Matters
- Serves as ongoing health and welfare and fiduciary counsel to large and complex employers, including public companies, health systems and private-equity-backed or other multi-entity organizations, on plan design and administration, fiduciary governance, vendor relationships, participant communications, regulatory developments and litigation risk.
- Represents employers in complex ACA-related IRS controversy matters, including responding to IRS inquiries and proposed assessments; contesting employer shared responsibility payments and failure-to-file and failure-to-furnish penalties relating to ACA information reporting; and developing factual, legal and correction strategies to seek reduction or abatement of asserted liabilities.
- Develops and advises on HIPAA privacy, security and breach-notification compliance programs for employer-sponsored group health plans, including required plan provisions and plan-sponsor certifications, restrictions on access to protected health information, privacy and security policies and procedures, workforce training, and business associate arrangements.
- Designed and implemented an enterprise-wide restructuring and compliance initiative for a large, acquisitive health care organization maintaining numerous separately administered ERISA welfare plans, including analysis of plan sponsorship, participating employers, funding, plan documentation, governance and potential MEWA status.
- Advises a growing multi-state organization on the operation and continuing evolution of a multiple employer welfare arrangement, including federal and state filings, regulator interactions, plan and trust governance, funding, annual renewals and acquisition-related expansion.
- Conducted specialized health and welfare due diligence and litigation-risk analysis in connection with a proposed acquisition involving a benefits-services business and voluntary-benefit program, advising management, the board and private-equity representatives regarding ERISA, fiduciary, insurance and litigation exposure, mitigation measures, residual risk and pre- and post-closing actions.
- Advises health technology and other benefits service providers on the design and launch of employer-facing health and population-health products, including ERISA, ACA, HSA and HDHP, excepted-benefit, PBM and insurance issues, as well as customer contracts, implementation materials and internal training.
- Advises companies undergoing acquisitions, corporate separations or affiliate realignments on plan sponsorship, participating-employer provisions, controlled-group and MEWA issues, the treatment of acquired or separating populations, vendor arrangements, documentation and the development of workable post-transaction benefit structures.
- Counsels health plan fiduciaries regarding PBM and other service-provider arrangements, including fiduciary governance, prudent selection and monitoring processes, fees and compensation, rebates, data and audit rights, contractual protections, participant communications and developing litigation trends.
- Reviews and negotiates PBM, TPA, master services, stop-loss, business associate and related agreements for self-funded health plans and advises on the integration of contractual terms with governing plan documents and administrative practices.
