Assisted in Advice and Counseling in DOL Audits

The Departments of Labor (DOL), Health and Human Services, and the Treasury (together, the “tri-agencies”) have made a significant investment in enforcing mental health parity laws through investigations and audits of insurance plans’ parity practices.

The investigation process involves reviewing an insurance plan’s mental health parity documentation and, if warranted, conducting an audit to further investigate a plan’s parity practices to uncover potential parity violations. The DOL audit and investigation process typically entails an initial request for parity documentation, a chance for the plan to resubmit its parity documentation after initial questions or concerns of insufficiencies are raised by the DOL, an initial determination of noncompliance by the DOL if deficiencies continue, a corrective action plan submitted by the insurance provider to correct deficiencies, and a final finding of noncompliance if the corrective action plan fails to ameliorate deficiencies.

Epstein Becker Green (EBG) has been providing advice to its health plan clients who have undergone audits and investigations led by the DOL.

For example, a Nevada-based health insurance provider received a request from the DOL to review its mental health parity documentation, including its non-quantitative treatment analyses (NQTLs). Upon review, the DOL cited multiple potential issues and asked the plan to resubmit its NQTL documentation. The DOL then issued an initial determination of noncompliance, which requires plans to correct any deficiencies cited by the DOL and create a corrective action plan to address potential parity issues. EBG advises the Nevada health plan on strategies for responding to the DOL, defending the plan’s parity practices to demonstrate compliance, and remedying or explaining any potential differences in the provision of the plan’s behavioral health services.

Our attorneys provide strategic advice and oversee all necessary steps in a DOL investigation or audit, including the initial submission of parity materials to regulators, response to inquiries from DOL, creation of a corrective action plan, and advocacy for demonstrating a plan’s parity-compliant practices in the face of allegations of noncompliance. EBG’s advocacy for this Nevada health plan has led to successful conversations with DOL, and despite DOL’s initial concerns with the plan’s parity practices, DOL did not issue a final determination of noncompliance due to EBG’s advocacy on behalf of its client. We are pleased to be playing a role in providing positive outcomes for our clients undergoing mental health parity audits and investigations, especially given the highly active enforcement focus the tri-agencies have demonstrated in the mental health parity space.

Results may vary depending on your particular facts and legal circumstances.