: Four years after the privacy rule went into effect, hospitals and other covered entities (CEs) are struggling with basic concepts that underlie compliance, such as what the 'minimum necessary' standard means. Mistrust among CEs is rampant, and many have implemented business practices in the name of privacy and security that have no basis in law.

National Review of HIPAA Compliance Finds Rampant Confusion and Mistakes

Supreme Court Declines Review of Oklahoma Law Regulating PBMs

"A 2023 ruling by the 10th Circuit U.S. Court of Appeals will stand after the nation's highest court denied certiorari in the legal dispute over Oklahoma's Patient's Right to Pharmacy Choice Act, which regulates pharmacy benefit managers (PBMs)." [PCMA v. Mulready, No. 22-6074 (10th Cir. Aug. 15, 2023; cert pet. denied Jun. 30, 2025, No. 23-1213)]

Video: What the Supreme Court's Review of the Federal Health Care Law Could Mean for California

"Jamie Court sits down with the FOX 11 News team to discuss the ways in which California and the nation could be affected by the review of the constitutionality of the federal health care law by the Supreme Court."

First Circuit: Duty to Mitigate Causation in ERISA Claims Falls on Defendants

"The First Circuit joined the Fourth, Fifth and Eighth Circuits holding that once a plaintiff demonstrates a fiduciary breach, the defendant has the burden to negate loss causation. Other circuits, including the Sixth, Ninth, Tenth and Eleventh Circuits, have held that a plaintiff bears to burden to establish loss causation. This issue is ripe for Supreme Court review." [Brotherston v. Putnam Investments, LLC, No. 17-1711 (1st Cir. Oct. 15, 2018)]

Solicitor General Weighs In on ERISA Preemption Battle Over PBM State Statutes

"On December 4, 2019, the Solicitor General submitted his brief, which recommends that the Supreme Court accept the ... petition for certiorari, and recommends that the Court overturn the appeals court decision. At issue ... is whether an Arkansas statute that regulates the rates charged by Pharmacy Benefit Managers (PBMs), is preempted by [ERISA].... [T]he Arkansas law required PBMs to reimburse pharmacies for generic drugs at a price at least equal to what the pharmacy had paid for the drug." [Pharmaceutical Care Mgmt. Assoc. v. Rutledge, Nos. 17-1609 and 17-1629 (8th Cir. June 8, 2018; cert. pet. filed Oct. 22, 2018)]

Consider Retirement Plan Mandates When Expanding to New States

"[M]any employers -- especially employers that currently offer 401(k) or pension plans to their employees -- may quickly dismiss these laws as not applicable. However, as employers add small employee groups, resulting from multistate expansion through organic growth or acquisitions, they should be aware of state-run retirement plan mandates to ensure compliance and avoid the accumulation of penalties."

ERISA Attacks Move From Church Plans to Government Plans

"Having settled many of its attacks on pension plans sponsored by several large church-affiliated healthcare organizations, the plaintiff's bar appears to be shifting focus ... One of the same firms that previously challenged the application of ERISA's 'church plan' exclusion several years ago represents the plaintiffs ... Notably, the 'church plan' cases have thus far been limited to pension plans. [This] case opens up a new front in the larger war being waged by the plaintiffs' law firm by challenging the status of Atrium's health plan as well."

ARPA Multiemployer Pension Plan Special Financial Assistance Program: What It Is, and What to Consider

"This update describes key features of the IFR and IRS guidance ... [T]his article also discusses what contributing employers may wish to monitor in those affected plans and what they may need to consider in terms of their own business planning."