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Just eight days after a federal court slammed CIGNA with a $13M judgement, 113 of CIGNA’s self-insured clients, along with their Plan Administrators have been named as defendants in a massive fraud lawsuit, alleging the plans “participated in a conspiracy and pattern of unlawful, reckless, and deceptive conduct to conceal an embezzlement and/or skimming scheme”. more »
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In a monumental decision for Out-Of-Network Providers nationwide, on June 1, 2016, U.S. District Judge Kenneth Hoyt of the Southern District of Texas ruled against Cigna and ordered the insurer to pay $11.4 million to cover underpaid claims and, an additional $2.3 million in ERISA penalties, in perhaps the first instance where a claims administrator more »
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On May 10, 2016, in the southern district of Texas Federal Court, United HealthCare administered self-insured ERISA plan, GAP Inc. and its Plan Administrators, Cynthia Radovich and Lesley Dale, were sued for alleged ERISA plan assets “self-dealing and embezzlement”, deceptively concealed through an “illegitimate recoupment scheme that financially rewards United for wrongfully recouping valid benefits”. more »
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One Texas lawyer is helping companies opt out of workers’ compensation and write their own rules. What does it mean for injured workers? by Michael Grabell, ProPublica, and Howard Berkes, NPR October 14, 2015 STANDING BEFORE A GIANT MAP in his Dallas office, Bill Minick doesn’t seem like anyone’s idea of a bomb thrower. But backed by more »
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Posted March 21, 2014 by Kevin Knauss As the ACA open enrollment winds down, attention now turns to helping individuals and families in the new health plans actually get health care from their insurance. While there have been significant challenges just getting people signed up for health insurance, there will surely be additional hurdles as more »
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“Frequently Asked Questions” on the Bulletin Entitled the Sale of Individual Market Policies to Medicare Beneficiaries under 65 Losing Coverage Due to High Risk Pool Closures.” http://www.cms.gov/Medicare/Health-Plans/Medigap/Downloads/High-Risk-Pool-FAQs.pdf
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Department of Justice Office of Public Affairs FOR IMMEDIATE RELEASE Friday, December 20, 2013 Justice Department Recovers $3.8 Billion from False Claims Act Cases in Fiscal Year 2013 Second Largest Annual Recovery in History Whistleblower Lawsuits Soar to 752 The Justice Department secured $3. 8 billion in settlements and judgments from civil cases involving fraud more »
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Department of Justice Office of Public Affairs FOR IMMEDIATE RELEASE Monday, December 2, 2013 Health Care Clinic Owners Sentenced for Role in $8 Million Health Care Fraud Scheme Two health care clinic owners were sentenced today in connection with an $8 million health care fraud scheme involving the now-defunct home health care company Flores Home more »
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With enrollment deadlines approaching, California officials, insurers and agents are opening stores in outlets across the state to sign up individuals for Obamacare policies. Comments 44 Email Share 46 Certified counselor Helen Lee, right, signs up a woman for health coverage at a Covered California exchange office in the Baldwin Hills Crenshaw mall. (Anne Cusack, Los more »
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Washington (CNN) — The high-stakes fight over implementing parts of the troubled health care reform law will move to the U.S. Supreme Court in coming months, in a dispute involving coverage for contraceptives and religious liberty. The justices agreed on Tuesday to review provisions in the Affordable Care Act requiring employers of a certain size to more »
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