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Oct 9 2015

U.S. DOL and New York Attorney General Team Up on Health Plan Oversight

Author(s): Blitman & King LLP

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The New York attorney general’s office and the U.S. Department of Labor Employee Benefit Security Administration (“EBSA”) recently announced that they have entered into an agreement to work together on enforcement of the Employee Retirement Income Security Act and state laws governing health insurance plans. The arrangement will help cover enforcement gaps in state and federal jurisdiction which regulate different types of health plans. Specifically, self-insured health plans are not covered by New York laws on health insurance and EBSA does not have authority to regulate health insurance companies in their role as insurers.

The agreement will allow the attorney general and EBSA to collaborate on enforcement efforts involving New York insurance companies violating state and federal law. They will  share information, work cooperatively, cross-refer cases and conduct joint investigations in an effort to protect the rights of participants in employee health plans, whether they are members of plans offered by insurance companies or self-insured plans created by private employers for employees.

The state investigative efforts will join forces with the EBSA Health Benefits Security Project, a national enforcement project begun in 2012 to root out systemic violations of federal law related to health benefits. The project focuses on employer-sponsored plans and their service providers, in an enforcement drive to ensure that promised benefits are paid, participants are told about their benefits and rights, and fiduciaries are held accountable for mismanagement. Laws covered by the EBSA project include the Mental Health Parity and Addiction Equity Act and the Affordable Care Act.

These efforts will help the two agencies identify and correct improper coverage denials since violations are often subject to both federal and state health coverage laws. Insurance carriers often use the same procedures to administer self-insured health plans on behalf of employers as they use in their own health plans. Information from state investigations of health plans will be helpful to federal investigators reviewing self-insured plans and information obtained through EBSA investigations concerning service providers to self-insured plans can provide leads when the same companies review claims as insurers.

In a statement, New York Attorney General Eric T. Schneiderman said that, by teaming up with the EBSA, his office “will make sure that all types of health plans comply with our vital federal and state consumer protection laws, such as the federal Affordable Care Act’s preventive services provisions and laws requiring equal coverage for mental health and addiction treatment.” EBSA Regional Director Jonathan Kay stated that the two agencies “share a common interest and a common mission”—protecting the rights of health benefit plan participants. He said, “We look forward to a productive and substantial relationship.”

If you would like additional information, or to have Blitman & King LLP assist in connection with a DOL/NY AG inquiry or audit, please contact us.