Adam V. Russo | November 22, 2010

By Liz Kowalczyk of The Boston Globe, www.boston.com

Massachusetts health officials published online today the most comprehensive state database in the country listing payments drug companies and medical device makers made to hospitals, doctors, nurses, pharmacists, and other health care providers in the state.

The report lists $35.7 million in payments from hundreds of companies for the six months between July 1 and Dec. 31, 2009, for speaking, consulting, food, educational programs, marketing studies, as well as charitable donations. Nearly half of that money — $16.4 million — went to physicians. (more…)

Category: Massachusetts, News | No Comments »
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Adam V. Russo | November 22, 2010

MyHealthGuide, www.myhealthguide.com

MyHealthGuide Source: Tom Croft, Esq., King & Croft LLP, 11/18/2010 www.StopLossLaw.com

Case: Hornady Manufacturing Co. v. Perico Life Ins. Co., et al. No. 8: 10CV150, in the United States District Court for the District of Nebraska, 9/22/2010) Court’s Opinion

Mr. Croft’s Comment: It never ceases to amaze me how the myth that somehow stop loss cases are ERISA cases and thus removable to federal court survives, despite overwhelming authority to the contrary. This case illustrates another futile attempt by a TPA to land a case in federal court that has no business being there. (more…)

Category: ERISA, Fiduciary Liability, Stop Loss, Third Party Administrators | No Comments »
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Adam V. Russo | November 22, 2010

MyHealthGuide, www.myhealthguide.com

MyHealthGuide Source: Adam V. Russo, Esq., Co-founder, CEO of The Phia Group LLC, and contributing editor for Thompson Publishing Group’s the Employer’s Guide to Self-insuring Health Benefits, Todd Leeuwenburgh, Editor.

When visiting London, there are many fascinating sights to visit. You may choose to spend some time strolling around Piccadilly Circus, visiting some of the local pubs, or seeing historic Westminster Abbey or Big Ben. Regardless, one of the fastest and easiest ways to get from point A to point B is via the London Underground, or if you’re a local, the Tube. The Tube is London’s subway system, and if you’ve ever had the pleasure of using it, you’ll remember one thing above all else: “Mind the Gap!” In England, they want you to avoid the space between the boarding platform and the train. (more…)

Category: Plan Language, Summary Plan Description, Third Party Agreements | No Comments »
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Adam V. Russo | November 22, 2010

by Denise M. Keyser, Clifford J. Schoner and Michelle M. McGeogh of Employee Benefit News, www.employeebenefits.com

The Equal Employment Opportunity Commission recently released final regulations implementing Title II of the Genetic Information Nondiscrimination Act of 2008 (GINA). Although GINA was effective Nov. 21, 2009, these regulations do not take effect until Jan. 10, 2011. (more…)

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Adam V. Russo | November 18, 2010

SIIA, www.siia.org

Agencies to Allow Groups to Change Fully-Insured Carriers

Late this afternoon Federal agencies issued an amendment to the interim rule released during the summer that dealt with grandfathering status. In that proposed rule, regulators stated that changing fully-insured health insurance carriers would cause groups to lose their grandfathered status. Today’s amendment to that rule reversed that provision to now allow groups to change their fully-insured carrier under certain circumstances and not lose their grandfathered status. (more…)

Category: Health Care Legislation, PPACA | No Comments »
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Adam V. Russo | November 18, 2010

By Heidi Turner, www.lawyersandsettlements.com 

Washington, D.C.: Proposed changes to ERISA (Employee Retirement Income Security Act) laws could strengthen the requirements of people who act as fiduciaries for an ERISA plan. The proposed ERISA benefits changes would increase the responsibility given to people who give advice about how an employee stock plan or employee savings plan is run, even if that advice is given infrequently. (more…)

Category: ERIC | No Comments »
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Adam V. Russo | November 18, 2010

MyHealthGuide, www.myhealthguide.com

Federal Court Chastises Stop Loss Carrier Over Efforts to Achieve Piecemeal Adjudication of Multiple Claims

MyHealthGuide Source: Tom Croft, Esq., King & Croft LLP, 11/10/2010 www.StopLossLaw.com

Case: Bekaert Corp. v. Standard Security Life Insurance Company of New York, Inc., No.5:09 CV 2903, in the United States District Court for the Northern District of Ohio, October 8, 2010) Court’s Opinion. (more…)

Category: Ohio, Stop Loss, Welfare Benefit Plans | No Comments »
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Adam V. Russo | November 18, 2010

MyHealthGuide, www.myhealthguide.com

MyHealthGuide Source: Jim Farley, J. P. Farley Corporation, 11/10/2010, www.jpfarley.com

USA Today (10/22/2010) featured a front page article (below) about a small physical therapy firm in Michigan who has successfully sued Blue Cross and Blue Shield of Michigan for tactics that would put the small firm out of business for offering Ford, GM and Chrysler an alternative that would have saved them millions of dollars per year on physical therapy claims. This is the same Blue Cross plan that has had suit filed against it by the U.S. Department of Justice for paying hospitals higher prices in exchange for bigger discounts. (It should be noted, others are being investigated by the feds and states for similar practices.) (more…)

Category: Claims Procedures, Claims Review | No Comments »
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Adam V. Russo | November 18, 2010

MyHealthGuide, www.myhealthguide.com

MyHealthGuide Source: Fred Hunt, President, Society of Professional Benefit Administrators (SPBA), 11/10/2010, www.SPBATPA.org

Preface by Mr. Hunt: For 30 years, I have been providing these very candid insights & prognosis. They are provided to all SPBA members as well as available for the outside world to read. To my own surprise, the accuracy rate of the forecasts has been extremely high. This time, I think the forecast will again be accurate, but the outcome more circuitous, with so many specific issues in flux right now. Flux will remain for about 4 years. (more…)

Category: Health Care Legislation, News, PPACA, Welfare Benefit Plans | No Comments »
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Adam V. Russo | November 4, 2010

Our industry is subject to a variety of regulations with which they must comply. Only when armed with up to date information can compliance be assured. The Phia Group is on forefront of such developments, and has established a service to provide clients with early notice and comprehensive updates. This information is essential to proactively address pending legislation in a timely fashion.

With this service, The Phia Group will inform subscribers of developments related to pending regulations meeting industry specific search criteria. Clients may then request additional in-depth research be performed for an hourly fee, regarding any particular regulation of which they are so advised. (more…)

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Adam V. Russo | November 2, 2010

Sent from Daran Kiefer, Esq. of NASP, www.subrogation.org

The Chicago Bar Association is following the footsteps of the Ohio Bar as its Insurance Law Committee votes today at 1:00 P.M. Central Time whether to support a bill to limit health and medical payments subrogation rights in Illinois. This proposed change has been recommended by the Civil Practice Committee and is pending review by the Insurance Law Committee today. The Chicago Bar Association Legislative Liaison urged the committee members to vote against recommending the bill. (more…)

Category: Illinois, Subrogation | No Comments »
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Adam V. Russo | November 1, 2010

MyHealthGuide, www.myhealthguide.com

MyHealthGuide Source: Matthew Brodsky, Senior Editor/Web Editor, Risk & Insurance® Article

Employers weigh the difficulties of grandfathering their employee-health plans under new federal guidelines versus the opportunities of self-insurance. The self-funded marketplace could win.

After fearing and lobbying against federal health reform, the industry that caters to self-funding employers might actually experience new, profitable opportunities, thanks to the Patient Protection and Affordable Care Act. (more…)

Category: Health Care Legislation, PPACA, Welfare Benefit Plans | No Comments »
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