Administration seeks comments to get ready for health reform expense ratio and related regulations
Client Alert | 1 min read | 04.14.10
The Departments of Labor, Treasury and Health and Human Services have issued a Federal Register notice requesting public comment on a series of questions concerning new Section 2718 of the Public Health Service Act, enacted as part of the Patient Protection and Affordable Care Act which became law on March 23rd.
The questions involve new requirements requiring reporting of individual and group market expense ratio information by insurance carriers, payment of rebates to enrollees if an issuer's clinical and quality improvement expense ratios do not satisfy statutory thresholds and establishment of key definitions required for administration of the new requirements. Another provision conditions qualification of certain non-profit health insurers for special tax deductions on the insurer maintaining a specified ratio of claim services reimbursement to total premium revenue.
The notice seeks public comment on a broad range of questions about current industry and state regulatory practices bearing on the subjects addressed by the new legislative requirements and also solicits comments on any issue under Section 2718 that commenters wish to address. Comments are due by May 14th.
Insights
Client Alert | 3 min read | 11.21.25
On November 7, 2025, in Thornton v. National Academy of Sciences, No. 25-cv-2155, 2025 WL 3123732 (D.D.C. Nov. 7, 2025), the District Court for the District of Columbia dismissed a False Claims Act (FCA) retaliation complaint on the basis that the plaintiff’s allegations that he was fired after blowing the whistle on purported illegally discriminatory use of federal funding was not sufficient to support his FCA claim. This case appears to be one of the first filed, and subsequently dismissed, following Deputy Attorney General Todd Blanche’s announcement of the creation of the Civil Rights Fraud Initiative on May 19, 2025, which “strongly encourages” private individuals to file lawsuits under the FCA relating to purportedly discriminatory and illegal use of federal funding for diversity, equity, and inclusion (DEI) initiatives in violation of Executive Order 14173, Ending Illegal Discrimination and Restoring Merit-Based Opportunity (Jan. 21, 2025). In this case, the court dismissed the FCA retaliation claim and rejected the argument that an organization could violate the FCA merely by “engaging in discriminatory conduct while conducting a federally funded study.” The analysis in Thornton could be a sign of how forthcoming arguments of retaliation based on reporting allegedly fraudulent DEI activity will be analyzed in the future.
Client Alert | 3 min read | 11.20.25
Client Alert | 3 min read | 11.20.25
Client Alert | 6 min read | 11.19.25
