Employee Benefits/ERISA & Compliance Leader
Employee Benefits/ERISA & Compliance Professionals
Employee Benefits/ERISA & Compliance Areas of Practice
Employee Benefits/ERISA & Compliance Related Sectors & Services

Employee Health Plans

Our legal team is skilled in guiding clients on issues related to insured and self-funded group health plans and applicable federal and state laws and regulations. Our experience includes reviewing client plan documents to provide recommendations and best practices pertaining to the Affordable Care Act (ACA), Health Insurance Portability and Accountability Act (HIPAA), Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage, Mental Health Parity and Addiction Equity Act (MHPAEA), Emergency Medical Treatment and Labor Act (EMTALA), Genetic Information Nondiscrimination Act (GINA), Fraud and Abuse Laws, data privacy, and other state and federal laws regarding employee medical and welfare benefit plans. We advise clients on changes in the law to ensure that their medical and welfare benefit plans remain in compliance with these applicable laws and regulations.

Our firm offers a wide variety of services designed to help clients navigate the complex regulatory, security, privacy, and transactional issues that come into play under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. This includes advising clients regarding standards and practices to guarantee HIPAA compliance, developing appropriate policies and procedures and business associate agreements, and reviewing group health plans, documents, and privacy notices to ensure that both patient and recipient rights are protected at every level. We regularly provide HIPAA training to clients and counsel clients on their duties and responsibilities in the event of a HIPAA breach.

We also counsel clients regarding the potential implication of federal and state fraud and abuse laws, including the federal Stark Law and Anti-Kickback Statute, state Anti-Solicitation Statutes, and similarly adopted state-specific statutes or regulations governing relationships in the healthcare industry.

Experience

With assistance from  Kristi Gauthier,  Ed Hammond, Peter Domas and Bishop Bartoni, Kevin Hendrick and Nicole Tersigni successfully defended an insurance priority dispute, resulting in an extremely favorable judgment for firm client, United States Steel Corporation’s ERISA-governed Retiree Benefits Plan.  U. S. Steel Retirement Plan was joined as a third-party defendant in a pending dispute by a No-Fault Automobile Insurance carrier,  which had been sued by a healthcare service provider for unpaid patient attendant care fees.  The No-Fault Carrier claimed that the obligation to pay for these services under Michigan No-Fault law  fell to U. S. Steel Retirement Plan, which covered the patient (who was a former U. S. Steel employee).  Ed, Bishop, Kristi and Peter lent their expertise to Kevin and Nicole in interpreting alleged conflicting insurance priority provisions and explanations of benefits.  Kevin and Nicole crafted a legal argument that ultimately led to summary disposition in favor of U.S. Steel Plan, and against the No-Fault carrier, saving U.S. Steel Plan from payment of the healthcare fees, and also reimbursing U.S. Steel Plan for benefits it had earlier paid by mistake, out of priority.  As the No-Fault carrier had rejected the Case Evaluation award prior to the filing of cross motions for summary disposition, it also appears that attorney  fees are recoverable for our client.  Kristi and Ed on Employee Benefit law, Bishop on Michigan No-Fault law, and Pete on Health Care issues, proved to be unbeatable resources.

Newsletter Alerts
Important Employer Considerations With Respect to Health Plan Opt-Out BenefitsIRS Adopts Final Regulations With Required and Optional Changes to Hardship Distribution Rules for 401(k) and 403(b) PlansDepartment of Labor Issues Final Association Retirement Plans RuleFederal District Court Rejects Trump Administration’s Proposal for Association Health Plans Affordable Care Act Held Unconstitutional – What’s Next?2019 Benefits Limits and Recent Changes to 401(k) and Other Qualified Retirement PlansPresident Trump Announces Association Retirement Plans; DOL Publishes New ACA Notices2018 Benefits LimitsSupreme Court Unanimously Extends the "Church Plan" ERISA Exemption to Plans Originally Established by Non-Church AffiliatesDOL Extends Fiduciary Rule Effective Date for 60 DaysPresident Issues Executive Order Addressing Affordable Care Act RepealSome Small Employers May Reimburse Employees' Premium and Other Uninsured Medical ExpensesIRS Offers A Short Extension For Certain ACA ReportsIRS Taketh and Giveth: Plan Determination Letter Program Scaled Back, Remedial Amendment Period Extended“They’re Here!” – Department of Labor Issues Final ERISA Fiduciary and Conflict of Interest RegulationsSome Small Employers May Have Reporting Obligations Under the Affordable Care ActHealth Coverage Providers: Deadlines for Health Coverage Providers to Report Minimum Essential Coverage are Approaching Supreme Court Reaffirms Limits on Benefit Plan Subrogation ClaimsWisconsin Court Rules Wellness Program Not a Violation of the ADAIRS Announces Short Extension in Affordable Care Act ReportingCadillac Tax Delayed Until 2020 Under New Spending BillThe Impact of the Obergefell Decision on Employer Health and Welfare Benefits Frequently Asked Questions Regarding the "Cadillac" Health Plan TaxEEOC to Issue Proposed Rule on the Impact of the ADA on Wellness ProgramsDOL Issues Much-Anticipated Fiduciary Definition and Conflicts of Interest RuleDOL Final Rule Provides Flexibility on Annual Participant Fee Disclosure RequirementsIRS Issues Transitional Relief for Certain Employers Sponsoring Employer Payment Plans2015 Benefits Limits - Multiemployer Pension Reform Signed Into LawEEOC Sues Employers Over Wellness Programs, Despite Lack of Guidance
News
Clark Hill Attorneys Named to DBusiness Magazine's 2020 Top Lawyers ListBrad Oxford to Present Webinar on Retirement Plan Audits on October 1, 2019Clark Hill Attorneys Named 2019 Michigan Super Lawyers & Rising StarsClark Hill Attorneys Named 2019 “Leaders in their Field” by Chambers USAClark Hill PLC Receives National and Regional Tier 1 Rankings in the 2019 Edition of Best Lawyers, “Best Law Firms” Sixty-Six Clark Hill Attorneys Named 2018 Michigan Super Lawyers & Rising Stars143 Clark Hill Attorneys Selected for Inclusion in the 2019 Edition of Best Lawyers in AmericaClark Hill Attorneys Named 2018 “Leaders in their Field” by Chambers USASixty-Seven Clark Hill Attorneys Named 2018 Leading LawyersClark Hill PLC Receives National and Regional Tier 1 Rankings in the 2018 Edition of Best Lawyers, “Best Law Firms”Clark Hill Attorneys Named to DBusiness Magazine's 2018 Top Lawyers ListSixty-Six Clark Hill Attorneys Named 2017 Michigan Super Lawyers & Rising StarsSeventy-Four Clark Hill Attorneys Selected for Inclusion in the 2018 Edition of Best Lawyers in AmericaClark Hill Attorneys Named 2017 “Leaders in their Field” by Chambers USATwenty-Eight Clark Hill Attorneys Named to DBusiness Magazine's 2017 Top Lawyers ListClark Hill PLC Receives National Rankings in the 2017 Edition of U.S. News-Best Lawyers, “Best Law Firms”Sixty Clark Hill Attorneys Named 2016 Michigan Super Lawyers & Rising StarsSixty-Four Clark Hill Attorneys Selected for Inclusion in the 2017 Edition of Best Lawyers in AmericaClark Hill Attorneys to Present During the 2016 MCMCFC Spring Management Conference & Trade ShowClark Hill Attorneys Named 2016 “Leaders in their Field” by Chambers USATwenty-Six Clark Hill Attorneys Named to Pennsylvania Super Lawyers & Rising Stars 2016 ListSixty-Six Clark Hill Attorneys Selected for the 2015 Super Lawyers Business EditionTwenty-Eight Clark Hill Attorneys Named to DBusiness Magazine's 2016 Top Lawyers ListClark Hill PLC Receives National Tier 1 Ranking for Litigation – Construction in the 2016 Edition of U.S. News-Best Lawyers, “Best Law Firms”