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USAP filed a motion to dismiss the FTC's lawsuit against it. USAP predictably argued that it was not violating antitrust laws, but it also argued that Section 13(b) of the FTC Act did not support the FTC's lawsuit where the FTC did not file a simultaneous administrative proceeding against USAP, and for good measure that the FTC is unconstitutional. USAP also raised the issue in its motion to dismiss that the FTC based its claims on an impermissible market definition.
USAP's motion to dismiss was denied by the District Court, and USAP filed an appeal from the District Court's denial of its motion to dismiss. FTC v. Anesthesia Ptrs., Inc., No. 4:23-cv-03560, 2024 WL 2137649, at *6-*9 (S.D. Tex. May 13, 2024), app. docketed, No. 24-20270 (5th Cir. June 17, 2024). In the course of denying USAP's motion to dismiss, the District Court quoted several of the FTC's allegations, including this one:
The FTC quotes an insurance executive describing USAP's consolidation strategy as “tak[ing] the highest rate of all ... and then peanut butter spread that across the entire state of Texas.”
FTC v. Anesthesia Partners, 2024 WL 2137649, at *9.
The District Court granted Welsh Carson's motion to dismiss, in contrast. FTC v. Anesthesia Partners, 2024 WL 2137649 at *4-*6. Welsh Carson successfully argued that it, the private equity financier, did not violate and was not about to violate antitrust laws based on the allegations in the FTC's complaint.
So it's on to the Fifth Circuit where USAP hopes that it will find a more receptive audience for its arguments including that the FTC is unconstitutional despite some 90 years of precedent to the contrary.
Today is the 54th anniversary of Earth Day! Honor Earth Day by telling your country about changes in your Health Care in 2024!
Uncle Sam has a Request For Information (RFI), your information. The RFI is only 12 pages long, which is not too long for Uncle Sam who can be very wordy as we all know. Click on the blue underlined Request For Information to read all 12 pages of it.
Have there been changes in your health care since a provider was bought or merged or changed procedures?
Has your work safety in the health care industry, or have your wages from a health care provider, changed in recent times?
Is health care affordable for you as a patient or as a taxpayer, both, since one or more of your health care providers changed their business operations because they were bought by some other company, or because they bought some other company or merged with it somehow?
THEN UNCLE SAM WANTS TO HEAR FROM YOU!
Tell the U.S. Department of Justice, and the U.S. Department of Health and Human Services, and the Federal Trade Commission! You can send your comments to them by U.S. Mail, or you can leave your comments online at www.regulations.gov. Put the Docket Number ATR 102 on your comments, and send them in before May 6, 2024. That's it!
Except to remember this, as Uncle Sam put it:
Privacy Note: The agencies’ general policy is to make all comments received from members of the public available for public viewing in their entirety on the Federal eRulemaking Portal at www.regulations.gov. Therefore, commenters should be careful to include in their comments only information that they wish to make publicly available.
Tomorrow is the 54th anniversary of Earth Day! Honor the Day by leaving a Comment on changes in your Health Care in 2024!
Uncle Sam has a Request For Information (RFI), your information. The RFI is only 12 pages long, which is not too long for Uncle Sam who can be very wordy as we all know. Click on the blue underlined Request For Information to read all 12 pages of it.
Have there been changes in your health care since a provider was bought or merged or changed procedures?
Has your work safety in the health care industry, or have your wages from a health care provider, changed in recent times?
Is health care affordable for you as a patient or as a taxpayer, both, since one or more of your health care providers changed their business operations because they were bought by some other company, or because they bought some other company or merged with it somehow?
THEN UNCLE SAM WANTS TO HEAR FROM YOU!
Tell the U.S. Department of Justice, and the U.S. Department of Health and Human Services, and the Federal Trade Commission! You can send your comments to them by U.S. Mail, or you can leave your comments online at www.regulations.gov. Put the Docket Number ATR 102 on your comments, and send them in before May 6, 2024. That's it!
Except to remember this, as Uncle Sam put it:
Privacy Note: The agencies’ general policy is to make all comments received from members of the public available for public viewing in their entirety on the Federal eRulemaking Portal at www.regulations.gov. Therefore, commenters should be careful to include in their comments only information that they wish to make publicly available.
In discovery confidentiality litigation, large companies are consistent in fighting to keep their secrets including whether they have been sued and how many times for bad faith, for example.
In this case, UnitedHealth is accused of buying secrets:
The Complaint against Optum, the UnitedHealth Group subsidiary set to acquire Chicago Healthcare, "a company that offers technology services to insurers," David McCabe, Justice Dept. Sues to Block Deal By UnitedHealth Worth $13 Billion, NEW YORK TIMES, Friday, February 25, 2022, at B6, expresses the governments' concern that when Chicago Healthcare gathers data during the course of helping to "process insurance claims," UnitedHealth as its owner will be able to see the procedures used in processing claims by competing insurance carriers who pay Chicago Healthcare for its claims data services.
This is significant and real, not unimportant or theoretical. "The lawsuit claims that, according to a UnitedHealth estimate, more than half of American medical insurance claims 'pass through (or touch)' Chicago Healthcare's systems." David McCabe, NEW YORK TIMES, supra (emphasis added).
The Complaint further alleges the governments' concern that UnitedHealth could steer Chicago Healthcare's systems away from UnitedHealth's competitors, or even bar the competing insurance companies from buying those systems, if UnitedHealth is allowed to buy Chicago Healthcare. This has the clear potential to become a significant competitive advantage in the healthcare insurance industry, especially during a pandemic.
The Complaint also alleges that UnitedHealth could end up with a monopoly if this acquisition is allowed to proceed. The resulting monopoly would be over Chicago Healthcare's "type of service that was used to screen insurance claims for errors and speed up processing." David McCabe, NEW YORK TIMES, supra,
The case has been assigned to Judge Carl Nichols. A former clerk of Supreme Court Justice Clarence Thomas, he was appointed to the federal bench in 2019. Since then he has also been assigned to oversee the contempt citation case against Steve Bannon, which has been set for trial in July, 2022.
In the last sentence of the judge's standing order in civil cases, he says: 'The parties shall not file a discovery motion without leave of Court." Download J. Carl Nichols D.C.D.C. Standing Order. Putting aside the question of whether this kind of blanket ruling is even valid, it is hard to imagine an antitrust case like this one without lots of discovery. There are likely to be lots of requests for "leave of Court" to file discovery motions concerning the discovery disputes that will pile up in the future.
Here's hoping they are resolved faster than the contempt citation against Steve Bannon.
At least some health insurance companies began charging their policyholders the full amount of their deductibles, copays, and coinsurance. Other carriers are joining them, even as a pandemic continues to ravage their policyholders with illness and, in some cases, death.
When the pandemic began a year ago, these same health insurance carriers voluntarily waived all deductibles, copays, and other costs because people who fell ill with Covid-19 had enough to deal with, what with hospitalizations, doctor visits, medications, and other treatments. Then, it was good public relations for these carriers to waive what they call "cost sharing."
"Cost sharing." What a polite way of saying "You caught Covid, now pay for it." What was put into place with great fanfare is now done in silence. Most if not all of these health insurance carriers are secretly ending their voluntary waivers of cost sharing, and many have already done so. What was good public relations in the sunshine, is taken back in the dark.
Except for Covid tests and vaccinations. They should still be free to people, because the federal government requires that these costs be free.
Some people think it's wrong to make a profit off of other people's misery. The insurance companies' profits are going through the roof since the pandemic began. They can afford to pay for Covid treatments; Covid patients, not so much.
Still think insurance is boring? Get Covid? Pay for the full treatment on top of being hospitalized and treated for Covid? People can EMail, write and telephone their own state's Insurance Commissioners. Let them know that you know what's going on in the dark, and let them know if you don't like it.
Let them and your federal Representatives and Senators know, too, if you want the federal government to require the costs of treatment to be paid by you or by your insurer, or if you want the costs of treatment for Covid to be treated (pun intended) like the costs of testing for Covid.
Image of Insurance Policy for Warwick, a Slave, courtesy of New York Public Library Rare Photograph Collection.
Another effect of taking the Affordable Care Act away is taking away one of the ACA's protections of Medicare. Since it was enacted in 2010, the Affordable Care Act has whittled away at the so-called "doughnut hole" for Medicare Part D premiums.
Medicare Part D has been notorious for a "coverage gap." After reaching a certain choke point or threshold, Medicare Part D required Medicare recipients to pay 100% of their drug costs from that point until they reached a second threshold where "low deductible, catastrophic coverage" would kick in. In other words, people on Medicare would pay low premiums for drug expenses, up to a point.
When that point was reached Medicare recipients became responsible for every penny of drug costs and you can only imagine how expensive that was for many people. The experience gave rise to many stories of cutting pills into smaller pieces, stretching supplies by taking your pills every other day or every third day, and similar workarounds. Then once the patients paid enough money to reach a second threshold, they qualified for catastrophic coverage which it turns out was well-named for more than one reason.
The Affordable Care Act changed all that by making the costs of prescription drugs even under Medicare Part D, well, affordable. If the ACA is taken away, affordability will go away too.
"(Of course, if the Supreme Court ends up striking down the Affordable Care Act, the hole will return.") See Paula Span, The New Old Age / A Medicare Part D Coverage Gap Closes (Mostly), NEW YORK TIMES, Tuesday, Jan. 21, 2020, at D3, available at https://www.nytimes.com/2020/01/17/health/medicare-drug-costs.html?searchResultPosition=1.
To summarize, there have been three judges in these lower federal Fifth Circuit cases who have held the ACA's individual mandate unconstitutional now. All three are members of the Federalist Society. In each case, the votes of all three accurately reflect the opinions of the Federalist Society.
One additional judge dissented. She is not a member of the Federalist Society and her opinion does not look like the opinions of the Federalist Society. The dissenting judge is Judge Carolyn Dineen King on the Fifth Circuit panel. Judge King pointed out the undeniable fact that the true legislative history of the ACA shows that Congress never amended or repealed the individual mandate provision. Congress did one thing only; it reduced the tax penalty for failure to comply with the mandate to zero dollars. Command without coercion is not unconstitutional in the eyes of the dissenting judge.
The effects of the lower federal Fifth Circuit rulings perhaps do not change the outcomes of their persuasive capacities if any. Regardless, the collective effects of these lower court decisions are a catastrophe causing uncertainty in healthcare and in every other area affected by the Affordable Care Act. The other areas affected by the ACA include financial, regulatory, and commercial planning. The introduction of uncertainty in these areas is a fact, not a contest.
State and local government agencies rely on billions of dollars in aid under the ACA each time they set their budgets. Government budget planning can take months and even years. Insurance companies too plan for years in advance based on the ACA. Carriers must decide far in advance of implementing their decisions of how and whether to ask for any changes in regulated health insurance premiums and health insurance markets.
The pending catastrophe also includes consumer and individual life-changing decisions such as whether to move, to change a job, to start a family, or to care for an aged parent. Without being able to rely on healthcare required by the ACA, individuals as well as businesses, and state and federal government agencies, face uncertainty whether their reliance on the ACA has been misplaced and the uncertainty of what if anything will replace the availability of healthcare insurance under the ACA.
In short, after the lower court decisions in the federal Fifth Circuit, all healthcare decisions will have to be made without knowing whether the ACA will ultimately be held valid by judges, or not. As Judge King put it in her dissenting opinion in the Fifth Circuit: "It is unlikely that Congress would want a statute on which millions of people rely for their healthcare and livelihoods to disappear overnight with the wave of a judicial wand." Put another way, "it is difficult to imagine that this is a matter Congress intended to turn over to the judiciary."
And now it's on to the U.S. Supreme Court once again, and let's see if they have the votes there to "repeal, defund, delay, or otherwise amend the ACA."
The two judges in the majority did not affirm the entire ruling all at once. They did not want the Supreme Court to decide the appeal during the 2020 election. See Sun Sentinel Editorial, Obamacare Ruling Deserves to Take Center Stage in Presidential Election, ORLANDO SENTINEL, Sat., Dec. 28, 2019, p. A10 (the Orlando Sentinel may charge you for online access).
The people in power who are against health care are a minority, including the 17 States that brought this case in a Texas court. They want to stay in power and they are happy to rely on judicial activism for that, just not yet so that they do not get blamed.
Talk about the tail wagging the dog. To the point of this particular decision, they will be happy to have the court delete health care entirely. Again, just not yet. "Make no mistake: [They] want the court to trash Obamacare, but not in time for the voters to hold it against them in November. And no matter the potentially drastic, even deadly, consequences for everyone who depends on its coverage. That's nearly everyone in America ...." Sun Sentinel Editorial, Obamacare Ruling Deserves to Take Center Stage in Presidential Election, ORLANDO SENTINEL, Sat., Dec. 28, 2019, p. A10 (again, online access may be charged by the Orlando Sentinel).
Now we can understand the Fifth Circuit panel's 2-to-1 decision to affirm one ruling and remand the case back for more of the same. The two judges are playing politics, simple as that really. Sometimes the answers that are right in front of our eyes are the hardest to see.
Best wishes, and hopes and prayers, for less judicial activism and better decisions by courts in 2020. Happy New Year!
On December 18, 2019 two judges of the Fifth Circuit Court of Appeals decided two things. First, they affirmed a lower court's announced decision to gut the Affordable Care Act's requirement to purchase health insurance, the so-called "individual mandate." Second, the two judges agreed to remand the case to the same judge to decide, as he already has, that the entire ACA should be gutted too.
In a stinging dissent, "textbook judicial overreach" was highlighted as the basis not only of the decision of two judges of a Fifth Circuit panel, but the entire basis of the underlying decision to gut the Affordable Care Act on December 18, 2019:
Limits on judicial power demand special respect in a case like this. For one thing, careless judicial interference has the potential to be especially pernicious when it involves a complex statute like the ACA, which carries such significant implications for the welfare of the economy and the American populace at large. For another, the legitimacy of the judicial branch as a countermajoritarian institution in an otherwise democratic system depends on its ability to operate with restraint—and especially so in a high-profile case such as the one at bar. The district court's opinion is textbook judicial overreach. The majority perpetuates that overreach and, in remanding, ensures that no end for this litigation is in sight.
Texas v. United States, ___ F.3d ___, No. 19-10011, 2019 WL 6888446, at *44 (5th Cir. December 18, 2019).
And so it continues. How much longer can this go on?
even if a "filed insurance rate doctrine" were to be recognized.
Aetna started it. Aetna sued Insys. Aetna alleged that Insys defrauded Aetna into reimbursing Insys and its officers for off-label prescriptions of a certain drug.
MSI tried to join the party. Specifically, MSI tried to intervene in Aetna's lawsuit against Insys. Its motion for leave to intervene was ultimately denied, but the Court's treatment of the filed rate doctrine raised by Aetna is worth noting.
MSI alleged that it is Aetna's insured, and that it, MSI, purchased healthcare coverage for its employees from Aetna. MSI alleged against Insys that Insys's alleged misconduct caused MSI to pay increased premiums, higher deductibles, and pay greater co-pays charged by Aetna than otherwise would have been the case without Insys's alleged misconduct.
Aetna did not want MSI at Aetna's party. Aetna opposed MSI's intervention in part by raising the filed rate doctrine. Aetna contended that its rates "are filed with and approved by the Pennsylvania Insurance Department," so that the Court did not have jurisdiction to adjudicate MSI's claims which challenged Aetna's filed insurance rates, Aetna contended.
This Court would have none of that. The Federal Judge ruled that "this doctrine is a defense to claims rather than a jurisdictional bar." Aetna Inc. v. Insys Therapeutics, Inc., 330 F.R.D. 427 (E.D. Pa. 2019) (pinpoint page numbers not available from Westlaw at the time of publication).
Simple as that. No ruling whether Pennsylvania would recognize a filed insurance rate doctrine or not, and no need to rule on that question. Instead, the filed rate doctrine as the Court recognized in this case is a defense on the merits, not a defense to jurisdiction.
A guest article by John K. DiMugno, Esquire, a California attorney, legal educator, and the author or coauthor of multiple legal treatises and legal periodicals published by Thomson Reuters.
William P. Barr, Attorney General of the United States, recently spoke at the American Law Institute’s Annual Meeting in Washington, D.C. The ALI likely extended the invitation shortly after Mr. Barr’s confirmation when there was hope that he would play a role similar to that of the departed General Mattis and General McMaster and place guardrails on the President’s more authoritarian instincts. By the time of the Annual Meeting, those hopes had evaporated. Mr. Barr’s dissembling about the contents of the Mueller Report raised serious concerns about the Attorney General’s complicity in administration efforts to undermine the rule of law.
This Blog highlighted the incongruity between Mr. Barr’s conduct in office and the core mission of the ALI. Notably, Mr. Wall’s post made no attempt to silence Mr. Barr, a solution that would have satisfied the wishes of many in the ALI who were rightfully appalled by Mr. Barr’s transparent attempt to mislead the American public. But barring Mr. Barr from speaking would have entangled the ALI in partisan politics, something the organization scrupulously avoids for good reason. Staying above the political fray insulates the ALI’s Restatements of the Law against charges of political bias and broadens their influence on courts and legislatures around the country.
Mr. Wall’s proposed solution—letting Mr. Barr speak while contributing the ALI’s earnings from the speech to legal aid societies around the country—perfectly balanced those competing concerns. It had the salutary effect of simultaneously benefitting public interest groups that desperately need the money while drawing attention to questions about Mr. Barr’s integrity.
Mr. Barr’s penchant for making transparently misleading and often contradictory statements has left some wondering what he hopes to achieve other than aggrandize power and influence in the Trump administration. Sharon LaFraniere, Charlie Savage and Katie Benner, People Are Trying to Figure Out William Barr. He’s Busy Stockpiling Power, New York Times on line, June 9, 2019.
He misled the American public about the contents of the Mueller Report knowing full well that when the report was released several weeks later his lies would be evident to everyone.
When Mr. Barr sought confirmation as Attorney General, he told the U.S. Senate that he had known Robert Mueller for years and did not believe that Mr. Mueller would engage in a “witch hunt.” Yet, shortly before his confirmation hearings, he sent a memo to the Justice Department characterizing the obstruction of justice charges against the President as “asinine” and sent an e-mail stating he saw far less reason to scrutinize the Trump campaign’s ties to Russia than to investigate whether donations to Hillary Clinton’s family foundation had influenced her actions as secretary of state. Once he was confirmed, he enabled the President’s attempts to distract from the contents of the Mueller Report by opening an investigation of those who investigated him.
When Mr. Barr was seeking confirmation, he told the U.S. Senate Judiciary Committee that he was willing to reconsider the Justice Department’s decision not to defend the Affordable Care Act (ACA). But, when he became Attorney General, he put the resources of the Justice Department behind litigation in Texas federal district court seeking to invalidate the entire Affordable Care Act.
As the song goes, “There’s something happening here. What it is ain’t exactly clear.” Buffalo Springfield, For What It’s Worth. I say let Mr. Barr speak. Listen closely to what he says and watch what he does. Only then will whatever is happening start to become clear.
Consumers have a right of action under Washington's Consumer Protection Act against their insurance carriers for breach of the duty of good faith and fair dealing, i.e., for insurer bad faith. This rule has been applied recently against a health insurance carrier accused of failing to deliver the insurance services for which it charged insurance premiums approved by the Washington State Office of the Insurance Commissioner.
In particular, the plaintiff-policyholder alleged that the defendants' "unfair or deceptive acts or practices in conducting its insurance business" consisted in pertinent part of failing to have in-network providers as represented, and failing to provide coverage represented by the defendants to be within the plan. Harvey v. Centene Mgt., Co. LLC, ___ F. Supp. 3d ___, No. 2:18-CV-00012-SMJ, 2018 U.S. Dist. LEXIS 198773, at *13-*14, 2018 WL 6112407, at *4 (E.D. Wash. Nov. 21, 2018).
Another agency of the current Federal Government is taking actions to dismantle consumer protections with a new Administrative State. This time it is the Centers for Medicare and Medicaid Services (CMS), located in the Department of Health and Human Services (HHS). They propose to substitute generic drugs for brand drugs when consumers fill their doctors' prescriptions. Their proposal was only posted on January 24, 2019 and, in a relatively short period for Comments, the deadline for leaving a Comment including in opposition to these new-Federal Government proposals, is Tuesday, February 19, 2019.
Here are the complete Comments I left on https://www.regulations.govon Sunday, February 17, 2019 in opposition to these particular proposals.
February 17, 2019
To: The Centers for Medicare and Medicaid Services (CMS),
Re: Proposed Changes to ACA Benefits and Payments Parameters for 2020.
CMS-9926-P
To CMS, HHS:
These Comments are regarding your proposed addition to Regulations in 45 CFR, new proposed §§ 147.106(e)(5) and 148.122(g)(5), and wherever else the same proposed changes discussed in these Comments may be found in your proposals. Your proposed new regulations §§ 147.106(e)(5) and 148.122(g)(5) are published in 84 F.R. at pp. 313-314.
You advise in 84 F.R. at p. 234 that your proposed new § 147.106(e)(5), for example, would allow issuers of drug plans in all three markets -- individual, small group, and large group -- to allow changes to a formulary. (Although you do not define the term in your proposals, I understand from general usage by CMS/HHS that "formulary" in this context means a list of prescription drugs covered by a plan, a/k/a a drug list.)
The new additions you propose to existing law would be to allow issuers of plans covering prescription drugs to remove the equivalent of brand drugs from the formulary, i.e., from the plan of prescription drugs that are covered by the issuer. See, e.g., 84 F.R. at 234.
There are at least three obstacles to implementing these proposed new regulations as law. The three I would like to address in these Comments are (1) that the proposed new regulations are not a reasonable approach to the availability of prescription drugs to consumers who pay for prescription drug plans, or formularies; (2) that the proposed new regulations are a windfall to the issuers of plans covering prescription drugs, at the expense of consumer choice, and (3) that the term, "generic equivalent," is new and undefined, without so much as a reference I can find to the Federal Food and Drug Administration's process of testing and approving generic drugs for use by consumers.
First, the proposed new regulations are not a reasonable approach to the availability of prescription drugs to consumers who pay for prescription drug plans, or formularies. The goal of adding generic medical equivalents to prescription drug plans, or drug lists, could reasonably be accomplished without mentioning the removal of brand drugs from the formulary at all.
The real effect of proposed new regulations like §§ 147.106(e)(5) and 148.122(g)(5) is not to permit the addition of generic equivalent drugs to an issuer's list of covered drugs, but rather to permit the issuer to remove brand drugs from the issuer's list.
That in itself is an unreasonable change to the law and, moreover, it is not authorized by the enabling Congressional legislation in the first place. The clear purpose of the enabling statute was to foster consumer choice, not to limit consumer options, especially when it comes to prescription drugs.
That ties in to the second objection addressed in these Comments. The proposed new regulations, such as for example §§ 147.106(e)(5) and 148.122(g)(5), are an undeserved windfall for the makers of generic drugs, and at the expense of consumer choice. Lists of covered drugs are of course lists contained in plans for coverage of drugs. These plans are paid for by consumers in whole or in part including by the payment of deductibles and co-pays, and often paid for as well by a share of the premiums charged for coverage under these plans. Consumers have paid for the right to have their physicians and medicalcare providers prescribe drugs and to fill these prescriptions with brand drugs at the option or choice of the consumer, and not by the choice either of the pharmaceutical manufacturer or the issuer. For this reason as well, the proposed new regulations, including §§ 147.106(e)(5) and 148.122(g)(5), should not and cannot be adopted.
The third and final objection to proposed new regulations §§ 147.106(e)(5) and 148.122(g)(5) which will be addressed in these Comments is the undefined use of the phrase, "generic equivalent." This phrase is found in the proposed new authority to be conferred upon issuers to "add a generic equivalent to a formulary[.]" See, e.g., proposed new regulation § 147.106(e)(5), 84 F.R. at p. 314, and proposed new regulation § 148.122(g)(5), also in 84 F.R. at p. 314.
The phrase used in this new proposed regulation is not limited to "medically equivalent." (Emphasis added.) Nor is it limited by reference, so far as I can find, to FDA-generic-approved medicines. Without such limitations, the proposed new authority to replace brand drugs on drug lists with "a generic equivalent" is overly broad and so it is meaningless. It would, for example, allow issuers and generic drug manufacturers to buy their way onto drug lists to add drugs that their own proprietary 'research' and support has 'determined' to be "a generic equivalent," without limitation to generic medicines already approved by the FDA. For this reason as well, the proposed new regulations, including §§ 147.106(e)(5) and 148.122(g)(5), provide no limiting guidelines and so are void and of no effect. They cannot validly be promulgated.
For each and all of these reasons, whether taken separately or together, the proposed new regulations, including §§ 147.106(e)(5) and 148.122(g)(5), cannot validly be promulgated as administrative regulations and, moreover, they are void and of no effect as new law.
In Washington State as elsewhere, the filed rate doctrine is a defense under certain circumstances. In basic and general terms as laid out by a federal court in the case of Harvey v. Centene Mgt. Co. LLC, No. 2:18-CV-00012-SMJ, 2018 WL 6112407, at *5 n.1 (E.D. Wash. Nov. 21, 2018), it is Washington State law that the "filed rate doctrine" was made by courts to cover cases involving regulated utilities. The effect is to shelter the appropriately filed rate from attack, whether directly or indirectly. In other words, the reasonableness of a rate filed with a governing regulatory administrative agency and approved by that agency is a settled issue, not subject to dispute.
The Harvey case is an insurancecase. Specifically, that case involves health insurance policies.
In the Harvey case, the plaintiff alleged that the defendants breached contracts and violated Washington's Unfair Business Practices and Consumer Protection Statutes by failing to deliver the benefits of their "Ambetter health insurance policy" which they allegedly promised and represented that they would deliver. The plaintiff alleged these claims on behalf of a putative class of Ambetter policyholders. Harvey v. Centene Mgt. Co. LLC, No. 2:18-CV-00012-SMJ, 2018 WL 6112407, at *1 (E.D. Wash. Nov. 21, 2018).
In part here pertinent, the federal judge in Washington held in accordance with the concisely phrased headings of his rulings that "1. The filed rate doctrine does not apply to claims that are merely incidental to and do not directly attack Insurance Commissioner-approved health insurance premiums," Harvey v. Centene Mgt. Co. LLC, No. 2:18-CV-00012-SMJ, 2018 WL 6112407, at *5 (E.D. Wash. Nov. 21, 2018), and "2. Harvey's claims are merely incidental to and do not directly attack Insurance Commissioner-approved health insurance premiums." Harvey v. Centene Mgt. Co. LLC, No. 2:18-CV-00012-SMJ, 2018 WL 6112407, at *6 (E.D. Wash. Nov. 21, 2018). In short, claims based on allegations that the defendants did not deliver the insurance benefits they sold were not barred by the filed rate doctrine.
Even if the Court had not been completely convinced of this ruling, the Court went further in Harvey and stated that this decision was based on a motion to dismiss and "'the better practice'" in any case is to address the filed rate doctrine either on a motion or motions for summary judgment, or at trial. Harvey v. Centene Mgt. Co. LLC, No. 2:18-CV-00012-SMJ, 2018 WL 6112407, at *7 (E.D. Wash. Nov. 21, 2018).
Rick Scott is one of many politicians who spent millions of their own dollars to get elected only to claim "fraud" when maybe they did not win the election.
And if they do win the election, it's not "fraud" any more if you pay attention to them.
"States urgently need to change their regulations to limit hospital prices for out-of-network emergency care." This is the conclusion of an informative op-ed in the New York Times by a researcher at the Schaefer Center for Health Policy and Economics and professor of public policy at U.S.C. Glenn Melnick, "Limit Hospitals' Pricing Tower" p.A23 (New York Times, Monday, September 10, 2018).
Here's why.
The statistics he relates come from California's experience with hospital charges for mandated emergency room care:
Between 2002 to 2016, total charges billed by hospitals apparently just for emergency room care rose to $386 Billion. This was an increase of an additional $263 Billion.
There was no increase in the number of patients admitted to hospitals during that time. The number of patients remained the same. Only the charges increased.
Hospitals charged your health insurance plans -- which most States mandate to cover emergency room visits regardless of whether they are in your network or not. During that period we mentioned above, between 2002 to 2016, the charges billed to health insurance plans "grew from $6,900 per day to over $19,500 per day." Recall that there was no increase in the number of patients during that time, only in the charges billed by hospitals during that time.
"Capping billed charges at 125 percent of contracted prices would keep hospitals from exploiting their E.R. advantage." Reportedly Maryland is trying this approach.
Solutions are certainly welcome, and not just in Maryland or California. These increased health insurance charges are paid by increased health insurance premiums. The idea that it is not necessary for people to have health insurance coverage that covers their health, because everyone can go to an emergency room without consequences, is not reality. It isn't even true.
Is your attention focused on the tax cuts for everybody but you? Don't miss this.
This week the leadership of the United States Senate pulled a bait and switch. Or you can say that they pulled a fast one. They lost straight up on repealing Health Care on what seems like about half a dozen votes.
What they have done now is insert a provision into a tax bill which will effectively repeal healthcare for 13 Million people in the United States. So says the Congressional Budget Office. That is the CBO's best estimate of how many people will have their healthcare taken away in order to fund the tax cuts in the bill for a couple of dozen people.
This was literally done in the dark, apparently. The Senate leadership introduced this new back-door repeal legislation in the night.
The difference between the 13 Million people on the one hand, and the couple of dozen people at most on the other hand? The couple of dozen people on the other hand have more money than all of the 13 Million people put together.
And they spend it. On the politicians who are proposing this travesty.
But they do not spend their money on the economy and they obviously do not spend their money on taxes. Instead, other people pay the taxes they do not pay. If the other people do not make up the difference, then the other people go without.
Sometimes, like the case of the bill secretly slipped into the mix by the Senate leadership, even if the other people pay their taxes they can still end up going without. In this case, that means going without health insurance that covers anything. To say again, this affects more or less 13 Million people.
Call your Members of Congress, Representatives and Senators, and let them know if you support or if you oppose the substance of this plan, and let them know too if you support or if you oppose the deceitful way it is being attempted.
If you or your clients do not have health insurance coverage, check out and sign up at www.healthcare.gov.
You may not have heard the word that health care coverage is available -- right now, today, even as you read these words. It's your right. It's the law of the land!
The current federal government decided not to spend money appropriated by Congress for advertising upcoming deadlines to sign up for Healthcare, and to remind people how to apply for coverage on the exchanges (and eligible for tax credits for their premium payments). Failing a change of federal government direction, "a consortium of insurers offering plans on the exchanges should come up with advertising of its own." "Further, TV and radio stations should offer public service announcements" or PSA's, it has been suggested, to remind people of the November 1 - December 15 enrollment period. SeeEditorial, "Predictions of Obamacare's Demise Fail Again" (posted in the Boston Globe online on Sunday, August 27, 2017).
There really shouldn't be secrecy about signing up for health insurance coverage. The need for healthcare will not go away just because some people ignore it.
It is too much to hope, perhaps, that the current federal government will do anything much to help those who need health insurance. If that proves to be the case, perhaps the private sector will.
Did you see the pictures of disabled people in wheelchairs being arrested in the halls of the Capitol and handcuffed by the Capitol Police because in the eyes of the police the wheelchair people were threats to the public safety?
They were in the halls of the Capitol to highlight the fact that they received Medicaid benefits, probably public benefits from SSI but perhaps insurance from the Social Security Disability Insurance Program. In any case, Medicaid makes their lives possible.
The aim of these disabled people was to make more and more other people aware that Medicaid is not just for poor people. Medicaid supports the lives of many more people who are disabled, than there are people who receive Medicaid because they are poor. Here is a very good summary of how Medicaid helps disabled people even though they are not poor people, perhaps contrary to some wrong perceptions: Abby Goodnough, "For Millions, Life Without Medicaid Services is No Option" (New York Times Online, posted on Saturday, July 1, 2017).
This all came to the forefront because the Trumpcare bill introduced in the U.S. Senate by Senator Mitch McConnell, the senior from Kentucky and the Republican leader in the Senate, cut the guts out of Medicare. This was part of a supposed effort to address the "repeal and replace" of the Affordable Care Act which gutting Medicaid will not fix in any case.
If it comes to that, what does taking money away from disabled people to make their lives miserable have to do with healthcare?
PART ONE: Insurance Class Action Secrecy REVERSED. Hang on; this may be only a part of the story of this decision, but it is a LONG part. We'll discuss the background of this case first.
The background.
Blue Cross Blue Shield of Michigan is a huge player in health insurance plans in Michigan. With over 60% of the market, it can help many people. Or it can allegedly fix prices.
By 2007, or so the United States Department of Justice alleged in a complaint, Blue Cross initiated a "price-fixing scheme." Blue Cross insisted on either one of two kinds of agreements with Michigan hospitals. One was an "MFN" agreement, in which "Blue Cross agreed to raise its own reimbursement rates for each hospital's services, so long as the hospital agreed to charge other commercial health insurers rates at least as high as the hospital charged Blue Cross."
The other was an "MFN-plus agreement." Under that second kind of agreement, "Blue Cross agreed to pay higher rates to each hospital so long as the hospital agreed to charge even higher rates -- up to 40% higher, according to DOJ's complaint -- to other commercial health-insurers."
Blue Cross's two plans brought results. "Few if any of the hospital systems in Michigan can afford to turn away an insurer that brings with it more than half of the privately insured patients in Michigan." Shane Grp., Inc. v. Blue Cross Blue Shield of Mich., Nos. 15-1544/1551/1552, ___ F.3d ___, 2016 WL 3163073, at *1 (6th Cir. June 7, 2016).
DOJ's lawsuit soon attracted class action lawsuits filed on behalf of individuals who alleged that they and their putative classes of Michigan hospital patients were damaged by the increased fees which Blue Cross allegedly caused Michigan hospitals to charge for medical services. "Thus, the effect of Blue Cross's market power was not to lower its customers' rates, as typically advertised. Instead the effect was to raise them, for Blue Cross's customers and everyone else -- while preserving or expanding Blue Cross's market share." Shane Grp., Inc. v. Blue Cross Blue Shield of Mich., Nos. 15-1544/1551/1552, ___ F.3d ___, 2016 WL 3163073, at *1 (6th Cir. June 7, 2016).
The consolidated class action lawsuits ultimately resulted in secrecy agreements which were confirmed by secrecy orders, and an overall order approving a health insurance class action settlement.
This article is in two parts. This first part addresses the secrecy orders in this case which the Sixth Circuit reversed. The second part will address the Sixth Circuit's rejection and remand of the lower court's order approving the insurance class action settlement.
Part 1. The Secrecy of the Health Insurance Class Action Settlement.
Plaintiffs' class counsel attached 90 exhibits to their motion for class certification. All of it was filed in the Court file under seal.
Blue Cross attached 42 exhibits to its brief opposing the class action certification. All of these too were filed in the Court file under seal.
Later, Blue Cross filed a motion to exclude the plaintiffs' class action expert's "report and testimony, attaching his report and 34 other exhibits." All of these materials were also filed under seal. Parenthetically, the settlement provided that the expert would be paid $2 Million from the class action settlement for his sealed report. Shane Grp., Inc. v. Blue Cross Blue Shield of Mich., Nos. 15-1544/1551/1552, ___ F.3d ___, 2016 WL 3163073, at *4 (6th Cir. June 7, 2016).
Ultimately, the parties requested that the District Court seal certain pleadings plus 194 exhibits in the Court file, and the District Court entered the requested sealing orders during the course of approving the parties' proffered settlement.
Objectors who were not class members argued that their lack of access to the Court record, particularly to the record of materials upon which the class action plaintiffs settled with Blue Cross, deprived them of the ability to evaluate the settlement. A "group of 26 self-insured businesses with health plans administered by Blue Cross (a group we call the 'Varnum Group') also sought to unseal the court record by means of a motion to intervene for that limited purpose." The district court approved the proposed settlement and the secrecy of the sealed materials, and denied the motion to intervene. Shane Grp., Inc. v. Blue Cross Blue Shield of Mich., Nos. 15-1544/1551/1552, ___ F.3d ___, 2016 WL 3163073, at *3 (6th Cir. June 7, 2016).
The Sixth Circuit reversed the trial court's secrecy rulings. To the contrary, the Sixth Circuit held that the District Court "abused its discretion when, at the parties' behest, it sealed from public view most of the court filings and exhibits that underlay the proposed settlement in this case." Shane Grp., Inc. v. Blue Cross Blue Shield of Mich., Nos. 15-1544/1551/1552, ___ F.3d ___, 2016 WL 3163073, at *3 (6th Cir. June 7, 2016).
Without necessarily ruling on any of the secrecy stipulations and secrecy orders entered with regard to discovery in this case, the Sixth Circuit pointedly noted that there is a great difference between discovery protective orders, and orders to seal court records entered upon adjudication. Unlike "a mere protective order [which] restricts access to discovery materials," an order adjudicating the case and sealing materials in the Court file affects the public interest. Shane Grp., Inc. v. Blue Cross Blue Shield of Mich., Nos. 15-1544/1551/1552, ___ F.3d ___, 2016 WL 3163073, at *5 (6th Cir. June 7, 2016). There is in other words a presumption against sealing Court files and in favor of public disclosure because keeping Court files open to the public is infected with a public interest.
In the "adjudicative" stage, the public's strong interest is in having access to the Court record. "That interest rests on several grounds," said the Sixth Circuit, and none was addressed either the parties or by the trial court in this case. The grounds for the public's interest, said the Sixth Circuit, are:
The litigation's result;
The "conduct giving rise to the case," and
"[I]n any of these cases, the public is entitled to assess for itself the merits of judicial decisions."
Shane Grp., Inc. v. Blue Cross Blue Shield of Mich., Nos. 15-1544/1551/1552, ___ F.3d ___, 2016 WL 3163073, at *3 (6th Cir. June 7, 2016) (emphasis added).
Further, "[t]he burden of overcoming that presumption [of openness as to Court records] is borne by the party that seeks to seal them." This requires only the most compelling reasons. Further, those reasons must be articulated "'in detail, document by document,'" with legal citations. Shane Grp., Inc. v. Blue Cross Blue Shield of Mich., Nos. 15-1544/1551/1552, ___ F.3d ___, 2016 WL 3163073, at *3 (6th Cir. June 7, 2016). The parties all sought to seal the Court records in this case. None of the parties met their burdens.
Nor did the District Court meet its own duties before it entered orders sealing materials in the Court file in the course of approving the parties' class action settlement. Before a District Court can properly enter such orders, it must set forth its "specific findings and conclusions," regardless of whether any party objects to the sealing. A District Court's failure to set forth its detailed reasons for sealing the Court file before it enters its orders sealing the Court file "is itself grounds to vacate an order to seal." Shane Grp., Inc. v. Blue Cross Blue Shield of Mich., Nos. 15-1544/1551/1552, ___ F.3d ___, 2016 WL 3163073, at *4 (6th Cir. June 7, 2016).
As noted, the Sixth Circuit reversed the District Court's sealing orders which the District Court entered during the course of its order adjudicating the class action settlement with approval. However, the Sixth Circuit did not base its holding simply on the lower court's failure to state its detailed reasons for sealing. The Sixth Circuit examined the record. It noted that among other materials in the Court file which the District Court sealed from public view were "the Plaintiffs' Amended Complaint, the Plaintiffs' Motion for Class Certification and Blue Cross's Response," and a total of 194 exhibits. Shane Grp., Inc. v. Blue Cross Blue Shield of Mich., Nos. 15-1544/1551/1552, ___ F.3d ___, 2016 WL 3163073, at *4 (6th Cir. June 7, 2016). The District Court accepted the bases for sealing these materials which the parties put before the Court, reasons which "were brief, perfunctory, and patently inadequate." According to the Sixth Circuit, the parties and the District Court in this case "conflated" discovery protective orders with sealing a Court file as a part of a Court's adjudication of the case. The class plaintiffs, for example, asserted that sealing was proper simply because Blue Cross or a third party designated the materials as confidential.
This in short is not a proper standard for sealing a Court file when a case is adjudicated. Whether or not parties can properly designate anything and everything "confidential" during discovery does not have any bearing when a case is adjudicated. Parties do not get to seal the Court file simply because they wish it so:
One can only conclude that everyone in the district court was mistaken as to which standard to apply. But one point is unmistakable: on the showings set forth in this record, every document that was sealed in the district court was sealed improperly.
Shane Grp., Inc. v. Blue Cross Blue Shield of Mich., Nos. 15-1544/1551/1552, ___ F.3d ___, 2016 WL 3163073, at *4 (6th Cir. June 7, 2016).
The Sixth Circuit accordingly reversed and told the parties and the District Judge to do it again if they wanted to seal the Court file again in this insurance class action case. It is well worth noting that although this case involves a health insurance class action settlement, the supposed justifications advanced by counsel and accepted by the trial Court are often found in many other types of insurance -- and other -- class action lawsuits.
Lawyers who meet more poor people than health insurers during their careers point out in the article that poor people are not generally aware enough of the Affordable Care Act to try to figure out ways to game it.
I understand that the health insurance companies helped to write the law.
In any case, we are left to wonder I suppose what complaint in 2016 these same health insurance companies would have, if the costs of providing health insurance were the same as they are now because all of the people signing up during the extension actually signed up before the original deadline?
Objecting to an extension reminds me of the occasions during litigation when a few lawyers were known to habitually complain about opposing counsel receiving an extension on a deadline in a court case. These same lawyers would often ask for an extension for themselves and their clients without blushing.
First, here are the prices charged by pharmaceutical companies for three examples, and the illnesses the drugs in these examples are prescribed to treat:
Kalydecon, Three Hundred Thousand Dollars a year ($300,000.00/year), prescribed in the treatment of cystic fibrosis;
Revlimid, One Hundred-Fifty Thousand Dollars per year ($150,000.00/year), prescribed for cancer; and our third example,
Various drugs prescribed to treat multiple sclerosis, which are reported in the article to draw about $10,000.00 per year in the late 1990s and “more than $60,000 now”.
The pharmaceutical companies deny that they are charging what they can get away with. They justify these eye-popping prices by claiming that the high prices pay for research and development, but when demands are made to see the costs of research and development, the pharmaceutical companies reply that the costs of research and development are basically irrelevant. The pharmaceutical companies are apparently oblivious to the fact that the prices they charge and the reasons they give for their high prices are so obviously distorted that they all but demand questions.
The pharmaceutical companies may have a right to charge high prices, if we let them, but they have no right to call their gouging good for us.
And where champerty and maintenance have gone to die.
The latest challenge to the Affordable Care Act a/k/a Obamacare seems to be coming apart at the seams. Some or all of the named plaintiffs in this suit, which is filed as a class action, seem to lack standing to sue because they will suffer no harm from the law they challenge. See, e.g., the article posted here on Lincoln's Birthday, "SUPREME COURT LATEST OBJECTORS TO OBAMACARE SUE WITHOUT STANDING ... Because they can. For some reason known only to them, their handlers, and others in their orbit."
Without being damaged by Obamacare, the named plaintiffs would lack more than their own individual standing to sue. Each one of them is supposed to be representative of the class of persons who are damaged by Obamacare. They filed their lawsuit as a class action. It is axiomatic, as they say, that in order to be a class representative, a plaintiff in a class action must share the significant characteristics of the alleged class. Perhaps the most significant of these is shared harm. If these people do not share the harm alleged to the class, they have no previously recognized right to represent the class.
These things are recognized immediately by lawyers, of course. Except, it seems, for lawyers employed by the Obama administration. "While the Obama administration hasn't said whether it will pursue a new challenge to the case based on the latest information, several legal experts said it would be a strong strategy." Sarah Ferris, "O-Care Fans: SCOTUS Case 'Unraveling'" posted by The Hill on Friday, February 13, 2015.
There is another issue lurking in the back of the minds of lawyers of a certain age. Perhaps these minds include the minds of lawyers involved in the latest lawsuit. While this issue may not justify a legal ruling in this instance, it may subconsciously affect not only the credibility of the plaintiffs, but also the credibility of the case itself. This particular issue exists separately but in tandem with the likely-to-prevail-but-only-if-they-are-raised-arguments surrounding standing and adequate class representation.
Wikipedia sets out commonly accepted definitions of "champerty" and "maintenance" as follows:
Champerty and maintenance are doctrines in common lawjurisdictions, that aim to preclude frivolous litigation. "Maintenance" is the intermeddling of a disinterested party to encourage a lawsuit. It is "A taking in hand, a bearing up or upholding of quarrels or sides, to the disturbance of the common right." "Champerty" is the "maintenance" of a person in a lawsuit on condition that the subject matter of the action is to be shared with the maintainer. Among laypersons, this is known as "buying into someone else's lawsuit."
"Champerty and Maintenance," Wikipedia. It is widely reported that the plaintiffs were recruited for the latest litigious attack on Obamacare: "A problem with standing could be trouble for the plaintiffs and the conservative groups leading the lawsuit," including the one funding it. Sarah Ferris, The Hill, supra.
In order to reach the "merits" of the pending case, let alone decide the case, the Supreme Court is going to have to ignore a lot of reality.
Please Read The Disclaimer. Copyright 2015 by Dennis J. Wall. All rights reserved.
I wish I had known it was that easy to allege standing. I would never have wasted a minute arguing against allowing people to sue who lack all standing to sue when they have not been harmed. The fact that the lawsuit filed in the name of these particular people has gotten all the way to the Supreme Court may definitely assist in predicting the outcome.
This standing business might be worth a further look.
Please Read The Disclaimer. Copyright 2015 by Dennis J. Wall. All rights reserved.
You may have noticed the recent television and radio advertisements for cancer treatments, oncologists, and cancer centers which offer both treatments and physicians.
Pegged to consumers, meaning in this case pegged to victims of cancer, the ads began playing very recently. Their obvious purpose it to persuade consumersto influence their doctors who make the medical decisions where cancer patients get treatment and what treatments they get.
And thereby to persuade their health insurers to pay for it once the primary treating physician makes the referral.
This campaign is similar to the familiar "erectile dysfunction" TV and radio ad campaign that has gone on for awhile. The goal is the same in both ad campaigns: to persuade consumers in each case to influence their doctors about medical decisions which can bring huge income to the sellers.
Maybe we can expect to hear this catchy marketing disclaimer (it could happen):
If you have a cancer lasting more than 4 hours, see your doctor.
Please Read The Disclaimer. Copyright 2014 by Dennis J. Wall. All rights reserved.
The concept of a corporation as a person may have started as an economic theory. The concept of the corporation as a person is now being translated into the different languages of law and political theory. See Binyamin Appelbaum, "They're Not Like You and Me," p. 14, Sunday New York Times Magazine, Sunday, July 27, 2014.
According to the cited article, the idea that a corporation should be treated as a person in particular ways, includes the idea that if you or I encounter the corporation and do not like the experience, we can go elsewhere. There is a problem with that idea. It is pretty accurate from one economic perspective, but it does not translate well into discussions of constitutional rights.
When we are a purchaser, we certainly can take our money and go down the street to someplace else. When we are a seller and the corporation is the purchaser, however, it is the corporation that decides that it does not need to purchase what we are selling, and the corporation that can take its money and go elsewhere.
When we are employees,we are sellers of our labor and not purchasers. The prospective employer like Hobby Lobby is the purchaser in that situation. If we do not like the exemptions they claim from providing benefits, it is meaningless to say that we can take our labor elsewhere -- particularly if the only other prospective purchasers of our labor, if the only other prospective employers available to us, claim the same exemptions from providing benefits.
So, whoever thought that anyone would say that corporations have faith? That corporations got religion as it were? Or that anyone would hear that good faith and fair dealing would require an exemption from providing insurance benefits to laborers?
QUESTION: My wife wonders whether Hobby Lobby and other employers pay for group health plans that cover drugs for men which can cause side effects that, if they last longer than four hours, the man should see a doctor? But they do not pay insurance premiums for contraceptive coverage? I wonder, too. I'll bet you do, too.
Please Read The Disclaimer. Copyright 2014 by Dennis J. Wall. No claim to original U.S. Government works.
They blame Obamacare. See id. There are a couple of problems with this line. For one thing, the Affordable Care Act a/k/a "Obamacare" does not require employers to provide health insurance to part-time workers.
Further, blaming Obama for healthcare premiums is misplaced. The trend toward cutting health insurance benefits for part-time employees began sometime around 2007. George W. Bush, not Barack Obama, was President. Obamacare was not even thought of and it was not enacted into law until 3 years later.
So, do you think that these employers will give any part of the money back by paying higher wages?
TODAY IS EARTH DAY. LEAVE A COMMENT!
Today is the 54th anniversary of Earth Day! Honor Earth Day by telling your country about changes in your Health Care in 2024!
Uncle Sam has a Request For Information (RFI), your information. The RFI is only 12 pages long, which is not too long for Uncle Sam who can be very wordy as we all know. Click on the blue underlined Request For Information to read all 12 pages of it.
THEN UNCLE SAM WANTS TO HEAR FROM YOU!
Tell the U.S. Department of Justice, and the U.S. Department of Health and Human Services, and the Federal Trade Commission! You can send your comments to them by U.S. Mail, or you can leave your comments online at www.regulations.gov. Put the Docket Number ATR 102 on your comments, and send them in before May 6, 2024. That's it!
Except to remember this, as Uncle Sam put it:
Privacy Note: The agencies’ general policy is to make all comments received from members of the public available for public viewing in their entirety on the Federal eRulemaking Portal at www.regulations.gov. Therefore, commenters should be careful to include in their comments only information that they wish to make publicly available.
Please read the disclaimer. ©2024 Dennis J. Wall. All rights reserved.
Posted by Dennis Wall on April 22, 2024 at 06:36 AM in Comments to Proposed Rules Changes, Health Insurance | Permalink | Comments (0)
Tags: #AntitrustDivision, #AntitrustLaw, #DepartmentOfJustice, #FederalTradeCommission, #HealthCare, #HHS, #RequestForInformation