ERISA Plan Disclosures Not “Actual Knowledge” Unless Read

ERISA requires plaintiffs with “actual knowledge” of an alleged fiduciary breach to file suit within three years of gaining that knowledge under 29 U. S. C. §1113(2). For plaintiffs without “actual knowledge, a 6-year period applies. The United States Supreme Court addressed the requirements for having “actual knowledge” in a case decided on February 26, … Continued

Balance Billing Defense, an “Op Ed” by James F. Koehler

The authors of this newsletter have followed, and occasionally written about, various state and federal legislative efforts to reign in and address the problem of balance bills, or as the legislators incorrectly name them, “surprise medical bills.” Incorrectly named because in many cases the bills are anticipated by the patient, albeit unknown in amount. “A … Continued

2019 Federal Health Care Legislation – Action or No Action

Funding for the ACA continues to be reduced. “As part of a 1.4 trillion dollar spending package the Senate passed [December 19, 2019] and which President Donald Trump has said he’ll sign, three taxes that were created to fund the Affordable Care Act are set to be repealed. The outgoing fees include the “Cadillac tax,” … Continued

Constitutionality of the ACA – A Brief Timeline and Update

State of Texas, et al. v. United States (N.D. Tex. Case No. 4:18-cv-167-O; 5th Cir. Case No. 19-10011) will follow the traditional litigation path and not be fast-tracked. Here is a look back over the case’s history: December 2017: Congress set the shared responsibility payment at $0 as of January 1, 2019 after enacting the … Continued

Non-Profit Hospitals Profit From Tax-Exempt Status

Approximately 60% of community hospitals are nonprofit hospitals.[1] A nonprofit hospital is a hospital that is granted 501(c)(3) status by the IRS. Nonprofit hospitals benefit from this status by being: Exempt from federal, state and local taxes; Permitted to receive charitable donations; and Allowed to issue tax-exempt bonds. To qualify for 501(c)(3) status, a hospital … Continued

The Fate of the ACA Remains Uncertain

On December 18, 2019, the 5th Circuit Court of Appeals entered its decision in State of Texas, et al. v. United States of America, Case No. 19-10011, which was on appeal from the District Court for the Northern District of Texas. As framed by the 5th Circuit, the narrow questions before the Court were whether: … Continued

Will Federal Surprise Billing Legislation Ever Move Forward?

As 2019 draws to a close, and despite a flurry of activity throughout the year, the House and Senate have been unable to reach agreement with respect to balance billing. Members of the House and Senate introduced a myriad of bills all targeting “surprise medical billing.” They held hearings and negotiations. They spoke repeatedly about … Continued

Health Care Costs Continue to Grow

One thing is certain as we head into 2020, health care costs continue to rise. Here are some of the key statistics reported in 2019: $3.8 trillion is the predicted health care spend in 2019[1] 4.8% is the predicted increase in health care spend in 2019[2] 5.7% is the average rate national health spending is … Continued

An Accident of History

A fascinating article entitled, “The employer-health insurance connection an ‘accident of history’” by David Balat appeared in the November 9, 2019 edition of The Hill. The article briefly traces the history of healthcare in the United States and how it evolved into an employer-sponsored benefit. “Most early prepaid medical care programs in this country began … Continued

The Cost of Inpatient Care

Kaiser State Health Facts has issued a report of 2017 adjusted expenses per inpatient day for all 50 states.[1] “These figures, which are based on information from the 2017 American Hospital Association Annual Survey, include all operating and nonoperating expenses for registered U.S. community hospitals, defined as public, nonfederal, short-term general and other hospitals. The … Continued