Mid-Atlantic Health Law TOPICS
Did You Know? - Fall 2023
Mental Health Parity: Did you know that the Biden Administration proposed new mental health parity rules which would increase compliance standards for health insurance companies and employer plans? In July 2023, the Administration issued proposed rules that would incorporate into the Mental Health Parity and Addiction Equity Act (MHPAEA) regulations, definitions and standards that were previously only found in agency guidance. Additionally, the proposed rules require health plans to analyze specific data, and create a presumption of noncompliance in certain situations when the data is less favorable for mental health/substance use disorders than for medical/surgical treatment. This proposed rule comes after over a decade of enforcement of MHPAEA that critics have said has not achieved the goal of equal access to mental health/substance use disorder treatment as compared to medical/surgical treatment. These proposed rules are another step the federal government is taking to attempt to achieve that goal.
Employee Kickbacks: Did you know that an owner of a Texas based compounding pharmacy was found guilty on four counts of paying kickbacks and one count of conspiring to commit money laundering in U.S. v. Hall? The pharmacy paid marketing staff commissions on a per-referral basis. When the prescription was to be paid by a private payor, the marketing staff was paid as 1099 contractors by a shell company. When the prescription was to be billed to a federal payor, the marketing staff was paid as “purported” W-2 employees of the pharmacy. Because the Federal Anti-Kickback Statute has broad exceptions for payments to bona fide employees, the defendant argued that these payments were permitted. The jury did not agree that the marketing staff were bona fide employees at the time of payment.