What to look for in the Supreme Court decision in King v. Burwell

US Supreme Court building

Posted by Anne Phelps, Principal, US Health Care Regulatory Leader on May 27, 2015.

In June 2015, the Supreme Court is expected to issue a ruling in King v. Burwell, a case that challenges an important coverage provision of the Affordable Care Act (ACA). The ACA makes federal tax credits available to certain individuals to help them offset their premiums when they purchase health coverage on an insurance Exchange established by a state. If the state does not elect to establish an Exchange, the ACA charges the Secretary of Health and Human Services with establishing and operating one within the state. To date, 34 states have elected not to run insurance Exchanges of their own and have fallen back to the federal government. The Department of the Treasury, through a regulation issued by the Internal Revenue Service, has made the federal tax credits available to individuals who purchase health insurance on both state-run and federally-facilitated Exchanges.

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The next frontier in managing risks


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Disruptive innovations can arrive at any time, from any direction. They have the potential to unravel the assumptions that make your business viable. But for the companies that keep an eye on the horizon, disruptions also carry the seeds of opportunity.

Instead of fearing the next disruption, what if you were poised to exploit it? The telephone, the computer, overnight delivery – in each case, someone was first to embrace the implications. What is the “next next” thing, and how will you respond?

In a new column for Best’s Review, Deloitte LLP Global Insurance Regulatory Leader Howard Mills defines a new evolution in the race against risk.
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Proposal to apply fiduciary standards to retirement advice could have a far-reaching impact on financial services


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On April 20, 2015, the Department of Labor (“DOL”) proposed regulatory changes that could have a widespread impact on the financial services industry. The amended rules are designed to protect the public from questionable retirement investment advice by requiring retirement advisers to follow strict “fiduciary” standards – putting their clients’ best interests before their own. However, the potential ripple effect of the proposed changes extends far beyond the realm of retirement advice.

Existing rules in this area were defined by the Employee Retirement Income Security Act of 1974 (ERISA), which was established at a time when professionally managed pension funds were the retirement norm. Over the past 40 years, however, self-managed investments such as Individual Retirement Accounts (IRAs) have taken over as the primary way to save for retirement – increasing the risk and impact that ordinary, middle class investors will be harmed by bad advice from retirement advisers tempted by hidden fees, back-door payments, and other conflicts of interest.

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As public light shines on Medicare payment data to medical providers, planning becomes key

Medicare payment data

Posted by Kimberly Zeoli , Partner, Governance, Regulatory & Risk Services Practice, Deloitte & Touche LLP on April 16, 2015.

Recent news articles talk about how Medicare payment data won’t stay pent up in the databases of providers and federal agencies. For example, it was recently reported that Medicare will publish physician-payment data yearly. This information is finding its way into the spotlight as news organizations and other groups aggressively seek to understand more about how Medicare dollars flow to healthcare providers.

The heightened curiosity surrounding Medicare payment data should prompt healthcare organizations to ask important questions about what they are billing and why they are billing it. On one hand, organizations with many physicians on staff should understand that high volumes or potential anomalies in payment data aren’t necessarily a sign of impropriety. On the other hand, these organizations should become serious about understanding the implications of detailed Medicare payment data and other relevant information available in the public realm. While there are many considerations that organizations will need to evaluate, below highlights four key points for organizations to know now.

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King v. Burwell: the Supreme Court as a catalyst

US Supreme Court building

Posted by Anne Phelps, Principal, US Health Care Regulatory Leader on February 27, 2015.

On March 4, 2015, the Supreme Court will hear arguments in King v. Burwell, a case that challenges an important coverage provision of the Affordable Care Act (ACA). The ACA makes federal tax credits available to certain individuals to help them offset their premiums when they purchase coverage on an insurance Exchange established by a state. If the state does not elect to establish an Exchange, the ACA charges the HHS Secretary with establishing and operating one within the state. The IRS has made the federal tax credits available to certain individuals who purchase health insurance on both state-run and federally-facilitated Exchanges through regulatory rules.

The major issue that the Supreme Court will determine is whether the IRS has the authority to make federal tax credits available to individuals who purchase coverage through the federally-facilitated Exchanges. To date, 34 states have elected not to run insurance Exchanges of their own and have defaulted to the federal government. If the Supreme Court invalidates the IRS rule, millions of Americans who are receiving tax credits through the federally-facilitated Exchanges would lose these subsidies.

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Cross-Industry Compliance Leadership Summit finds we have a lot in common


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Posted by Tom Rollauer on February 19, 2015.

Regulation can apply to each of our industries in such specific ways—from a liquidity coverage ratio in banking to an ICD-10 code in medicine—that we may sometimes feel the very process of regulatory compliance is unique to our industries too. It isn’t, of course. Regulatory compliance is an experience we share across many ways of doing business.

On October 29, 2014 Deloitte’s Center for Regulatory Strategies invited more than 30 corporate compliance chiefs, regulators and others to use that common experience as a bridge. The Cross-Industry Compliance Leadership Summit was a day-long dive into well-earned wisdom and leading practices across not only financial services and healthcare but also energy, education, life sciences, retail, and other sectors.

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An ethical culture helps uphold the rules—but it doesn’t begin with them

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Posted by Keith Darcy on February 19, 2015.

Culture is one of those words we use a lot, but have trouble getting our hands around. At our recent Cross-Industry Compliance Leadership Summit at Deloitte University, we gave it a try. Compliance leaders from the financial services, healthcare, life sciences, consumer, energy, and other industries joined me and several of my Deloitte colleagues to discuss the challenges in culture-building that extend across disparate industries—and the common strategies as well.

The heart of the discussion focused on the notion that a culture of compliance is made up of human interactions. The right attitude can be worth more than the number of rules you promulgate. Fostering trust is a good way to earn it back. Organizations that build trusting relationships with stakeholders experience reciprocity from them.

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To assess compliance, look beyond the rules

Culture Posted by Paul Campbell on February 19, 2015.

I recently moderated at an interactive discussion on evaluating compliance programs at Deloitte’s Cross-Industry Compliance Leadership Summit, where compliance executives from a variety of industries compared notes on the methodologies and metrics they use to measure their efforts.

“If my compliance program prevents, that’s great,” one attendee stated. “If it fails to prevent but detects, that’s okay too. Where it ultimately fails is if there’s management inaction.”

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Building relationships with regulatory agencies

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Posted by Peter Reynolds on February 19, 2015.

When a number of C-level compliance officers joined me recently for a discussion about their relationships with regulatory agencies, it was more than a meeting, it was an education. That’s because we had two regulators with us, and the give and take between them and among the other Compliance officers—the candor, and constructive input—could serve as a model for regulatory interactions all year round.

The occasion was Deloitte’s Cross-Industry Compliance Leadership Summit. Chief Compliance Officers from energy, healthcare, finance, retail, and other sectors all took part, as did Jim Sheehan from the New York State Attorney General’s office and Carlo di Florio, Chief Risk Officer of the Financial Industry Regulatory Authority (FINRA).

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NFA reps say examinations vary, and cooperation is part of the answer

NFA reps say examinations vary, and cooperation is part of the answerPosted by Mike Prokop, Director, Deloitte & Touche LLP

On October 2, 2014, two representatives of the National Futures Association (NFA) — an independent self-regulatory organization for the futures industry — co-led a discussion on that body’s examination approach as part of Deloitte’s Dodd-Frank Compliance Leadership Academy.

Dale Spoljaric, managing director of NFA’s Compliance section, and Michael Brosius, director in NFA’s OTC Derivatives section, pointed out that the NFA has substantial authority. In addition to communicating information about violations to the CFTC, it can also bar an NFA member from doing business with other member firms, discipline members that violate its rules, and facilitate arbitrations between its members. In conducting examinations, the NFA can look at any activity covered by CFTC regulations.

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