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What is Shannon Wiley looking forward to at this year's Asembia Specialty Pharmacy Summit? Find out more>


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Primary Care Providers Win Challenge of CMS Interpretation of Enhanced Payment Law

With the help and support of the Tennessee Medical Association, 21 Tennessee physicians of underserved communities joined together and retained Bass, Berry & Sims to file suit against the Centers for Medicare & Medicaid Services to stop improper collection efforts. Our team, led by David King, was successful in halting efforts to recoup TennCare payments that were used legitimately to expand services in communities that needed them. Read more

Tennessee Medical Association & Bass, Berry & Sims

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Download the Healthcare Fraud & Abuse Review 2017, authored by Bass, Berry & Sims

The Healthcare Fraud & Abuse Review 2017 details all healthcare-related False Claims Act settlements from last year, organized by particular sectors of the healthcare industry. In addition to reviewing all healthcare fraud-related settlements, the Review includes updates on enforcement-related litigation involving the Stark Law and Anti-Kickback Statute, and looks at the continued implications from the government's focus on enforcement efforts involving individual actors in connection with civil and criminal healthcare fraud investigations.

Click here to download the Review.

Reminder - Annual Deadline to Report and Pay PCORI Fee is Rapidly Approaching

Firm Publication


July 18, 2016

The annual filing (and fee payment) for applicable self-insured health plans and specified health insurance policies used to fund the Patient-Centered Outcomes Research Institute (the PCORI fee) is due by August 1, 2016. Internal Revenue Service (IRS) Form 720, Quarterly Federal Excise Tax Return, on which the PCORI fee is required to be reported (in Part II, IRS No. 133), typically is due by July 31 of each year; however, because that date falls on a Sunday this year, the Form 720 deadline falls on August 1 this year. 

The filing rules have not changed, although the applicable rate has increased to $2.17 per covered life.

For an insured plan, the filing obligation falls on the insurer. However, for an "applicable self-insured health plan," the filing obligation lies with the plan sponsor. Applicable self-insured health plans include self-insured major medical coverage and health reimbursement arrangements (HRAs) for both employees and retirees, but do not include "excepted benefits" (e.g., most health flexible spending arrangements (health FSAs), standalone dental or vision plans, certain employee assistance programs (EAPs) that do not provide significant benefits in the nature medical care, etc.). The IRS provides a helpful chart to help identify the plans to which the PCORI fee applies.

The PCORI fee is currently calculated at $2.17 times the average number of lives covered for the plan year (determined using one of the IRS's prescribed counting methods). However, for a plan year ending before October 1, 2015, the prior year's PCORI fee rate of $2.08 will apply on this filing (and will increase to $2.17 on next year's filing).

For example, for an employer that in 2015 sponsored an insured major medical plan (operated on a calendar year plan year) that was integrated with an HRA, the insurer will have the filing obligation with respect to the average number of lives covered by major medical in 2015 (times $2.17) for the insured the major medical, but the employer will also have a filing obligation with respect to the average number of lives covered by the HRA in 2015 (times $2.17), and both such filings are due August 1, 2016.

If the same employer in 2015 instead sponsored a self-insured major medical plan that was integrated with an HRA, that employer could generally treat the medical plan and HRA as a single applicable self-insured health plan for the purpose of counting the average number of covered lives (times $2.17, to determine the fee), and that filing is due August 1, 2016.

The Instructions to the Form 720 are available here, and the IRS website has a page dedicated to the PCORI fee, here.

If you have questions regarding the information in this reminder, please contact any of the attorneys in our Employee Benefits Practice Group.

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