Recent Articles

:: Virginia District Court Rules Individual Mandate Unconstitional

Roy F. Harmon III
December 13, 2010 19:48

More on this later, but Judge Henry Hudson has ruled that the PPACA individual mandate is unconstitutional: Judge Henry E. Hudson ruled Monday for the state’s claim that the requirement for people to purchase health care exceeds the power of Congress under the Constitution’s Commerce...

:: Fiduciary Duties Not Implicated In Managed Care Rate Negotiations

Roy F. Harmon III
December 10, 2010 01:39

Thus, in a nutshell, Blue Cross lowered rates for its own subsidiary by effectively raising them for Flagstar and other self-insured plans. The letter agreements between Blue Cross and the hospitals spell out these facts in black and white. But that does not mean that Flagstar knew about the deals....

:: Plaintiff’s Section 502(a)(3) Claim Prevails Over Varity-Based Defense

Roy F. Harmon III
November 29, 2010 16:28

The Courts of Appeals disagree as to whether Varity prohibits a plaintiff from simultaneously pursuing equitable relief pursuant to Section 502(a)(3) and benefits due under the terms of the plan pursuant to Section 502(a)(1)(B).  The Third Circuit has not ruled on the issue, and district judges...

:: Feds Ease Grandfather Rule Requirements For Insured Plans

Roy F. Harmon III
November 17, 2010 23:46

The federal agencies regulating under the PPACA have determined that changing issuers should not result in a loss of a plan’s grandfathered status. The new guidance was anticipated inasmuch as a change in insurers is frequently necessary and the distinction between self-funded plans (that...

:: Florida District Court Rules That PPACA Challenge May Proceed

Roy F. Harmon III
October 14, 2010 19:49

It appears that the individual mandate under the PPACA may be headed for rough sailing. Here is an excerpt from an opinion today in which the Obama administration’s motion to dismiss was denied. The government has never required people to buy any good or service as a condition of lawful...

:: PPACA FAQ Resources Page

Roy F. Harmon III
October 14, 2010 13:13

The Employee Benefit Security Administration has published several “frequently asked questions” installments.   These FAQ’s supplement the several interim rules providing guidance on some of the many vague standards set forth in the PPACA. The regulatory effect of a FAQ is perhaps an untested legal...

:: ERISA’s Plan’s Reimbursement Claim Enforced Against Disbursed UIM Benefits

Roy F. Harmon III
September 02, 2010 23:37

Here, US Airways seeks the restoration of particular funds, the lawsuit settlement and UIM benefits, as distinct from McCutchen’s general assets, traceable to the Plan and subject to an equitable lien for the benefit of the Plan. Therefore, even if the monies paid to McCutcheon are not specifically...

:: Resource On False Claims Act & Qui Tam Claims

Roy F. Harmon III
August 31, 2010 11:11

There are a number of federal criminal, civil and administrative enforcement provisions set forth in the Medicare statutes which are aimed at preventing fraudulent conduct, including hospice fraud, and which help maintain program integrity and compliance. Some of the more prominent enforcement...

:: Failure To Substantially Comply With Claims Procedures Proves Costly To Plan

Roy F. Harmon III
August 23, 2010 16:17

“ERISA provides certain minimal procedural requirements upon an administrator’s denial of a benefits claim.” Wade v. Hewlett-Packard Dev. Co. LP Short Term Disability Plan, 493 F.3d 533, 539 (5th Cir. 2007). The plan administrator must “provide adequate notice in writing to...

:: Equitable Reformation Of Plan Permitted As § 502(a)(3) Relief

Roy F. Harmon III
August 12, 2010 16:57

We have never considered whether § 502(a)(3) authorizes equitable reformation of an ERISA plan due to a scrivener’s error, but our case law addressing the related problem of ambiguous plan language suggests that such relief may be appropriate. Young v. Verizon’s Bell Atl. Cash Balance...