As discussed here, D.K. et al. v. United Behavioral Health et al. is a case that has been carefully watched in the health benefits space for its potential to change what health plan administrators must include in adverse benefit determination letters. On May 15, 2023, the Tenth Circuit issued its opinion affirming the district
As discussed here, administrators’ health plan benefit denial letters have recently been under scrutiny by the courts. For example, in D.K. et al. v. United Behavioral Health et al., the Tenth Circuit is reviewing a district court’s decision that health plan benefit denial letters must contain more fulsome discussions of the administrator’s determination
On March 16, the Federal Communications Commission (FCC) adopted its first set of regulations targeting what is perceived as the increasing problem of scam text messages sent to consumers. The first rule requires mobile service providers to block text messages that appear to come from phone numbers that are unlikely to transmit text messages. This
In recent years, several lawsuits have challenged wilderness therapy program exclusions in health plans. Not only do members typically assert a claim for benefits, alleging a denial of wilderness therapy benefits was improper under their health plan, but they also insist the plan’s exclusion that serves as the basis for the denial violates the Mental
Chris Willis, co-chair of the CFS Regulatory Practice, Announces the Publication of the 2022 CFS Year in Review and a Look Ahead
Troutman Pepper’s Consumer Financial Services Practice Group consists of more than 120 attorneys and professionals nationwide, who bring extensive experience in litigation, regulatory enforcement, and compliance. Our trial attorneys have litigated thousands of individual and class-action lawsuits involving cutting-edge issues across the country, and our regulatory and compliance attorneys have handled numerous 50-state investigations and nationwide compliance analyses.
We are pleased to share our annual review of regulatory and legal developments in the consumer financial services industry. Our team has prepared this organized and thorough analysis of the most important issues and trends throughout our industry. We not only examined what happened in 2022, but also what to expect — and how to prepare — for the months ahead.
Recently, the Tenth Circuit Court of Appeals held an arbitration provision impermissibly blocked rights afforded to a retirement plan participant under the Employee Retirement Income Security Act (ERISA) and was therefore unenforceable.
As background, in Harrison v. Envision Management Holding, Inc. (Envision), the plaintiff, a former employee of Envision and participant in Envision’s defined contribution
On February 1, the Centers for Medicare & Medicaid Services (CMS) published a final rule strengthening their authority to recover alleged overpayments made to Medicare Advantage plans. The rule formalizes the Medicare Advantage Risk Adjustment Data Validation (RADV), which CMS uses to risk-adjust payments made by CMS to a Medicare Advantage Organization (MAO). While legal
On January 9, the district court for the Eastern District of New York dismissed a pro se plaintiff’s TCPA lawsuit for failure to properly allege that the defendants used an automatic telephone dialing system (ATDS) when placing calls to the plaintiff.
In Kannon v. Warranty Protection Services, the plaintiff alleged that the auto warranty
Effective September 1, the American Arbitration Association (AAA) has finally updated its Commercial Rules and Mediation Procedures, concluding a two-year internal review. The amendments provide greater procedural discretion to arbitrators, further streamline expedited arbitrations, change the amount-in-controversy requirements for certain arbitration paths, and provide express confidentiality protections, among other things.
First, the amended
On March 22, the Ninth Circuit reversed the trial court’s order and underlying decision in Wit et. al. v. United Behavioral Health and Alexander et al. v. United Behavioral Health (Case Numbers 20-17363, 20-17364, 21-15193, and 21-15194). In doing so, the court undid a pair of orders that had required UnitedHealthcare Group, Inc.’s (United) behavioral