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No Matter the Remedy – No Language, No Luck!

On January 23, 2023
Recently, the 9th Circuit, a jurisdiction that has historically not been kind to benefit plans engaging in third party recovery activity, issued a decision that gives life to benefit plans whose participants shirk their obligations to reimburse their benefit plans from settlements they obtain in third-party liability cases.

Empowering Plans: P153 – Living Up To Expectations

On January 20, 2023
Over the last decade, The Phia Group’s leaders have made quite a few predictions. There have been some hits and misses. Join attorneys Ron Peck and Jen McCormick as they discuss past predictions, their predictions for 2023, and what the best health plans need to do to stay ahead of the game this year!

An Omnibus Edition to Kick Off 2023

On January 19, 2023
It’s only January, but 2023 already promises to be a momentous year in healthcare law. From the recent passage of The Consolidated Appropriations Act of 2023—and its inclusion of protections for pregnant and nursing mothers—to regulatory updates regarding the No Surprises Act and manufacturer assistance programs, there’s quite a bit to break down as the new year unfolds. Join The Phia Group’s panel of experts as they discuss how such sweeping changes will impact your group’s health plan.

Accommodating Pregnant Workers: Enhanced Protections Under New Legislation

On January 18, 2023
On December 29, 2022, President Biden signed the Consolidated Appropriations Act of 2023 (CAA 2023). Among many, many other things, the CAA included a key law expanding protections for pregnant workers. This law addresses significant limitations in the current regulatory framework for these workers, particularly under the Americans with Disabilities Act (ADA) which does not consider pregnancy a covered disability, and the Pregnancy Discrimination Act (PDA) which does not require accommodation (beyond those afforded to other similarly situated employees).

The Phia Group's 1st Quarter 2023 Newsletter

On January 17, 2023
The Phia Group is off to a great start in the first quarter of 2023! Check out our newsletter to get acquainted with some of the latest happenings in our neck of the woods.

The Phia Group is Proud to Announce that Joanie Verinder has Joined their Team

On January 17, 2023
Read about Joanie Verinder joining The Phia Group as Service Strategist Director. Learn how Joanie will strengthen their efforts to empower plans.

Empowering Plans: P152 – The Contemporary Fiduciary: Emerging Law on an Old Topic

On January 5, 2023
In this installment of The Phia Group’s Empowering Plans podcast, join attorneys Katie MacLeod and Jon Jablon as they discuss fiduciary status, both traditionally and in the new age of self-funding. This industry is faced with changes all the time, even to some of its oldest rules; in the spirit of consumer protection, the legal and regulatory winds are once again changing to challenge certain long-held understandings about fiduciary duties. TPAs in particular should tune into this one!

New Year, New Rules – But Don’t Forget About the Old Ones

On January 3, 2023
The self-funded health plan industry continues to evolve every year based on new rules, guidance, and medical advancements; however, the Department of Labor (DOL) doesn’t overlook old rules either. In case you missed it, there was a case in mid-2022 that seeks to remind us that the DOL is still considering all Affordable Care Act (ACA) rules when they review complaints and perform audits. In Walsh v. Board of Trustees of Local 272 Welfare Fund and Local 272 Welfare Fund, 22-cv-592 (S.D.N.Y August 2, 2022), the DOL filed suit against a Taft-Hartley welfare plan and its trustees for alleged violations of certain amendments that the ACA made to ERISA, including the maintenance of grandfathered status.

Second Circuit Affirms Private Right of Action for MAO's in Aetna Life Insurance Company v. Big Y Foods Inc.

On December 22, 2022
The Medicare Advantage program, created in 1997, allowed private health insurance companies (“Medicare Advantage Organizations” or “MAO’s”) to contract with CMS to deliver Medicare benefits for a fixed fee per month per enrollee (“capitated payment’). Medicare Advantage Organizations have become increasingly popular and in 2022 close to half of all Medicare eligible beneficiaries are enrolled in a Medicare Advantage Plan. While the Medicare Secondary Payor Act and Federal Codes state that MAOs have the same recovery rights as traditional Medicare, the primary cause of action for MAOs to enforce their rights is through a freestanding provision in the MSP Act, which is separate from the provisions granting the United States the right to seek reimbursement that “there is established a private right of action for damages (which shall be in an amount double the otherwise provided) in the case of a primary plan which fails to provide for primary payment…” 4s U.S.C. 1395y(b)(3)(A). This section does not identify which individuals or entities may take advantage of this private right of action nor against whom these actions may be taken.

Debunking Myths About COVID

On December 21, 2022
In sharing his thoughts about the ongoing pandemic at the MAHP (Massachusetts Association of Health Plans) 2022 Annual Health Care Conference held at the Seaport Hotel in Boston on November 17, Michael Osterholm, Director of the Center for Infectious Disease Research and Policy at the University of Minnesota, made it a point to debunk several widely circulated myths while emphasizing that there continues to be an illusion of knowledge about what will transpire next.

Empowering Plans: P151 – The Who, What, and When of Offsetting Benefits

On December 20, 2022
In this installment of The Phia Group’s Empowering Plans podcast, attorneys Chris Aguiar and Cindy Merrell discuss offsetting benefits and when a Plan may want to consider it.

The Stacks – 1st Quarter 2023 Newsletter

On December 14, 2022
This is "The Stacks" from The Phia Group's 1st Quarter 2023 Newsletter

How the Adderall Shortage is Affecting Millions of Americans

On December 13, 2022
Across the country, Americans with attention-deficit hyperactivity disorder (ADHD) are struggling to find good alternatives to the highly popular stimulant Adderall, which has been in short supply in recent months and will likely not be sufficiently restocked until early 2023 due to skyrocketing demand and manufacturing delays. Because of the shortage, many patients and their families have been forced to try alternative treatments or to go without their medication altogether. This has led to frustration and concern among patients and advocates alike, who argue that the shortage is putting the health and well-being of those who rely on Adderall at risk.

A Flip of the Calendar: Looking Ahead to Healthcare in 2023

On December 13, 2022
With a new year comes new developments in healthcare — and 2023 will be no exception. While ever-increasing healthcare costs remain at the forefront of our attention, landmark healthcare legislation — in particular, the No Surprises Act (“NSA”) — continues to cause unforeseen issues for health plans and stop-loss carriers. Additionally, evolving business trends involving mergers, acquisitions, and investments from non-traditional entities promise to impact the industry. Join The Phia Group’s panel of cost containment experts as they look ahead to the challenges and opportunities that await us next year.

Empowering Plans: P150 – Manufacturer Assistance Programs

On December 8, 2022
Attorneys Brady Bizarro and Andrew Silverio discuss manufacturer/copay assistance programs and outline some of the different approaches being utilized to manage specialty drug spending. Also on the agenda is a current lawsuit against one such program administrator, and how the landscape might be shaped in the coming months.