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In The News
“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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On November 7, 2013, the United States District Court for the Northern District of Illinois granted in Summary Judgment against BCBS in an overpayment ERISA class action for certain plaintiff providers. The court clarified among other issues that: Providers are entitled to sue under ERISA; Certain BCBS entities completely violated ERISA; These providers are not more »
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A Federal Court in Tennessee orders United Healthcare of Tennessee, Inc (United) to pay $99,000 in ERISA penalties for failing to provide a patient with treatment guidelines for 900 days. The $99,000 ERISA penalty is almost 3 times the amount of the medical claim benefits owed of $35,724.80 The US District Court Eastern District of more »
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A recent case may help out of network providers, which have complete valid ERISA assignments regarding appeal and reimbursement rights, receive checks directly from insurers. For the first time federal courts have rendered the clearest answers to date: managed care network participation is immaterial, ERISA assignment is the critical controlling factor to health-care benefits reimbursement. more »
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The 7th circuit panel, citing a recent Supreme Court decision, seems to have established new insurance verification laws under ERISA, in a case where a patient is entitled to a $77,974 monetary damage award after her health plan falsely verified coverage for a procedure when none existed thereby creating an ERISA fiduciary breach, holding the more »
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