DOL Files Papers to Enforce Petition against TPA

The Department of Labor has sued a southeastern Pennsylvania third-party administrator to get health consultant Independence Administrators—a subsidiary of Independence Blue Cross and therefore of its parent company, Independence Health Group Inc.—to comply with a summons issued as part of an Employee Benefits Security Administration investigation.

The DOL filed a complaint on March 28 in U.S. district court for the Eastern District of Pennsylvania as part of its effort to determine if the firm and its Employee Retirement Income Security Act clients are complying with the Mental Health Parity and Addiction Equity Act of 2008. The DOL alleges Independence, a TPA to self-funded employee health and welfare plans, has failed to comply with a subpoena issued on October 25, 2022.

“Independence’s refusal to comply with the Subpoena is baseless,” wrote attorneys for the DOL. “Because the acting secretary has exhausted efforts to obtain compliance, she respectfully requests that the court convene a show-cause hearing … and compel Independence to promptly respond to Request Nos. 3–7, 8–14, 17–21, and 24–28, without limitation.”

Independence confirmed on November 15, 2022, that it received the subpoena, according to the DOL filings. EBSA granted Independence an extension to respond until December 7, 2022, and Independence started producing responsive materials on January 6, 2023.

However, neither Independence nor Independence Blue Cross has communicated with EBSA or the Philadelphia Regional Solicitor’s Office since January 12, (they had communicated via phone on January 4), and the company has not produced any of the subpoenaed information since June 15, 2023, the DOL’s filing states.

The subpoena requested seven reports for each of four separate mental health or substance use disorder benefits: applied behavior analysis for autism spectrum disorders; medication-assisted treatment related to alcohol or substance use disorder; speech therapy; and nutritional counseling.

“Among other things, EBSA is attempting to determine if there are any limitations on those four benefits, the nature of those limitations, their rationale and whether there is parity between those limitations and limitations on comparable medical and surgical benefits available under the same ERISA Plan,” wrote DOL attorneys in the filings.

The recent DOL filing requests the court order Independence to appear at a show cause hearing and afterward immediately and completely respond to the subpoena.

In December 2023, the IRS announced it would finalize in June 2024 a new rule related to the Mental Health Parity and Addiction Equity Act. The MHPAEA was enacted in 2008 and later incorporated into ERISA.

The law ensures that, “in the case of group health plans which provide both medical and surgical benefits and mental health or substance use disorder benefits, there [is] parity between the two categories of benefits.”

In 2020, Congress amended MHPAEA to require plan sponsors and issuers to perform and document comparative analyses of certain nonquantitative treatment limitations.

The lawsuit is Julie A. Su, Acting Secretary of Labor, United States Department of Labor v. Independence Administrators.

Neither representatives of Independence Administrators nor those for the DOL responded to requests for comment.