Adam V. Russo | April 20, 2010
Introduction
Over the course of the past several years, the value proposition of Preferred Provider Organizations (PPOs) has come under increasing scrutiny. Many have thought that if price can be controlled, health care costs can be controlled or at least mitigated. The truth is that health care costs are an intricate and complex balancing act between [...]
Adam V. Russo | August 19, 2009
by Paul Raeburn, www.kaiserhealthnews.org
On the evening of March 1, 2008, Gary Diego was relaxing with his wife, Ellen, when she abruptly lost her hearing, began repeating herself, and seemed to be losing her grip.
Adam V. Russo | August 11, 2009
by Jeremy Smerd – Workforce Management, www.workforce.com
A medical billing company may be blowing smoke, but could reimbursing patients for medical marijuana lower drug costs for employers?
Adam V. Russo | August 5, 2009
Reaction from AMA, TMA, GMA, Self-Funded Employer• Getahn Ward, The Tennessean, 5/16/09, Tennessee HRI Article
• Emily Berry, American Medical News, 4/13/09, AMedNews Article
• Tennessee Medical Association (TMA) Legal Department 5/5/09, TMA Alert on HRI Recoupment Letters
Franklin (TN)-based Health Research Insights, has temporarily halted efforts to collect on potential overpayments of medical claims by two Nashville-area [...]
Adam V. Russo | May 27, 2009
Legal action is one option against Health Research Insights.
by Emily Berry, American Medical News, www.amednews.com
Medical societies in several states are talking about how to fight back against a Tennessee-based firm hired by self-insured companies to collect perceived overpayments to physicians.
Doctors in Georgia were the first to be contacted by Health Research Insights, and the Medical [...]
Adam V. Russo | May 27, 2009
Doctors protested self-insured Georgia-Pacific’s attempt to collect refunds of suspected claims upcoding.
by Emily Berry of American Medical News, www.amednews.com
Following an outcry from physicians and discussions with the Medical Assn. of Georgia, one of Atlanta’s largest employers has temporarily halted work by a company it hired to seek supposed overpayments from doctors.
Adam V. Russo | May 20, 2009
by Emily Berry of American Medical News, www.amednews.com
Following an outcry from physicians and discussions with the Medical Assn. of Georgia, one of Atlanta’s largest employers has temporarily halted work by a company it hired to seek supposed overpayments from doctors.
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 [...]
Adam V. Russo | January 28, 2009
One of the biggest problem areas in the healthcare industry is the practice of balance billing of patients by non-participating providers for services reimbursed by the patient’s insurer at less than the provider’s billed charges. The providers’ demand to be paid the balance then becomes a point of contention in a three way battle between [...]
Adam V. Russo | October 6, 2008
When negotiations concerning a possible settlement of plaintiff’s subrogation claim failed, Ms. DeBoer demanded her share of the settlement, and the attorney defendants paid over to her the amounts they had recovered, less their counsel fees and expenses. In doing so, they carefully notified Ms. DeBoer of her obligation to repay the plaintiff’s subrogation claim, [...]
Adam V. Russo | November 28, 2007
There is a recent newsworthy item that I wish to discuss, as it is pertinent to our industry. The November 20, 2007 Wall Street Journal featured an extremely negative cover story, relating to the self-insured industry’s subrogation activities under ERISA. These types of prominent news stories do nothing for the self-insured industry except motivate the [...]
Adam V. Russo | November 13, 2007
On September 25, 2007, a Federal District Court in New Jersey held in Mulholland v. UFCW Local 1776 Participating Employers Health and Welfare Fund, 2007 WL 2814648 (DNJ) that the purchase of stop loss insurance does not preclude self-funded ERISA status. The court went on to say that because self-funded plans can come close to [...]
Adam V. Russo | November 13, 2007
The United States District Court for the Eastern District of Texas recently presided over a case involving a plan’s denial of claims due to a lack of signed subrogation agreement. Don Burgett, Et. Al. v. MEBA Medical and Benefits Plan, 2007 U.S. Dist. LEXIS 70934, (September 25, 2007). The Plan in this case lost, and [...]
Adam V. Russo | November 13, 2007
The Texas Made-Whole Rule, adopted in Ortiz v. Great Southern Fire & Casualty Insurance Co., no longer applies to cases where the Plan disclaims the rule and requires full reimbursement in the plan document. 597 S.W.2d 342, (Tex. 1980). In the Ortiz case the insurance carrier relied upon arguments made in equity. The court held [...]
Adam V. Russo | November 13, 2007
In the case of Bauhaus USA, Inc. v. Lillie Regina Holmes Copeland, et. al., 2007 Miss. LEXIS 545 (September 27, 2007), a self-funded Plan coming under the purview of ERISA sought reimbursement of claims it had paid on behalf of a minor child. The court took possession of funds in order to create a trust [...]
