Tag:Health Insurance
New Mental Health Parity Rules on the Horizon
On July 25, 2023, the Departments of Labor, Health and Human Services, and the Treasury (the agencies) proposed new rules placing heightened compliance standards on health insurers and plans regarding the use of Non-Quantitative Treatment Limitations (NQTLs) for mental health and substance abuse disorder (MHSUD) services. These new rules amend the current reporting requirements with the intent to establish ongoing reporting that more clearly demonstrates whether MHSUD services are provided in compliance with the law.
Exploring the Ramifications of the Department of Justice’s Withdrawal from Health Care Antitrust Guidelines
On February 3, 2023, the Department of Justice (DOJ) formally withdrew its support for three policies that created longstanding safe harbors from antitrust enforcement, relied upon by the healthcare industry for nearly thirty years. Assistant Attorney General, Jonathan Kanter, of the DOJ’s Antitrust Division stated that these changes were “long overdue”, and that the, “[DOJ] will continue to work to ensure that its enforcement efforts reflect modern market realities.” In striking these guidelines, the DOJ notably left no new guidelines in its place, leaving many healthcare providers and purchasers uncertain of whether they will face litigation or even criminal prosecution under the Sherman Act.
How the Inflation Act of 2022 has Impacted the Pharmaceutical Industry
Prescription drug price increases have long been a detriment to Americans. The Inflation Reduction Act (the Act) is in part designed to assist in this corporate pharmaceutical problem. This Act plans to do this through the implementation of seven major prescription drug provisions. Two of the major ones are requiring negotiations for certain drug prices by the federal government and limiting the monthly cost-sharing for insulin to $35. Through these changes along with various others, advocates hope that the burden will be lifted off Medicare beneficiaries. It has also been estimated that the Act will work to reduce the federal deficit by $237 billion over 10 years (2022-2031).
The Sicker, The Better: Cigna Orchestrates Fraudulent Scheme to Defraud Government
Cigna Corporation (Cigna)–a global juggernaut in the insurance arena–faces a health care fraud lawsuit brought by the government under the federal False Claims Act (the FCA). By allegedly exaggerating patients’ illnesses to boost its own risk scores, Cigna secured inflated payments from the Medicare Advantage reimbursement system.
Considerations for Employer-Provided Abortion Benefits
Following the ruling of Dobbs v. Jackson Women’s Health Organization and subsequent reversal of Roe v. Wade, employers have begun to re-strategize how to help their employees legally access abortions. Several U.S. companies, including Amazon, Meta, Apple, and Microsoft, have released statements that they will cover transportation costs to other states for employees seeking an abortion.
Advancing Abolition Is a Must — Abolition Means Transformative Wellbeing and Prevention
Policing is a settler colonial creation to control native populations and is exported aboard to teach other empires how to do the same. In 2007, the FBI found that cops averaged roughly four hundred “justifiable homicides” every year, whereas nearly eighty cops were murdered in the line of duty. These disparities have only further developed, where since 2014, cops averaged nearly one thousand homicides each year, and the number of cops killed in the line of duty remained around forty-eight. Policing and prison systems are premised on punishment, rather than transformative healing, health, and prevention. Thus, as stated in Decriminalization Is Not Enough, Abolition Is a Must, resources and funding which are currently given to our present system of policing and prisons should be reallocated to tools that actually serve the community, rather than on incarceration.
Justice is a means through which people can discuss, decide, and create environments that encourage them thrive and it involves the people who are most impacted by those conditions. In that vein, abolition will look different in each community. The goal of abolition should be prioritizing the needs of each community by allowing the community control and ultimate decision-making ability. Abolition allows each community to communicate, prioritize, and enact methods and means that will make that community the best environment for its members. As Dereka Purnell wrote in Becoming Abolitionists, “activists or abolition-curious people will often ask me, ‘What does abolition look like to you?’ My answers change all the time during conversation, especially since I believe that the dreaming and practicing should happen together. This is what I’m thinking about today as I’m writing the conclusion to this book. Every neighborhood would have five quality features: a neighborhood council; free twenty-four-hour childcare; art, conflict, and mediation centers; a free health clinic; and a green team.” Upon community needs, discussion, and approval, funds currently spent on police and prison systems should be reallocated to education, housing, health care, and public spaces.
Senate Brings Bipartisan Attempt to Update Health Privacy Regulations
On February 9, a group of senators led by Tammy Baldwin of Wisconsin and Bill Cassidy of Louisiana introduced a new bill, the Health Data Use and Privacy Commission Act (the “Act”), in attempt to revitalize current legislation regarding the protection and use of health data. The bill also has the support of a number of representatives from within the healthcare industry, including Epic, IBM, and Teladoc Health, as well as a number of professional associations like the American College of Cardiology, the Association for Behavioral Health and Wellness, and the Association of Clinical Research Organizations.
Decriminalization Is Not Enough, Abolition Is a Must
In the United States, since the 1980s, the federal prison population has increased by roughly 790%. Specifically, presently within Illinois, there are approximately 76,000 citizens who are incarcerated. In 2014, Illinois appropriated and spent nearly $1.3 billion on prison budgets. Where even though cannabis is now legal, in Illinois, roughly 90 inmates are still incarcerated for offenses relating to the use, manufacturing, and selling of cannabis. According to the Last Prisoner Project, inmates remain incarcerated even though House Bill 1438 establishes that persons who have been convicted on an offense are granted a pardon because the Bill provides no resentencing or commutation procedures, and the process to have sentences pardoned is slow.
In examining the injustices of carceral punishment, statistics like these show that these injustices are not an anomaly, but rather the norm. Because prisons are premised on punishment, rather than transformative healing, health, and prevention, prisons are a human rights issue, rather than a criminal justice issue. Prisons are premised on punishment, rather than transformative healing and health, and prevention. As a result, resources and funding which are currently given to our present system of policing and prisons should be reallocated to tools that actually serve the community, rather than on incarceration.
The Supreme Court Is Not Protecting Women’s Rights, so Will the 49th Anniversary of Roe v. Wade Be Its Last?
In 1973, the Supreme Court ruled in Roe v. Wade that states could not create onerous requirements that interfered with a patient’s right to an abortion up to the point of viability of the fetus, which was around 24 weeks. Roe and Planned Parenthood v. Casey established and protected patients’ rights to privacy and healthcare autonomy in reproductive health. However, as I previously explained in Abort Texas’ New Abortion Law, Texas’ new law erodes that decision. On January 20, 2022, the Supreme Court was presented with the opportunity to address this issue. The Court denied Texas abortion clinics’ request to immediately return to litigation over the Court’s acceptance of Texas’ six-week abortion law. However, the threat to reproductive health is not isolated to Texas; other states have enacted similar laws.
NBA Healthcare Fraud Scheme
Krista Solano Associate Editor Loyola University Chicago School of Law, JD 2023 Eighteen former NBA players were charged with defrauding the league’s health and welfare benefit plan. The former players were charged under 8 USC Section 1347, otherwise known as the federal healthcare fraud statute. The fraud scheme submitted $3.9 million in fake claims, for …
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