Roberta Casper Watson | The Wagner Law Group The Wagner Law Group 2026-06-18T16:04:25Z https://www.wagnerlawgroup.com/feed/atom/ WordPress /wp-content/uploads/sites/1101401/2021/06/cropped-wagner-fav-icon-2-32x32.png by The Wagner Law Group <![CDATA[Chambers USA Recognizes The Wagner Law Group and Attorneys Harold Ashner, Eric Keller, Andrew Oringer, Roberta Casper Watson and Stephen Wilkes]]> https://www.wagnerlawgroup.com/?p=68506 2026-06-08T14:24:59Z 2026-06-05T14:18:17Z Chambers USA Recognizes The Wagner Law Group and Attorneys Harold Ashner, Eric Keller, Andrew Oringer, Roberta Casper Watson and Stephen Wilkes - EIN Presswire, June 5, 2026 (PDF)]]> by The Wagner Law Group <![CDATA[Proposed PBM Fee Disclosure Regulations – A Major Gamechanger]]> https://www.wagnerlawgroup.com/?p=67857 2026-02-17T21:05:32Z 2026-02-17T21:05:32Z Background Pharmacy benefit managers (“PBMs”), the third-party intermediaries or “middlemen” between group health plans, pharmacies, drug manufacturers, and other parties within the pharmaceutical supply chain, have long faced scrutiny and calls for regulation and reform. PBMs and their affiliated brokers and consultants are involved with virtually all parts of the prescription drug marketplace. These entities perform a variety of services for group health plans covered under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), including negotiating drug rebates and pharmacy reimbursement amounts, structuring pharmacy networks, establishing the plan’s prescription drug formulary, and pharmacy benefits claims processing. These arrangements often involve complex and opaque compensation and fee structures, which can make it difficult for plan fiduciaries to fulfill their ERISA fiduciary duties to prudently select and monitor the service provider. There has been great interest in regulating PBMs providing services to group health plans given their central and influential role in the pharmacy benefits process. The Consolidated Appropriations Act, 2021 amended the statutory service provider prohibited transaction exemption to add ERISA section 408(b)(2)(B), which addresses disclosure by brokers and consultants to the responsible fiduciaries of group health plans. Additionally, as part of the current Administration’s push to lower prescription drug pricing and increase transparency into the direct and indirect compensation received by PBMs, Executive Order 14273, “Lowering Drug Prices by Once Again Putting Americans First,” directed the Department of Labor (the “DOL”) to propose PBM fee disclosure regulations under ERISA section 408(b)(2)(B). The DOL issued these proposed regulations on January 30, 2026, which are discussed in greater detail below. However, shortly following the issuance of the DOL’s proposed rule, additional PBM-related legislative reforms were enacted into law in the Consolidated Appropriations Act, 2026 (“CAA 2026”) on February 3, 2026. Key Provisions of the DOL’s Proposed Rule The DOL’s proposed regulations establish new disclosure and audit requirements for “covered service providers” that enter into contracts or arrangements with self-insured group health plans and reasonably expect to receive $1,000 or more in compensation in connection with providing pharmacy benefit management services or providing advice, recommendations, or referrals regarding the provision of such services. The proposed rule lists a number of examples of “pharmacy benefit management services,” encompassing a wide range of activities, including but not limited to acting as a drug price negotiator, establishing or maintaining drug formularies and pharmacy networks, processing prescription drug claims, and adjudicating appeals related to the plan’s prescription drug benefits, among other activities. The definition of “covered service provider” is expansive and covers not only PBMs, but also any affiliates, agents, or subcontractors of the PBMs. The proposed regulations establish new required initial and semiannual detailed written disclosures and reporting about covered service provider compensation and other practices. The proposed regulations require that these written disclosures are clear, concise, accurate, and include sufficient detail and specificity so plan fiduciaries can evaluate the reasonableness of the service contract or agreement. The initial disclosures must be provided to the plan fiduciary reasonably in advance of entering into, extending, or renewing a contract or arrangement with a covered service provider. These disclosures must provide a description of services as well as information about various types of compensation expected to be received by the covered service provider, including direct compensation, payments from drug manufacturers, spread compensation, copay claw-back compensation, and compensation for termination of the contract or arrangement. The disclosures are also required to describe any price protection agreements and formulary placement incentives, as well as drug pricing methodology. The initial disclosures must include a statement of fiduciary status from the covered service provider that discloses any activity or policy that may create a conflict of interest. The semiannual disclosures, which must be provided within 30 days after each six-month period, must disclose the actual compensation received by the covered service provider, including direct compensation, manufacturer payments, spread compensation, copay claw-back compensation, and compensation received pursuant to price protection agreements. These semiannual disclosures must also report any category of compensation that “materially” exceeds the estimate provided in the initial disclosure, with the regulation defining “materially” as exceeding 5 percent (or an agreed upon lower amount). Both the initial and semiannual required disclosures are expansive, as they include an “other compensation” category designed to capture any other compensation not covered under the other specific categories. Both required disclosures must also include a statement regarding the plan fiduciary’s right to audit the disclosures. This right to audit allows plan fiduciaries to request audits of such disclosures at least once per year, and grants the plan fiduciary the right to select the auditor without any limitations from the covered service provider. This will be a significant change, since PBMs typically impose significant restrictions on the audit process and on the plan’s choice of an auditor.  Covered service providers are required to comply with these audit requirements, including by providing requested information to complete the audit and splitting the audit’s cost with the plan. Given these extensive disclosure requirements and the risk of potential non-compliance by covered service providers, the rule also includes a proposed administrative class exemption, which provides relief to plan fiduciaries who report a service provider’s noncompliance with the disclosure or audit requirements to the DOL. This proposed “exemption for responsible plan fiduciary” shields such fiduciary from liability under the prohibited transaction rules when a covered service provider fails to provide the required disclosures provided notice is given to the DOL of such noncompliance. What to Expect Next As the DOL has requested comments on various elements of its proposal by March 31, 2026, it is expected there will be changes before a final rule is issued. DOL will also need to harmonize its proposal with the recently passed CAA 2026 legislation, which also institutes transparency and disclosure measures for PBMs. For example, if finalized, the DOL’s proposed rule would apply to plan years beginning on or after July 1, 2026, which is an earlier effective date than what is required under the CAA 2026 legislation. Key Takeaways and Noteworthy Issues As we digest the DOL’s expansive proposal, there are a number of items that stand out to watch and monitor.
  • The current proposal only applies to self-funded group health plans but the DOL has requested comments on whether this applicability should be expanded. We expect further development in this area and potential applicability expansion to include governmental, church, and other types of plans.
  • The definition of covered service providers under the proposed regulation is designed to be expansive and cover many entities. It includes not only PBMs, but other affiliates, agents, and subcontractors, including PBM-affiliated group purchasing organizations, also known as “rebate aggregators,” which have been a common structure in the market.
  • The required disclosures will provide plan fiduciaries with new insight into the revenue stream for covered service providers. It may be the first time plan fiduciaries are receiving such detailed information; in other words, plan fiduciaries will have visibility into amounts they may have already been paying over the years but were invisible in the spread pricing arrangement.  This insight may change how compensation and arrangements between group health plans and PBMs are negotiated and structured.
  • Covered service providers will be required to provide extensive detail in the disclosures, such as information about payments to PBMs from drug manufacturers, incentives received from the underlying formularies, and the net cost of each drug on the formulary. While covered service providers cannot restrict or limit these disclosures, there will be a place for confidentiality agreements with third parties.
  • The proposed rule provides plan fiduciaries with new tools, including strong audit rights and the proposed exemption for responsible plan fiduciaries. These tools will be crucial for ensuring that plan fiduciaries meet their own obligations under ERISA.
If you have any questions about how these developments may affect you or your organization, contact us for further assistance.  We have extensive experience serving as legal counsel or as ERISA Independent Fiduciary on PBM and health plan related matters. [author] [author_image timthumb='on']https://www.wagnerlawgroup.com/wp-content/uploads/sites/1101401/2023/04/StephenWilkes.jpg[/author_image] [author_info]Stephen Wilkes heads the firm's Investment Management Law practice. He also is a Practice Group leader for the firm's ERISA Fiduciary Compliance and Independent Fiduciary practices. Steve advises a national client base of mutual funds, CIFs, private funds, registered investment advisers, insurance companies, broker dealers, wealth management firms, banks, trust companies, third-party platform providers, Taft Hartley Funds and plan sponsors on ERISA, tax, and related securities law issues. [/author_info] [/author] [author] [author_image timthumb='on']/wp-content/uploads/sites/1101401/2025/07/castro_camille-1.jpg[/author_image] [author_info]With over a decade of experience in pension and employee benefits law, Camille brings a wealth of experience in matters related to ERISA and pension plans. Her career at PBGC has provided Camille with a unique understanding of federal pension insurance programs and the intricacies of government regulations that impact plan sponsors, fiduciaries, and participants.[/author_info] [/author] [author] [author_image timthumb='on']https://www.wagnerlawgroup.com/wp-content/uploads/sites/1101401/2021/07/Roberta-Casper-Watson.jpg[/author_image] [author_info]Roberta Casper Watson is the leader of the firm's health and welfare group. Her practice is in the areas of ERISA and employee benefits, with a focus on pension and profit sharing plans as well as health and welfare benefits, including COBRA, HIPAA, and the Affordable Care Act. Roberta also concentrates in ERISA fiduciary decision making and employee stock ownership plans.[/author_info] [/author]]]> by The Wagner Law Group <![CDATA[Roberta Casper Watson Recognized in Tampa Magazine’s 2026 Top Lawyers List]]> https://www.wagnerlawgroup.com/?p=67788 2026-02-02T17:14:21Z 2026-01-26T17:10:12Z Roberta Casper Watson Recognized in Tampa Magazine’s 2026 Top Lawyers List - The Wagner Law Group Press Release, January 26, 2026 (PDF)]]> by The Wagner Law Group <![CDATA[Employer Provided Fertility Benefits: Has the Time Come?]]> https://www.wagnerlawgroup.com/?p=67446 2025-10-28T18:54:54Z 2025-10-28T18:54:54Z Independent Non-Coordinated Benefit One type of excepted benefit is an independent non-coordinated benefit, which is a type of benefit provided in the group health insurance market.  To qualify as an independent, non-coordinated benefit in the group market (i) the benefit must be provided under a separate policy, certificate or contract of insurance; (ii) there must be no coordination between the provision of such benefit and any exclusion of benefits under any group health plan maintained by the same plan sponsor; and (iii) the benefit must be paid regarding an event whether or not benefits are provided for such event under any group health plan maintained by the same plan sponsor. In the FAQs, the Agencies have indicated that an employer may offer fertility benefits as an independent non-coordinated excepted benefit.  An independent non-coordinated benefit must be offered as a fully insured arrangement: it cannot be self-funded.  As such, if an employer offers a group health plan and a specified disease or illness policy that covers fertility benefits, participants will not be required to enroll in the employer’s traditional group health plan for the specified disease or illness policy to qualify as an excepted benefit and generally be exempt from the requirements of the ACA. An individual who is enrolled in fertility coverage provided under an independent non-coordinated excepted benefit is not disqualified from participating in a Health Savings Account, or HSA. Limited Excepted Benefit Another type of excepted benefit is a limited excepted benefit.  This is the category under which dental and vision benefits are exempted from most ACA requirements.  This category of benefit can be provided separately or in combination with other excepted benefits and can be either fully insured or self-funded.  If fully insured, the limited benefit must be offered under a separate policy from the group health plan.  A limited benefit must be limited in scope and must not be integrated into the employer’s primary health plan.  It must be available to all similarly situated employees or members of the plan and must not be considered an integral part of the plan. The FAQs allow fertility coverage to be provided as a limited excepted benefit.  As such, the Agencies have indicated that a plan sponsor may offer an excepted benefit health reimbursement arrangement, or HRA, that reimburses an employee’s out of pocket costs for fertility benefits.  The HRA must be entirely employer-paid, so there can be no employee premium for the coverage, and no employee cost-sharing for the benefit.  There must be a dollar cap on the benefit paid: $2,150 for plan years beginning in 2025 and $2,200 for plan years beginning in 2026. An employer may also offer benefits for fertility coaching, or for a fertility navigator service, to help employees and their dependents understand their fertility options.  This assistance may be offered under an employee assistance plan, or EAP, that qualifies as a limited excepted benefit.  An employee assistance plan must not provide significant medical benefits; a fertility benefit that consists of treatment for a fertility condition would be a medical benefit for purposes of evaluating the EAP’s compliance with this requirement.  However, employers could offer treatment for a fertility condition under its group health plan and just offer coaching or a navigator service under its EAP while preserving the EAP’s limited excepted benefit status. The Agencies stated that they intend to issue proposed regulations providing additional ways that certain fertility benefits may be offered as limited excepted benefits.  They are also considering whether to modify the standards under which supplemental health insurance coverage provided by a group health plan, including a supplemental benefit for fertility coverage, will be considered as satisfying the conditions for an excepted benefit.  For example, supplemental coverage excepted benefits currently are limited to 15% of the cost of the plan sponsor’s primary health care coverage, calculated in the same manner as COBRA premiums; the Agencies are considering whether that limitation should be increased. As we move into open enrollment season, employers who are considering increasing coverage for fertility benefits for their employees should be aware of these changes and the possibility of more alternatives to come when designing their 2026 benefit programs. If you are considering increasing fertility benefits for employees, please contact one of the authors to explore the alternatives available for 2026 benefit programs.]]> asonneberg <![CDATA[14 Attorneys from The Wagner Law Group to be Recognized in 2026 Edition of The Best Lawyers in America©]]> https://www.wagnerlawgroup.com/?p=67352 2025-08-27T20:06:54Z 2025-08-21T19:42:50Z 14 Attorneys from The Wagner Law Group to be Recognized in 2026 Edition of The Best Lawyers in America© - The Wagner Law Group Press Release, August 21, 2025 (PDF)]]> by The Wagner Law Group <![CDATA[Supreme Court Denies Petition for Review of ERISA Preemption Case Involving State PBM Law]]> https://www.wagnerlawgroup.com/?p=67249 2025-08-04T15:34:55Z 2025-08-01T15:24:33Z By Camille Castro, Roberta Casper Watson and Stephen Wilkes Whether serving as an ERISA Independent Fiduciary or as ERISA Legal Counsel, our firm is constantly facing the question of ERISA preemption of state legislative and regulatory activity affecting pharmacy benefit managers (“PBMs”).  On June 30, 2025, the United States Supreme Court denied a request for certiorari in Pharmaceutical Care Management Association (PCMA) v. Mulready, leaving in place the 10th Circuit Court of Appeal’s decision that ERISA preempted provisions of an Oklahoma law regulating PBMs. As PBMs have expanded their role in the healthcare industry, acting as an intermediary between health plans and pharmacies, states have attempted to regulate PBM practices through various state laws.  The Mulready case involved the “Patient’s Right to Pharmacy Choice Act” (the “Act”) enacted by Oklahoma in 2019.  PCMA challenged the Act in court, arguing that it was preempted by federal laws.  The Western District of Oklahoma court issued a mixed judgment for both parties, finding that ERISA did not preempt the Act, but that parts of it were preempted by Medicare Part D. PCMA appealed the decision, focusing its appeal on four sections of the Act requiring network access standards, a prohibition against using discounts as an incentive to choose between in-network pharmacies, required admission of  “any willing provider” to the PBM’s preferred network if standards are met, and a prohibition against denying, limiting or terminating a contract based on the pharmacy’s employment of a pharmacist placed on probation status if the pharmacist still maintains an “active license to dispense” despite being on probation status The 10th Circuit agreed with PCMA, overturning the lower court’s decision and holding that ERISA preempted these four provisions since they attempted to “govern a central matter of plan administration” and “interfere with nationally uniform plan administration.” The court found Medicare Part D also preempted one provision in the Act.  Following this decision, Oklahoma filed a petition for writ of certiorari.  The Solicitor General subsequently submitted an amicus brief expressing its view that the Court should deny the request, which it ultimately did. Although it declined to hear this case, the Supreme Court has previously opined on ERISA preemption challenges to state PBM laws.  In the 2020 Rutledge v. Pharmaceutical Care Management Association decision, the Court held that ERISA did not preempt an Arkansas law regulating pharmacy reimbursement rates, finding that the law was merely a cost regulation and did not require “plan administrators to structure their plans in a particular manner.”  While Rutledge presents an example of the type of PBM regulations that may survive preemption claims, the Court’s refusal to grant certiorari in the Mulready case suggests laws regulating plan design requirements are preempted by ERISA and would not survive such a challenge in court.  Other pending ERISA preemption challenges to state PBM laws may also provide some further clarification, such as McKee Foods Corp. v. BFP, Inc., in which a U.S. District Court invalidated Tennessee’s any-willing-provider requirement as well as prohibitions on incentivizing or disincentivizing the use of non-favored pharmacies.  That case is on appeal in the 6th Circuit. In addition to activity in the courts, future updates in this area are expected as PBMs continue to attract attention on both the state and federal levels.  For example, the “Lowering Drug Prices by Once Again Putting Americans First” Executive Order issued in April 2025 directs the Department of Labor, by October 12, 2025, to propose regulations to improve transparency into the fees received by PBMs.  We are monitoring these developments and will, of course, keep you informed. Final thoughts:  What Does This Mean for Employers Right Now? The 10th Circuit’s position stands for now, since the Supreme Court has declined to hear the PCMA v Mulready matter.  It will have a ripple effect on other states even though it is the law only for states within the 10th Circuit.  Presumably, it means that ERISA does not preempt state rate/pricing mechanisms, but ERISA does preempt state level regulation of plan design or coverage requirements.  That is a reasonable interpretation according to many.  Employers should confer with legal counsel on the issue of which state laws, if any, might apply to fully insured versus self-insured plans, and whether there is a preemption strategy to follow.]]> by The Wagner Law Group <![CDATA[Mental Health Parity Rules and Requirements for Plan Sponsors and Administrators]]> https://www.wagnerlawgroup.com/?p=67093 2025-07-14T12:47:30Z 2025-07-14T12:47:30Z Strafford live CLE webinar, September 23, 2025, 1:00 - 2:30 PM (EDT) - Click here for details and registration]]> by The Wagner Law Group <![CDATA[Chambers USA Recognizes The Wagner Law Group and Attorneys Harold Ashner, Eric Keller, Andrew Oringer and Roberta Watson]]> https://www.wagnerlawgroup.com/?p=66684 2025-06-11T14:54:08Z 2025-06-06T14:40:26Z Chambers USA Recognizes The Wagner Law Group and Attorneys Harold Ashner, Eric Keller, Andrew Oringer and Roberta Watson - The Wagner Law Group Press Release, June 6, 2025 (PDF)]]> by The Wagner Law Group <![CDATA[The Wagner Law Group’s Washington, D.C. Office Benefits Bulletin Newsletter]]> https://www.wagnerlawgroup.com/?p=67384 2025-10-06T19:16:42Z 2025-04-30T19:12:34Z
  • Federal District Court Declares Current Regulatory Framework for Assessing Excise Taxes Under the Affordable Care Act’s Employer Mandate is Void and Unenforceable – by Eric Keller and Roberta Casper Watson
    • The practical effect of the court’s potentially earthshaking declaration would seem to be that, unless such declaration is overturned on appeal, employers have no liability to pay excise taxes under Section 4980H of the Internal Revenue Code and may file a refund claim for such taxes previously paid.  For more information, click here.
    • Popular Benefits-Related Tax Provisions May be Targeted to Raise Revenue for Federal Tax Cuts – by Eric Keller
    Some of the largest tax expenditures found in the Internal Revenue Code provide tax-favored treatment for a variety of popular employee benefit programs, such as the exclusion from income for employer-provided health insurance as well as tax-favored retirement plans and accounts and equity-based compensation arrangements.  One or more of these or other popular benefits-related tax provisions may be targeted to help pay for the expected extension of the Tax Cuts and Jobs Act of 2017 as well as the possible implementation of other tax cuts that have been championed by President Trump, such as excluding tips and Social Security payments from income taxes.  For more information, click here. On April 30, 2025, the American Bar Association (“ABA”) posted a summary of the May 1, 2024, meeting between representatives of the Pension Benefit Guaranty Corporation (“PBGC”) and representatives of the ABA’s Joint Committee on Employee Benefits (“JCEB”). For a summary of the key highlights of meeting, click here.
    • Retaining an Independent Fiduciary to Address Prohibited Transactions or Enable Plan Fiduciaries to Appropriately Allocate Risk – by Stephen Wilkes and Seth Gaudreau
    The retention of an independent fiduciary plays a critical role not only to resolve a conflict in a prohibited transaction sense, but to provide an appropriate method of effective risk allocation to Plan fiduciaries who must otherwise discharge investment and other transactional duties (often quite complex in nature) in a prudent fashion, e.g., PBM service arrangements. For more information, click here. 
    • Executive Compensation in Volatile Times: Advice for Privately-held Companies and Their Executives – by Mark Poerio
    From tariffs to cash flows, small business owners may feel that mid-2025 warrants attention to how key employees are compensated and retained. For ideas on how to attract and retain key executives in volatile times, for more information, please click here. With the economy and the securities markets roiled by trade wars, many businesses are no doubt considering the possibility of a recession. We might also expect a major increase in bankruptcy filings. That may require consideration of how ERISA and the Bankruptcy Code interact. Judge Craig Goldblatt of the Delaware Bankruptcy Court has been conducting a master class in the Yellow Corporation Chapter 11 case. For a summary of the key rulings he has made to date, please click here. WLG’s Washington Office Welcomes Three Preeminent Attorneys The Wagner Law Group has expanded its Washington DC office with the arrival of three preeminent employee benefits attorneys: Joni Andrioff and Eric Keller who joined in February and Camille Castro who joined in April. Ms. Andrioff is recognized as a leader in the area of employee benefits and executive compensation law with over 35 years of working in partnership with employers, service providers, and ERISA fiduciaries. Mr. Keller has over 25 years of experiencing counseling employers, fiduciaries and service providers on the full spectrum of executive compensation and employee benefits law.  Ms. Castro brings over a decade of experience related to ERISA and pension plans, most recently as the PBGC’s Office of the Advocate. Ms. Andrioff and Mr. Keller are fellows of the prestigious American College of Employee Benefits Council, and Ms. Andrioff is the immediate past president of the ACEBC.  Our Washington Office has seven attorneys who are ACEBC fellows, two of whom are former ACEBC presidents.  The Wagner Law Group has 13 attorneys who are ACEBC fellows, more than any other law firm.]]>         by The Wagner Law Group <![CDATA[Federal District Court Declares Current Regulatory Framework for Assessing Excise Taxes Under the Affordable Care Act’s Employer Mandate is Void and Unenforceable]]> https://www.wagnerlawgroup.com/?p=66415 2025-04-30T17:47:37Z 2025-04-30T16:00:39Z by Eric Keller and Roberta Casper Watson The United States District Court for the Northern District of Texas declared earlier this month that a Department of Health and Human Services (“HHS”) regulation published in 2013 as part of the rulemaking for the Affordable Care Act’s (“ACA”) employer mandate was void and unenforceable.[1]   As a result, the court held that the employer who requested the declaration was not liable for excises taxes paid to the Internal Revenue Service (“IRS”) under Section 4980H of the Internal Revenue Code of 1986, as amended (“Code”) and was entitled to a full refund of the taxes. The practical effect of the court’s potentially earthshaking declaration seems to be that, unless the declaration is overturned on appeal, employers who have paid excise taxes under Code Section 4980H are entitled to a refund of the taxes, assuming the three-year statute of limitations[2] for making a refund claim has not lapsed.  Accordingly, employers who have paid such taxes and are within the three-year statute of limitations should consider filing a protective refund request with the IRS, particularly if the amounts are material.  And, at a minimum, employers who are in the process of having excise taxes assessed should not pay them or agree to their assessment until there are further developments. As background, Section 4980H of the Code imposes an excise tax against a “large employer” (an employer who has at least 50 or more full time employees (“FTEs”) and/or full-time employee equivalents) that either does not offer its FTEs minimum essential health coverage or offers its FTEs minimum essential health coverage that is not affordable or does not provide minimum value (as such terms are defined under ACA regulations).  The penalties are imposed only if, in either case, at least one FTE “has been certified to the employer under Section 1411 of the Affordable Act” as having enrolled in a qualified health plan on an ACA insurance exchange (“Exchange”) and having received a premium-tax credit for such coverage.[3] Code Section 4980H itself does not specify who must make the certification to the employer that is a pre-condition to assessing the excise tax.   Section 1411 of the ACA calls for the Exchanges to make such determinations.  Agencies early on considered the need for the Exchanges and IRS to coordinate to be cumbersome,[4] so HHS, by regulation, assigned that responsibility to the IRS,  stating: As part of its determination of whether an employer has a liability under section 4980H of the Code, the Internal Revenue Service will adopt methods to certify to an employer that one or more employees has enrolled for one or more months during a year in a QHP for which a premium tax credit or cost-sharing reduction is allowed or paid.[5] The Texas federal court declared that HHS regulation to be void and unenforceable, ruling that Section 1411 of the ACA did not permit HHS to assign to the IRS via its regulation the responsibility for the certification to the employer.   While the court acknowledged “that its ruling was not the only possible interpretation of the statutes in question,” it concluded that its ruling “is the best interpretation.” If you have any questions about this case or how to file a protective refund claim for Section 4980H excise taxes previously paid, please contact Roberta Casper Watson, Eric Keller or the WLG attorney with whom you work. [1] Faulk Co v. Becerra, 2025 U.S. Dist. LEXIS 68580 *19 (N.D. Tex., Apr. 10). [2] Code § 6501(a). [3] If a large employer does not offer minimum essential health coverage to at least 95% of its FTEs, the excise tax is assessed not only for each employee who receives the premium tax credit but also for all of its other FTEs, including those to whom the employer offered such coverage, less the first 30.   For 2025, the maximum amount of this excise tax is $2,900 per such FTE.   The excise tax imposed when unaffordable or non-minimum value coverage is offered by a large employer is limited the specific FTEs who receive a premium tax credit subsidy.   In 2025, the maximum amount of this excise tax is $4,355 per such FTE. [4] Christopher E. Condeluci and Alden J. Bianchi, Why the IRS May Be Unable to Assess ACA Employer Shared Responsibility Penalties for 2015, Bloomberg Daily Tax Report, January 8, 2018. [5] 45 CFR § 155.310(i).  See also 26 CFR § 54.4980H-1(a)(40), defining a “Section 1411 Certification” as “the certification received as part of the process established by the Secretary of Health and Human Services under which an employee is certified to the employer under section 1411 of the Affordable Care Act as having enrolled for a calendar month in a qualified health plan with respect to which an applicable premium tax credit or cost-sharing reduction is allowed or paid with respect to the employee.” [author] [author_image timthumb='on']https://www.wagnerlawgroup.com/wp-content/uploads/sites/1101401/2025/01/eric-keller.png[/author_image] [author_info] Eric Keller has focused his practice on executive compensation, employee benefits, and workforce restructuring matters A substantial portion of his practice is devoted to advising clients on labor, employment, and employee benefits matters in connection with domestic and cross-border mergers, acquisitions, divestitures and other business transactions, by conducting due diligence, negotiating, and preparing contract provisions, addressing transitional issues, and developing strategies to minimize financial expense and taxation.[/author_info] [/author] [author] [author_image timthumb='on']https://www.wagnerlawgroup.com/wp-content/uploads/sites/1101401/2021/07/Roberta-Casper-Watson.jpg[/author_image] [author_info]Roberta Casper Watson is the leader of the firm's health and welfare group. Her practice is in the areas of ERISA and employee benefits, with a focus on pension and profit sharing plans as well as health and welfare benefits, including COBRA, HIPAA, and the Affordable Care Act. Roberta also concentrates in ERISA fiduciary decision making and employee stock ownership plans.[/author_info] [/author]]]> by The Wagner Law Group <![CDATA[Florida PBM Audits Ensnare Self-Insured Employer Health Plans]]> https://www.wagnerlawgroup.com/?p=66473 2025-05-12T07:42:44Z 2025-04-29T16:38:15Z Florida PBM Audits Ensnare Self-Insured Employer Health Plans - Roberta Watson, Bloomberg Law, April 29, 2025 (PDF)]]> by The Wagner Law Group <![CDATA[Patients Target Insurers in Suits Over Flawed Doctor Directories]]> https://www.wagnerlawgroup.com/?p=66151 2025-03-13T15:55:50Z 2025-03-13T15:55:50Z Patients Target Insurers in Suits Over Flawed Doctor Directories - Roberta Casper Watson, Bloomberg Law, March 13, 2025 (PDF)]]> by WLG <![CDATA[12 Attorneys from The Wagner Law Group to be Recognized in 2025 Edition of The Best Lawyers in America©]]> https://www.wagnerlawgroup.com/?p=64980 2026-05-21T04:51:16Z 2024-08-15T14:14:59Z 2 Attorneys from The Wagner Law Group to be Recognized in 2025 Edition of The Best Lawyers in America© - The Wagner Law Group Press Release, Marcia Wagner, Thomas Clark, Jr., Andrew Oringer, Harold Ashner, David Gabor, Israel Goldowitz, Russell Gaudreau, Jr., Johanna Matloff, Mark Poerio, Linda Rosenzweig, and Roberta Casper Watson, EIN Presswire, August 15, 2024 (PDF)]]> by WLG <![CDATA[Benefits Rules Likely to Draw Fresh Fire After High Court Action Ari Sonneberg]]> https://www.wagnerlawgroup.com/?p=64452 2024-07-15T14:27:57Z 2024-07-02T14:24:56Z Benefits Rules Likely to Draw Fresh Fire After High Court Action - Roberta Casper Watson, Bloomberg Law, July 2, 2024 (PDF)
    ]]>         by WLG <![CDATA[Court Split Spells Trouble on Surprise Billing Award Enforcement]]> https://www.wagnerlawgroup.com/?p=64361 2024-06-18T15:10:21Z 2024-06-11T15:00:37Z Court Split Spells Trouble on Surprise Billing Award Enforcement - Roberta Casper Watson, Bloomberg Law, June 11, 2024 (PDF)]]> by WLG <![CDATA[Johnson & Johnson Case Signals Employee Drug Price Suits to Come]]> https://www.wagnerlawgroup.com/?p=63480 2024-02-15T17:24:47Z 2024-02-09T17:21:17Z Johnson & Johnson Case Signals Employee Drug Price Suits to Come - Roberta Casper Watson, Bloomberg Law, February 9, 2024 (PDF)]]> by WLG <![CDATA[Workers Poised to Get Benefits as Rule Creates ‘Employees’]]> https://www.wagnerlawgroup.com/?p=63383 2024-01-30T13:57:33Z 2024-01-29T13:45:57Z Workers Poised to Get Benefits as Rule Creates ‘Employees’ - Roberta Casper Watson, Bloomberg Law, January 29, 2024 (PDF)]]> by WLG <![CDATA[Could Skin Care be the Next Gold Rush Opportunity for Tax-Free FSA Shopping?]]> https://www.wagnerlawgroup.com/?p=63377 2024-01-30T13:43:48Z 2024-01-16T13:33:59Z Could Skin Care be the Next Gold Rush Opportunity for Tax-Free FSA Shopping? - Roberta Watson, Glossy, January 16, 2024 (PDF)]]> by WLG <![CDATA[DOL Proposes to Rescind 2018 Association Health Plan Rule]]> https://www.wagnerlawgroup.com/?p=63175 2023-12-28T14:54:57Z 2023-12-22T14:50:50Z DOL Proposes to Rescind 2018 Association Health Plan Rule - Roberta Casper Watson, PLANSPONSOR, December 22, 2023 (PDF)]]> by WLG <![CDATA[11 Attorneys from The Wagner Law Group to be Recognized in 2024 Edition of The Best Lawyers in America©]]> https://www.wagnerlawgroup.com/?p=62585 2026-05-21T04:52:50Z 2023-08-17T18:43:03Z Boston, MA, August 17, 2023 – The Wagner Law Group, widely recognized as the country’s top ERISA and employee benefits law firm, is delighted to announce that 11 of its attorneys will be recognized as Best Lawyers® in the  2024 edition of The Best Lawyers in America©, in practice areas including, Employee Benefits (ERISA) Law, Litigation - Labor and Employment, and Labor Law – Management.  These exceptional attorneys include  Marcia Wagner, the firm’s founder and Managing Director, Thomas E. Clark Jr., Partner and the firm’s Chief Operating Officer, Andrew Oringer, Partner and the firm’s General Counsel, and Partners Harold Ashner, David Gabor, Russell Gaudreau, Jr., Israel Goldowitz, Mark Poerio, Linda Rosenzweig and Roberta Casper Watson.  “We are extraordinarily proud that such a large percentage of our firm’s attorneys continues to be listed among The Best Lawyers in America©,” says Ms. Wagner. The Best Lawyers in America© is widely regarded as a respected reference guide to legal excellence.  Recognition by Best Lawyers® is based solely on confidential peer review. The rigorous methodology utilized for recognition is designed to capture the consensus of leading lawyers about the professional abilities of colleagues within the same country and legal practice area.  Best Lawyers® employs a sophisticated and transparent survey process that is tailored to elicit meaningful and substantive evaluations of the quality of legal services provided by attorneys.  The Best Lawyers in America© recognizes the top 5% of private practicing lawyers in the United States and is commonly used by consumers in need of legal services to identify the most qualified attorneys based on legal expertise, ethical standards, and professionalism.  The 2024 edition of The Best Lawyers in America© will be distributed in more than 30 leading publications around the country, including The New York Times, The Washington Post and The Wall Street Journal. The Wagner Law Group has also been nationally ranked, as well as locally ranked in Boston and Washington, D.C., as a Tier 1 Best Law Firm in the area of Employee Benefits (ERISA) Law in the U.S. News & World Report – Best Lawyers® most recently published "Best Law Firms" list.  Firms that receive this ranking are recognized for professional excellence with consistently high ratings from clients and peers.  Achieving a tiered ranking signifies a unique combination of quality law practice and breadth of legal expertise.  ]]>