Adam V. Russo | April 28, 2009
http://www.forbes.com/forbes/2009/0511/017-opinions-steve-forbes-the-fight.html?partner=email
The biggest domestic battle since the clintons tried to nationalize health care in the early 1990s is about to unfold. Sometime in June the Obama Administration will formally introduce its plan to deal with the problem of the 46 million Americans who don’t have health insurance. But the proposal will have far larger–and more ominous–implications for the country than the number of uninsured. This will be President Obama’s attempt to do what the Clintons couldn’t: truly socialize American health care. Make no mistake: Obama’s plan will be the Administration’s absolute top priority, trumping new energy taxes and the forced unionization of private-sector workers. Irrevocably sinking Washington’s claws deep into an area constituting 17% of the economy is too great an opportunity for this Administration to pass up. (more…)
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Adam V. Russo | April 28, 2009
The U.S. Congress announced the following on 4/24/09:
At a meeting with reporters on Friday, Senate Finance Committee Chair Max Baucus (D-Mont.) said he will temporarily set aside talks on a new public insurance option to focus on maintaining employer self-insurance plans, CQ Today reports. Self-insured companies qualify for tax exemptions through the Employee Retirement Income Security Act. The federal law allows firms to create their own tax-exempt insurance plan — a means of cutting costs by taking on the risks themselves — as long as the plans meet federal standards laid out by ERISA. Firms contract with private insurers to administer the plans. Baucus said he would aim to preserve this self-insurance system while expanding private coverage and public programs such as Medicaid. He said, “We’ll end up with more private insurance and more public insurance” (Armstrong, CQ Today, 4/24). (more…)
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Adam V. Russo | April 27, 2009
by Jim Foti of the Star Tribune, http://www.startribune.com/politics/state/43366962.html?elr=KArksD:aDyaEP:kD:aUnc5PDiUiD3aPc:_Yyc:aUU
When they added up all the losses incurred by survivors of the Interstate 35W bridge collapse and the families of those who died, the compensation panel came up with a number exceeding $99 million. (more…)
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Adam V. Russo | April 27, 2009
by Friedman, Domiano, & Smith, Co., L.P.A., please visit us at http://www.fdslaw.com
In a tort action in Ohio, a defendant is barred from introducing evidence of insurance payments to a plaintiff. This is known as the collateral source rule. The objective of the collateral source rule is to prevent liable defendants from benefitting from payments made to the plaintiff by third parties. (more…)
Category: Ohio |
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Adam V. Russo | April 23, 2009
We recently received an email from Karrie Andes, Director of Human Resources at Deffenbaugh Industries, Inc. & Affiliates informing us about The Savvy Self-Funding Healthcare Conference. Ms. Andes created this conference to help others learn about self-funding and affordable healthcare.
I will be attending the next conference, June 1st through the 3rd at The Westin Crown Center in Kansas City, Missouri. Click here to learn more about the conference.
Click here to see the Self-Funding Healthcare Conference press release.
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Adam V. Russo | April 23, 2009
Sharon Mondry worked for American Family and sought payment for speech therapy for her son from her self-funded health plan sponsored by American Family and administrated by the CIGNA the TPA. CIGNA denied payment fro Zev Mondry’s speech therapy on the basis that it was educational training and not restorative pursuant to the terms of the Plan Document. After months of trying, Mondry finally obtained all the relevant Plan documents and eventually got CIGNA to reverse its denial and pay the claims. Mondry filed suit alleging that American Family and CIGNA had violated a statutory obligation to produce plan documents and breached their fiduciary duties by misrepresenting the terms of the Plan. (more…)
Category: 7th, Summary Plan Description |
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Adam V. Russo | April 23, 2009
The HHS published its first guidance under the Health Information Technology for Economic and Clinical Health (HITECH) provisions of the American Recovery and Reinvestment Act. The HITECH Act amends the privacy and security provisions of HIPAA. This guidance provides key information to health care providers, health plans, health care clearinghouses and their business associates about the security of PHI. (more…)
Category: HIPAA |
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Adam V. Russo | April 22, 2009
by The Associated Press, 7 News, www.whdh.com
BOSTON — A prominent Boston area hospital has agreed to pay nearly $844,000 to settle allegations that it improperly billed the federal Medicare program from 2001 to 2005.
Federal prosecutors say the Lahey Clinic in Burlington submitted claims to Medicare for drug infusion therapy, chemotherapy and blood transfusion therapy services for multiple units of the services when only one should have been billed. (more…)
Category: Medicare, News |
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Adam V. Russo | April 21, 2009
Obama signed an executive order formally creating the new office assigned the task of pressing his goal of expanding and improving health coverage in America. In early March, Obama named former Clinton administration official Nancy-Ann DeParle to oversee the office. The executive order states as follows: (more…)
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Adam V. Russo | April 21, 2009
Critics contend further consolidation would give industry too much control
by Bruce Japsen of the Tribune Newspapers
Talk of potential mergers in the medical insurance industry has doctors and hospitals worried about health plans having too much clout over consumer choices and prices.
Speculation has run rampant that some of the nation’s biggest health plans may be looking to consolidate, including a possible takeover of Humana Inc. by Aetna Inc., as well as UnitedHealth Group’s interest in Coventry Health Care Inc. (more…)
Category: Medicare, News |
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Adam V. Russo | April 21, 2009
by Ricardo Alonso- Zaldivar, Associated Press Write of www.boston.com
WASHINGTON — A public health insurance option for middle class families could help cover the uninsured but it may well put private insurers out of business, a respected consulting firm concluded in a study released Monday.
The report by the Lewin Group, a numbers-crunching firm that serves government and private clients, said it all depends on details that lawmakers are far from deciding. Nonetheless, the report could provide ammunition for critics who say a public plan would move in the direction of government-run medicine. (more…)
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Adam V. Russo | April 17, 2009
by Marc Siegel of The Wall Street Journal
http://online.wsj.com/article/SB123993462778328019.html?mod=googlenews_wsj
Here’s something that has gotten lost in the drive to institute universal health insurance: Health insurance doesn’t automatically lead to health care. And with more and more doctors dropping out of one insurance plan or another, especially government plans, there is no guarantee that you will be able to see a physician no matter what coverage you have. (more…)
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Adam V. Russo | April 15, 2009
by Glorianna Scott, Denver Legal News Examniner, www.examiner.com
Colorado State Representative Christine Scanlan is expected to sponsor a bill to increase statutory caps on medical malpractice lawsuits. A similar bill, sponsored by Representative Terrance Carroll, failed last year. With only five weeks left in this session, Scanlan’s bill may be difficult to pass, but here’s why it should pass anyway: (more…)
Category: Colorado, Medical Malpractice |
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Adam V. Russo | April 13, 2009
by Emily Berry of AMNews staff, http://www.ama-assn.org/amednews/
When Snellville, Ga., internist Joel Fine, MD, read a note from a company called Health Research Insights, he thought it sounded a little bit like a chain letter — vaguely threatening, insistent on a quick response, with few details.
The letter, addressed “Dear Health Care Professional,” accused Dr. Fine of upcoding four claims for treating Georgia-Pacific employees. The earliest dated back to February 2005. “Of course, I was offended,” Dr. Fine said. “Dear Health Care Professional …” (more…)
Category: Provider Reimbursement, Third Party Administrators |
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Adam V. Russo | April 10, 2009
In the spring 2009 issue of the Texas Association of Benefit Administrators- The Benefit, you will find Adam V. Russo’s latest article “Never Events”.
click here to see Adam’s article.
Category: Never Events |
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