EEOC Proposes to Regulate Employer Wellness Plans Under GINA and ADA to Be More Consistent with HIPAA and ACA.

Last month, the EEOC proposed to amend its regulations under Title II the Genetic Information Non-discrimination Act (GINA) governing employer wellness programs that are part of group health plans (and are already subject to similar limitations under HIPAA and the ACA).  It also signaled that it might issue regulations governing the electronic security of employer records containing genetic information and wellness programs that seek the same information but are not part of a group health plan (which is already subject to HIPAA).   Unlike the current GINA regulation at 29 C.F.R. §1635.8(b)(2)(ii), the proposed regulations would permit an employer to provide financial and non-financial “inducements” (including penalties) in exchange for information gathered during a Health Risk Assessment (HRA) about the “current and past health status” of the employee’s spouse, if the spouse voluntarily consents, provides written authorization, and is covered by the health plan and if the program would have a reasonable likelihood of improving health or preventing disease.  This information would include, for instance, blood pressure, cholesterol, glucose levels, etc.  The proposed regulation does not similarly cover information about the employee’s children or the results of any genetic tests or other genetic information about the spouse. These regulations are similar to last April’s proposed regulations to govern employee wellness plans under the ADA, which also permit up financial incentives up to 30% of the cost of the health coverage.  In addition, the proposed regulations prohibit employers from conditioning the incentive on waiving the confidentiality of the genetic information (or agreeing to its sale).  

The EEOC’s current GINA regulations only permit an employer to seek genetic information (i.e., medical histories and information about an employee’s spouse, parents or children) in connection with a wellness program if, among other things, a financial incentive is not conditioned on the provision of the information.  The employer’s program may include a HRA or questionnaire seeking such information, but only if it is made clear that the financial incentive “will be made available whether or not the participant answers questions regarding genetic information.”  This existing regulation will still govern questions about the employee’s children, but a limited exemption is being created by the proposal to permit inducements for an employee’s spouse to participate in the wellness program and provide information about his or her current or past health status. 

As mentioned and like the proposed ADA regulations and existing HIPAA/ACA regulations, the program seeking this information must have a reasonable chance of improving health or preventing disease.  An employer can run afoul of this requirement when it seeks genetic information but then fails to provide follow-up information or advice, makes it overly burdensome (in time, intrusiveness or expense) for the participants to earn the reward (or avoid the penalty), or merely shifts costs from the employer to the employees based on their health. 

A HRA may include a questionnaire or medical examination, or both.  It must still comply with existing GINA regulations regarding consent, authorization, and confidentiality, etc.  

As mentioned, the financial incentive is limited to a similar 30% amount earlier discussed in the proposed ADA regulations (and apply under HIPAA and ACA for only health contingent programs).  However, while the ADA limitation was for employee-only health costs, the GINA provision can apply to the cost of family or employee +1 health plans, less the amount of incentive for the employee: 

The maximum amount of the inducement for an employee's spouse to provide information about current or past health status may not exceed 30 percent of the total cost of coverage for the plan in which the employee is enrolled less 30 percent of the total cost of self-only coverage.  For example, if an employer offers health insurance coverage at a total cost of $14,000 for employees and their dependents and $6,000 for self-only coverage, the maximum inducement the employer can offer for the employee and the employee's spouse to provide information about their current or past health status is 30 percent of $14,000, or $4,200. The maximum amount of the $4,200 inducement that could be offered for the employee's spouse to provide current or past health status information is $4,200 minus $1,800 (30 percent of the cost of self-only coverage), or $2,400.

 . . .The maximum amount of the inducement the employer may offer to the employee for participation is 30 percent of the cost of self-only coverage. For example, if an employer offers health insurance coverage at a total cost of $14,000 for employees and their dependents and $6,000 for self-only coverage, the maximum inducement that may be offered for the employee to respond to disability-related inquiries or take medical examinations is $1,800.

The EEOC explains that “the term “inducements” includes both financial and in-kind inducements, such as time-off awards, prizes, or other items of value, in the form of either rewards or penalties.”  Employers remain free to structure their incentives in a variety of ways, only some of which are subject to GINA:

However, an employer would be free to offer all or part of the $2,400 inducement in other ways as well, such as for the employee, the spouse, and/or another of the employee's dependents to undertake activities that would qualify as participatory or health-contingent programs but do not include requests for genetic information, disability-related inquiries, or medical examinations. Thus, in the example above, an employer could offer $1,800 for the employee to answer disability-related questions and/or to take medical examinations as part of a health risk assessment, could offer the same amount for the employee's spouse to answer the same questions and to take the same medical examinations, and could offer the remaining $600 for the employee, the spouse, or both to undertake an activity-based health-contingent program, such as a program that requires participants to walk a certain amount each week. Additionally, a wellness program may offer inducements in accordance with HIPAA and the Affordable Care Act without regard to the limits on apportionment set forth in this proposed rule if neither the employee nor the employee's spouse are required to provide current or past health status information, so long as the wellness program otherwise complies with the requirements of the ADA and GINA.

Title I of the ADA prohibits medical examinations and inquiries except in certain limited circumstances, such as “voluntary medical examinations, including voluntary medical histories, which are part of an employee health program available to employees at that worksite.”   42 U.S.C. § 12112(e)(4)(B).  Moreover, this information must remain subject to the same confidentiality obligations that cover other disability-related inquiries and examinations, although the EEOC proposes to extend the protections for wellness program information.   Under the EEOC’s recently proposed ADA regulations, “an employer may offer limited incentives up to a maximum of 30 percent of the total cost of employee-only coverage, whether in the form of a reward or penalty, to promote an employee’s participation in a  wellness program that includes disability-related inquiries or medical examinations as long as participation is voluntary.”  Wellness programs which do not involve medical inquiries or testing would not be subject to the proposed ADA limitations on financial incentives.  The EEOC also indicated that employees with disabilities should receive reasonable accommodations in order to receive the financial incentives or avoid the penalties. Employers may not take adverse action against employees who refuse to participate or fail to achieve certain health outcomes.   Finally, the EEOC invited comments on, among other things, whether it should raise the incentive percentage to 50% (as permitted by HIPAA) for tobacco cessation programs which include nicotine testing and other biometric measures.   

The proposed GINA regulations incorporate some of these issues:

(vii) Nothing contained in paragraphs (b)(2)(ii) through (vi) of this section limits the rights or protections of an individual under the Americans with Disabilities Act (ADA), as amended, or other applicable civil rights laws, or under the Health Insurance Portability and Accountability Act (HIPAA), as amended by GINA. For example, if an employer offers an inducement for participation in disease management programs or other programs that promote healthy lifestyles and/or require individuals to meet particular health goals, the employer must make reasonable accommodations to the extent required by the ADA; that is, the employer must make “modifications or adjustments that enable a covered entity's employee with a disability to enjoy equal benefits and privileges of employment as are enjoyed by its other similarly situated employees without disabilities” unless “such covered entity can demonstrate that the accommodation would impose an undue hardship on the operation of its business.”  . . . In addition, if the employer's wellness program provides (directly, through reimbursement, or otherwise) medical care (including genetic counseling), the program may constitute a group health plan and must comply with the special requirements for wellness programs that condition rewards on an individual satisfying a standard related to a health factor, including the requirement to provide an individual with a “reasonable alternative (or waiver of the otherwise applicable standard)” under HIPAA, when “it is unreasonably difficult due to a medical condition to satisfy” or “medically inadvisable to attempt to satisfy” the otherwise applicable standard.

The EEOC is considering even more modifications of the GINA regulations and seeks comments on the following issues: 

·        Whether employees should still receive inducements if the spouse refuses to disclose the requested information, but provides medical certification that the employee is under active medical treatment;

·        Whether the authorization requirement be limited only to wellness programs that offer more than de minimis rewards or penalties and how that would be defined;

·        Whether employers should be required to implement more specific electronic protections of medical and genetic information that is stored electronically to avoid hackers breaching the confidentiality of those records;

·        Whether employers offer (or are likely to offer in the future) wellness programs outside of a group health plan or group health insurance coverage that use inducements to encourage employees' spouses to provide information about current or past health status as part of a HRA, and the extent to which the GINA regulations should allow inducements provided as part of such programs. 

The proposed ADA regulations would require changes in gathering, using and maintaining information gathered under a wellness plan.  It would require the employer to notify employees “what medical information will be obtained, how the medical information will be used, who will receive the medical information, the restrictions on its disclosure, and the methods the covered entity uses to prevent improper disclosure of medical information.” It also would mandate that “medical information collected through an employee health program only may be  provided to a covered entity under the ADA in aggregate terms that do not disclose, or are not reasonably likely to disclose, the identity of specific individuals, except as needed to administer the health plan and except as permitted under 1630.14(d)(4).”  While HIPAA would govern when the employer is the plan administrator, the EEOC proposes its own requirements to essentially extend HIPAA’s Privacy Rule to employer non-administrators receiving information from a wellness program: “the aggregate information that the employer may receive from the wellness program under section 1630.14(d)(6) must be deidentified in accordance with the HIPAA Privacy Rule. Further, other disclosures of protected health information from the wellness program may only be made in accordance with the Privacy Rule.”

 

NOTICE: This summary is designed merely to inform and alert you of recent legal developments. It does not constitute legal advice and does not apply to any particular situation because different facts could lead to different results. Information here can be changed or amended without notice. Readers should not act upon this information without legal advice. If you have any questions about anything you have read, you should consult with or retain an employment attorney.

Hamilton County Court of Appeals Rejects Public Policy Wrongful Discharge Claim Based on Alleged HIPAA and Insurance Fraud Violations

Last week, a divided Hamilton County Court of Appeals reversed a jury verdict entered in favor of a terminated physician on a public policy wrongful discharge claim on the grounds that her accusations of HIPAA and insurance fraud violations were not supported by sufficiently clear sources of public policy because neither statute imposed an affirmative obligation on the plaintiff to report her concerns or prohibited the employer from retaliating against an employee who reports violations of the statute.  McGowan v. Medpace, Inc., 2015-Ohio-3743. Unlike Cuyahoga and Franklin County Courts of Appeal, the Hamilton County Court of Appeals requires a statutory source of public policy to parallel the general whistleblower statute by requiring an employee to report concerns and to prohibit the employer from retaliation for reporting those concerns.  Also, this case rejects a prior Montgomery County Court of Appeals decision finding HIPAA to be a valid source of public policy to support a wrongful discharge claim.

According to the Court’s opinion, the plaintiff had been hired into three positions to replace a retiring physician: to be the Executive Director of two research centers and to take over the retiring physician’s private practice.  In addition, the retiring physician appointed her to replace him as the Principle Investigator on the research studies being conducted by the two research centers.   While the research centers was not affiliated with the private medical practice, they shared office space, employees and patients. Shortly after she started, the plaintiff became concerned with how the staff treated patient files (in that the research studies and medical practice operated using the same file instead of having different charts).  Staff also left the charts open on carts outside patient rooms.  She felt that this violated HIPAA.  She was also concerned that the retiring physician routinely ordered larger doses of medication than medically necessary and directed the patients to split them.   She felt that this was insurance fraud.   She also conferred with an attorney who confirmed her suspicions.  Accordingly, at the next staff meeting, she directed the staff to cease the offending practices and expressed her opinion that they violated HIPAA and insurance fraud laws.  The retiring physician learned of her accusations and removed her as the PI and from his private practice.  The defendant employer did not fire her or remove her from her ED positions, but explained that she should not have made the allegations and it could not control the retiring physician from removing her from his practice and research studies.  After she refused to apologize to the retiring physician and accused the employer of retaliation, it fired her a few weeks later.  She was awarded $800,000 in compensatory and punitive damages by a jury.  The employer appealed.

Unlike Franklin and Cuyahoga Counties, the Hamilton County Court of Appeals only recognizes narrow exceptions to the employment at will doctrine and  public policies as actionable wrongful discharge claim if the underlying statute – like the general whistleblower statute – requires the plaintiff to report concerns and prohibits the employer from retaliating against the employee for reporting those concerns:

In a claim for wrongful discharge in violation of public policy, an employee satisfies the clarity element by establishing that a clear public policy existed, and that the public policy was one that imposed an affirmative duty on an employee to report a violation, that prohibited an employer from retaliating against an employee who had reported a violation, or that protected the public’s health and safety.

With respect to the plaintiff in this case, the Court concluded that the insurance fraud statute did not impose an affirmative duty on her to report her concerns about the retiring physician’s insurance fraud or prohibit her employer from terminating her for reporting those concerns.  Accordingly, that statute could not constitute a clear source of public policy as required for a public policy wrongful discharge claim under Ohio law.

The Court reached the same conclusion with respect to the HIPAA issues even though the Montgomery County Court of Appeals had previously recognized it as providing a sufficiently clear source of public policy protecting patient’s privacy rights.  The dissent would have recognized the HIPAA public policy claim as protecting public safety.

NOTICE: This summary is designed merely to inform and alert you of recent legal developments. It does not constitute legal advice and does not apply to any particular situation because different facts could lead to different results. Information here can be changed or amended without notice. Readers should not act upon this information without legal advice. If you have any questions about anything you have read, you should consult with or retain an employment attorney.

Sixth Circuit Dismisses ADEA Claims by Employees Who Claimed They Were Terminated For Budget Reasons Rather than For Violating Confidentiality Policy.

Today, the Sixth Circuit affirmed the dismissal of claims by two employees who alleged that they had been terminated on account of their age because the new CEO had sought to increase turnover among (more expensive) employees with more seniority so that he could hire less expensive, newer employees. Allen v. Highlands Hospital Corp., No. 07-6414 (10/21/08). The plaintiffs admitted to the conduct which the hospital explained motivated it to terminate their employment, but the plaintiffs denied their conduct was the actual reason for their termination. Indeed, the court was sympathetic that the plaintiffs had not actually violated patient confidentiality as alleged, but still gave more weight to the hospital’s argument that it held an honest belief that the plaintiffs had violated its HIPAA policy based on a thorough investigation by the human resources department. In any event, the court found that there was no evidence that the hospital’s business strategy to reduce its budget for employee compensation had a disparate impact on older employees and did not constitute direct evidence of age discrimination.

The plaintiffs were terminated for violating the hospital’s HIPAA policy when one of the plaintiffs obtained the x-rays of her own granddaughter (at the parent’s request) from the other plaintiff without having a signed authorization from the parent of the granddaughter. The grandmother plaintiff had been told by another employee that the parent’s signature was mandatory, but there was no written policy governing the situation. Moreover, the plaintiff grandparent then forged the parent’s signature on the authorization form, back-dated the form and placed it in the medical record (which may have shown knowledge of her own guilt in violating an unwritten policy). Both employees were terminated for violation of the HIPAA policy, which the hospital considered to be a major offense.

The Court acknowledged that the hospital’s actions in this case were unduly harsh: “the facts of this case are not a “textbook example” of a privacy violation for which a hospital would usually take such serious action against its long-time employees. The record shows that [plaintiff] was not only the biological grandmother of the patient, but also was involved in her care and guardianship (although [plaintiff] was admittedly not [the granddaughter’s] legal guardian). Moreover, [the hospital] does not dispute that [the mother], as [the granddaughter’s] mother and legal guardian, in fact gave [plaintiff] verbal authorization to retrieve the x-rays. The plaintiffs have thus undoubtedly pointed to a weakness in the Hospital’s policy, if for no other reason than that this case highlights the potential ambiguity caused by the lack of detail in the employee manual’s prohibition against an unauthorized release. But the fact that the Hospital would benefit from developing a more detailed policy on this issue does not mean that [the plaintiffs] have succeeded in creating a genuine issue of material fact about whether HHC’s stated reason for terminating them was a pretext designed to hide age-based discrimination. We thus agree with the Hospital that, in determining if the plaintiffs have raised a genuine issue of material fact as to pretext, we should consider not whether [the plaintiffs] actually breached patient confidentiality, but rather whether the Hospital had an honestly held belief that they had committed a Group I offense.”

To support their age discrimination claims, the plaintiffs produced evidence that the hospital’s new CEO sought to increase employee turnover among more senior (and presumably more expensive) employees. According to the court, the hospital’s budget manager testified “one of [the CEO’s] strategies was to terminate employees based on seniority to facilitate the hiring of new, less costly employees. In fact, [the CEO] increased the annual turnover rate from 2% to 28%. [The budget manager] did not know whether the cost-cutting measures had a disproportionate effect on older employees, but she said that [the CEO’s] focus was at all times on improving HHC’s financial situation.” In any event, the Court of Appeals found that this testimony did not constitute direct evidence of age discrimination.

“Indeed, the Supreme Court in Hazen Paper Co. v. Biggins, 507 U.S. 604 (1993), has specifically held that the strategies discussed by [the budget manager] are permissible methods for employers to cut costs: When the employer’s decision is wholly motivated by factors other than age, the problem of inaccurate and stigmatizing stereotypes disappears. This is true even if the motivating factor is correlated with age . . . . On average, an older employee has had more years in the work force than a younger employee, and thus may well have accumulated more years of service with a particular employer. Yet an employee’s age is analytically distinct from his years of service. An employee who is younger than 40, and therefore outside the class of older workers as defined by the ADEA, see 29 U.S.C. § 631(a), may have worked for a particular employer his entire career, while an older worker may have been newly hired. Because age and years of service are analytically distinct, an employer can take account of one while ignoring the other, and thus it is incorrect to say that a decision based on years of service is necessarily ‘age based.’”

Moreover, the court found insufficient evidence that the CEO’s budget practice had a disparate impact on older workers either. The hospital’s expert produced evidence that the hospital’s increased turnover did not result in a disproportionate reduction in the number of employees over the age of 40. “ Nor is the plaintiffs’ disparate-impact claim salvaged by the allegation that the number of terminations of those over 40 years of age increased from 14.3% to 62.5% of all terminations between 2002 and 2003. As the district court noted, this data is not statistically significant because the pools from which those percentages were drawn were very small—i.e., there were only 21 terminations in 2002 and 16 terminations in 2003.”

Finally, “[t]he plaintiffs, however, have failed to satisfy their burden of isolating and identifying a specific employment practice that disproportionately impacts employees who are at least 40 years old. As we have already explained, the plaintiffs have at best alleged that HHC desired to reduce costs associated with its highly paid workforce, including those costs associated with employees with greater seniority. But the plaintiffs have not established that this corporate desire evolved into an identifiable practice that disproportionately harms workers who are at least 40 years old. Because Allen and Slone have simply “point[ed] to a generalized policy,” as opposed to specific practice, they have therefore failed to raise a genuine question of material fact with respect to their disparate impact claim.”

The plaintiffs also produced evidence that a the supervisor of a hospital contractor told one of its employees that the employee should start looking for another job because it looked as though all of the older employees would be let go. The court also rejected this as direct evidence that the plaintiffs were terminated on account of their age because the solitary statement was not made by their supervisors and was, instead, made in connection with another employer.

Insomniacs can read the full decision at http://www.ca6.uscourts.gov/opinions.pdf/08a0381p-06.pdf.


NOTICE: This summary is designed merely to inform and alert you of recent legal developments. It does not constitute legal advice and does not apply to any particular situation because different facts could lead to different results. Information here can change or be amended without notice. Readers should not act upon this information without legal advice. If you have any questions about anything you have read, you should consult with or retain an employment attorney.