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A Florida district court (the “Court”) in United States v. AIMA Business and Medical Support, LLC held that a third-party medical billing company can be held liable under the False Claims Act (“FCA”) for pushing medically unnecessary genetic tests, even though it did not provide care directly to patients. This decision is important because it underscores that companies advising or facilitating health care providers’ billing practices can be targeted by the government if they knowingly encourage false claims, expanding…
Continue Reading Court Finds the Government Adequately Pleaded Its False Claims Act Complaint Against Third-Party Medical Billing Company

When Compassion Costs You: A Young Manager’s Injury, Walmart’s Silence, and the System That Failed Her
In the American workplace, we’re taught to be team players — to show up, follow the rules, look out for our coworkers, and do what’s right, even when it’s inconvenient. We’re taught that if we work hard, stay loyal, and lead with integrity, we’ll be protected and valued in return.

But what happens when that promise is broken?

Let me tell you a

…
Continue Reading When Compassion Costs You & Walmart

The Wisconsin Department of Health Services (DHS), Division of Quality Assurance (DQA), Bureau of Assisted Living (BAL), released updated guidance regarding the use of electronic recording, video monitoring, and filming equipment (collectively, “Monitoring Devices”) in assisted living settings. The goal of this guidance is to balance the use of emerging technologies with residents’ rights to privacy in their homes. This guidance applies to Wisconsin Adult Family Homes (AFHs), Community-Based Residential Facilities (CBRFs), and Residential Care Apartment Complexes (RCACs).

Key…
Continue Reading Wisconsin DHS Issues Updated Guidance on Use of Electronic Monitoring in Assisted Living Facilities

On May 19th of 2025, the legislature introduced a bill that gives drivers for Uber, Lyft, Instacart, and similar app-based companies the possibility of self-funded health insurance (in portable benefit accounts that could possibility also receive contributions from the companies if a company, for some reason, decides to help pay for such health insurance coverage) in return for losing their status as employees under current Wisconsin law.

The legislature rushed the hearings and passage of this bill and sent…
Continue Reading Network drivers pretense

On May 1, 2025, the IRS announced the Health Savings Account limits for 2026.  With respect to contribution limits, the limits are slightly higher than the ones for 2025 and the required deductible and out-of-pocket maximums have increased as well.  As a reminder, these inflation adjusted amounts are effective for calendar year 2026.

HSA/HDHP Requirement
Cost-of-Living Adjustments

Limit on HSA Contributions – Self-only HDHP

2025 – $4,300

2026 – $4,400

Limit on HSA Contributions – Family HDHP

2025 –…
Continue Reading 2026 HSA Limits Are Announced

Over the past year, numerous class actions have been filed against large employers claiming their health plan surcharge for tobacco use is not in compliance with HIPAA nondiscrimination rules. With yet another lawsuit filed on March 3, 2025 against LHC Group (a large home health care company), these cases show no signs of slowing down.

Several recognizable employers have faced similar class actions, including 7-Eleven, Inc. Walmart Inc., Target Corp., PepsiCo Inc., Tractor Supply Co., Whole Foods Market Inc.,…
Continue Reading Refusing to Quit: Class Actions on Tobacco Surcharges in Health PlansContinue

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

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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).

Deductibles…
Continue Reading CMS Releases Key Medicare Figures for 2022

Disabled senior man in a wheelchair in a office
Disabled senior man in a wheelchair in a office

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 (dol.gov).   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
Overview
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