A recent excellent New York Times article explains how a change in law first effective in 2022 has quickly come to be used by out-of-network providers to obtain significant overpayments for routine medical procedures. Not stated in the article is the impact on self-funded group health plans and the sponsors of those plans. Specifically, the
The Departments of Labor, Health and Human Services, and the Treasury (the “Departments”) recently released their 2025 Report to Congress on enforcement activity under the Mental Health Parity and Addiction Equity Act (“MHPAEA”).
MHPAEA is a federal law that generally requires group health plans and health insurance issuers that provide mental health or substance
On November 4, 2025, the U.S. District Court for the District of Rhode Island in Williams v. Bally’s Management Group, LLC dismissed a participant challenge to an employer’s tobacco surcharge under ERISA, rejecting both statutory discrimination and fiduciary breach theories. The court held that the plaintiff failed to state a claim that the surcharge violated
On July 25 the U.S. Departments of Treasury, Labor and Health and Human Services (“tri-agencies”) released guidance related to the Mental Health Parity and Addiction Equity Act (MHPAEA). Among other documents, the guidance includes a proposed update to the MHPAEA regulations and a report to Congress summarizing the tri-agencies’ enforcement efforts related to group health
So your company sponsors a self-insured health care plan, and you’ve been tasked with administering the plan, but in reality, most of the day to day administration is handled a third party administrator (“TPA”). Just curious – do you know what your TPA’s policies are with respect to recovering overpayments? Do you know whether your