News & Analysis as of August 27, 2025

Insurance Industry

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Discrimination is prejudicial treatment related to (or inappropriate consideration of) an individual's actual or perceived membership in a particular class, group or category, such as an individual's... more +

FCA Case Against Insurers Alleges Kickbacks and Discriminatory Practices

Rivkin Radler LLP on 5/12/2025

On May 1, a whistleblower filed a complaint under the federal False Claims Act (FCA) against Aetna, Elevance Health (formerly Anthem) and Humana alleging that the insurers paid hundreds of millions of dollars in illegal...more

California AG Issues AI Advisories

WilmerHale on 1/30/2025

On January 13, 2025, the California AG’s Office (“AGO”) issued two legal advisories regarding the application of existing California law to AI generally as well as the use of AI specifically in healthcare....more

Court Orders Claims Reprocessing After Finding TPA Illegally Excluded Gender-Affirming Care in Violation of ACA Section 1557

Hall Benefits Law on 4/12/2024

A federal district court has awarded injunctive relief, including claims processing, after finding that an insurer acting as a third-party administrator (TPA) for a self-insured plan violated Section 1557 of the Affordable...more

HHS Proposes Rules for Nondiscrimination in Health Care

K&L Gates LLP on 9/22/2015

On September 8, 2015, the U.S. Department of Health and Human Services (“HHS”) proposed new regulations implementing Section 1557 of the Patient Protection and Affordable Care Act (“ACA”). Section 1557 prohibits...more

Health Insurer Settles OFCCP Retaliation Allegations for $372,000

Proskauer - Government Contractor Compliance... on 7/19/2013

A health insurance provider in Massachusetts has agreed to pay $372,739 to resolve an Office of Federal Contract Compliance Programs (OFCCP) investigation into claims of discrimination and retaliation....more

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