Health Insurance

Healthcare fraud is a serious offense that can result in significant penalties for medical providers. In addition to criminal charges that may lead to fines or imprisonment if a person is convicted, accusations of fraud can lead to the loss of a professional license, loss of provider status with Medicare and Medicaid, and damage to a provider’s personal reputation. If you are facing healthcare fraud charges, it is crucial to understand your rights and options for defense.
Continue Reading How Can Medical Providers Defend Against Healthcare Fraud Charges?

There is understandable confusion among employees and their employers about an employee’s access to disability insurance coverage after termination of the employee/employer relationship.

Disability insurance coverage is an employee benefit, and some assume that when employment ends, employee benefits – including disability insurance – end. However, that is not always the case.

In fact, the termination of employment generally should not affect ongoing short-term disability (STD) or long-term disability (LTD) benefits or even prevent employees from applying for benefits
Continue Reading Disability Benefits: When Terminated Employees Are Still Eligible

On October 25, 2023, 2023 Act 34 became effective. Act 34 amends the statutory prohibition to negotiating health care plan design and selection between public sector employers and labor representatives of police, fire, and EMS unions. Specifically, the law amends Wisconsin Statute §111.70(4)(mc)6 in the following manner:

SECTION 1. 111.70 (4) (mc) 6. of the statutes is amended to read: 111.70 (4) (mc) 6. Except for whether or not to provide health care coverage and the employee premium contribution,
Continue Reading Legislature Amends Law Permitting Collective Bargaining Negotiations on Health Care

On July 6, 2022, the Wisconsin Employment Relations Commission (WERC) issued two rulings prohibiting collective bargaining over subjects related to employer-provided health care coverage plans per Wis. Stat. § 111.70(4)(mc)6. The two rulings—City of Racine, Dec. No. 39446 (WERC, 7/22) and Dec. No. 39447 (WERC, 7/22)—reaffirm the broad discretion and unilateral control that local government employers, like Racine, have under the statute including deciding whether to provide a health care plan to public safety employees. With regard to the
Continue Reading Recent Decisions Impact Public-Sector Health Insurance and Collective Bargaining

Effective January 15, 2022, the Biden Administration extended the provisions of the Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) by requiring health plans and insurers to cover the cost of over-the-counter (OTC) COVID-19 tests. Plans must cover OTC COVID-19 tests without imposing cost sharing, prior authorization or other medical management requirements, such as the need for a prescription. Plans may provide coverage for OTC COVID-19 tests directly at the
Continue Reading New Coverage Requirements for At-Home COVID-19 Tests

The Centers for Medicare and Medicaid Services (“CMS”) recently released key Medicare figures for 2022 that will affect all elderly and disabled individuals who receive program benefits.  This notice summarizes the changes and their impact on various benefits.

As is normally the case, Medicare deductibles and premiums have both increased and decreased for 2022.  Many deductibles and co-pays are covered by supplemental Medicare insurance policies, also known as “Medigap” policies (i.e., to cover the “gaps” in Medicare coverage).

Continue Reading CMS Releases Key Medicare Figures for 2022

In January 2022, a new law goes into effect limiting “surprise” medical bills, or bills insured patients receive for out-of-network care, either in emergency settings, or from out-of-network providers at in-network facilities. Congress passed the No Surprises Act as part of the 2020 year-end omnibus spending bill and, while many details of the No Surprises Act are still forthcoming as federal agencies engage in the necessary rulemaking (which may not be complete by the Act’s effective date), health care
Continue Reading Surprise! It’s the No Surprises Act

The U.S. Supreme Court declined to strike down the Affordable Care Act once again today, the third unsuccessful constitutional challenge to the far-reaching health care law since it was enacted in 2010. This time, the seven-justice majority dispatched the claims on purely technical grounds and did not even reach the substantive issues.

It was the first time the Supreme Court ruled on the ACA’s legality since Congress eliminated the penalty for failing to secure health insurance, an amendment that
Continue Reading The Affordable Care Act Survives Another (and Perhaps Final?) Constitutional Challenge

Today the Employee Benefits Security Administration (EBSA), the section of the Department of Labor that handles all things employee benefit plans, posted a dedicated webpage with much anticipated (and much needed) employer tools on the “COBRA subsidy” provision of the American Rescue Plan Act of 2021 (“ARPA”), which was enacted on March 11, 2021.  The webpage can be found here COBRA Premium Subsidy | U.S. Department of Labor (   The new webpage provides FAQs for both workers and
Continue Reading Department of Labor Posts ARPA COBRA Subsidy Notices; Dedicated Web Page

The American Rescue Plan Act of 2021, or ARPA, will allow some current and past employees and their dependents to receive fully subsidized COBRA continuation coverage for periods from April 1, 2021 through September 30, 2021 – even if they never elected COBRA or dropped coverage. Here is what employers with group health plans subject to federal COBRA need to know about the new law.
The Relief
ARPA provides three main areas of relief for affected individuals: (1)
Continue Reading What Employers Need to Know About Subsidized COBRA Under the American Rescue Plan

Starting in 2022, patients will know in advance what most health care services will cost. Enacted at the end of 2020 as part of the Consolidated Appropriations Act, 2021 (the CAA), the No Surprises Act requires that group health plans and insurers provide advance cost estimates, called advanced explanations of benefits (advanced EOBs), for scheduled services. The No Surprises Act also requires plans and insurers to provide price comparison guidance online and by phone, similar to what non-grandfathered plans
Continue Reading My Health Care Will Cost What? Advanced EOBs and Price Comparisons Coming in 2022