Phia Group Russo & Minchoff

Welcome To My Site...

The Health Insurance Blog of Attorney Adam V. Russo
Welcome to Passion for Subro! The purpose of this site is to share my passion for the health insurance industry with the rest of you fanatics. I hope this site will be your destination for the latest in health care as well as self insured news across the country. While I envision that this site will serve as a great educational resource, it will also keep you entertained with the funny, difficult, confusing and just plain weird world of self insurance.
Thanks for visiting!

September 2010
S M T W T F S
« Aug    
 1234
567891011
12131415161718
19202122232425
2627282930  

California Law Requires a Convict to Reimburse An Injured Party’s Billed Medical Expenses

Posted By bhoffman on August 25, 2010

Coordination of Benefits Handbook

The California Penal Law §202.4(f) requires that anyone who is found guilty of a criminal act that results in harm to a victim to provide restitution for economic losses incurred by the victim. A recent decision by a California Court of Appeal required such restitution based on the billed medical expenses incurred rather than on lower rates negotiated by that person’s medical insurer. The case is People v. Scott, 2010 WL 1820181 (Cal. App., 4 Dist., May 7, 2010). (more…)

Florida Statute Limits Insurer’s Reimbursement from Tort Settlement

Posted By bhoffman on August 25, 2010

Coordination of Benefits Handbook

In a case that does not involve a health plan subject to ERISA, a Florida appellate court ruled that a health plan’s reimbursement from the proceeds of a settlement of a medical malpractice case was limited to the amount paid by the plan less its pro-rata share of attorney’s fees incurred by the plaintiff. The case is Ingenix v. Ham, 2010 WL 1780012 (Fla. App., May 5, 2010). (more…)

Ohio Collateral Source Statute Permits Evidence of Actual Medical Expenses Paid by Injured Party

Posted By bhoffman on August 25, 2010

Coordination of Benefits

The common-law collateral source rule is intended to ensure that a person who suffers a financial loss as a result of other person’s wrongdoing does not achieve reimbursement of more than 100 percent of the loss from all sources. In Ohio, the modern collateral source rule is governed by a statute that permits the alleged wrongdoer to “introduce evidence of any amount payable as a benefit to the [injured party] as a result of the damages that result from an injury, death or loss to person or property that is the subject of a claim upon which the action is based, except of the source of collateral benefits has… a contractual right of subrogation.” The Supreme Court of Ohio recently considered the application of the statute in determining how much the injured party received in benefits from his health insurer. The case is Jacques v. Manton, 2010 WL 1816324 (S. Ct. Ohio, May 4, 2010). (more…)

New Jersey Collateral Source Rule Does Not Bar Medicare’s Recovery of Health Benefits

Posted By bhoffman on August 25, 2010

Coordination of Benefits Handbook

Medicare clearly has a right of reimbursement of payments it made for medical services when a third party is determined to have responsibility for those expenses. 42 U.S.C. 1395y(b)(2). New Jersey’s collateral source rule provides that if a person receives benefits for injuries from any source other than a joint tortfeasor, those benefits shall be disclosed to the court and the amount that duplicates any benefit contained in the award shall be deducted from any award recovered by that person. (N.J.S.A. 2A:15-97). A recent decision of the Appellate Division of the Superior Court of New Jersey considered how those two statutes interact. The case is Jackson v. Hudson Court, LLC, 2010 WL 2090036 (N.J. Super, App. Div., May 24, 2010). (more…)

Alabama’s Collateral Source Rule Statute is Upheld

Posted By bhoffman on August 25, 2010

Coordination of Benefits Handbook

Alabama’s collateral source rule statute has been through a turbulent history since it was enacted in 1987. In 1996, the Alabama Supreme Court ruled that the statute violated the due process and equal protection guarantees of the Alabama Constitution. However, in 2000, the Alabama Supreme Court reversed its earlier decision holding that statute to be unconstitutional. A recent decision by a U.S. District Court in Alabama dealt with the complexities resulting from this turbulent history. The case is Shelley v. White, 2010 WL 1904043 (M.D. Ala., May 10, 2010). (more…)

SIIA Legislative Update – 08/24/10

Posted By bhoffman on August 25, 2010

SIIA, www.siia.org

Oklahoma Tax on Paid Claims Ruled Unconstitutional

This afternoon, a recently enacted tax that would have applied to all claims paid in Oklahoma by health plans, was struck down by the Oklahoma Supreme Court.

Earlier this summer, the Oklahoma State Legislature passed a measure, subsequently signed into law by the Governor, which would have assessed a 1% tax on all health claims paid within the State. TPAs of self-insured health plans as well as stop-loss providers were to be taxable entities. (more…)

SIIA PPACA Update – 08/24/10

Posted By bhoffman on August 25, 2010

SIIA, www.siia.org

Departments of Labor, Treasury and Health and Human Services Issue Enforcement Safe Harbor for Compliance of Mandated External Review Process

Federal agencies released a Technical Notice detailing safe harbor options for non-grandfathered self-insured plans to avoid non-compliance of the PPACA’s external review process requirement. (more…)

Newly Proposed HIPAA Regulations Contain Some Surprises

Posted By bhoffman on August 16, 2010

By Norbert F. Kugele of Warner Norcross & Judd LLP, www.wnj.com

Back in February of 2009, many of us were somewhat taken aback to find HIPAA amendments in the economic stimulus bill. After months of delay, proposed regulations implementing these amendments – commonly known as the HITECH amendments – have finally arrived, and they contain a few surprises! Here’s a quick summary of some key provisions that will impact employer-sponsored health plans. (more…)

HIPAA Isn’t a Shield Against Third-Party Payor Audits

Posted By bhoffman on August 16, 2010

By Deborah J. Williamson of Warner Norcross & Judd LLP, www.wnj.com

A frequent question of physicians, medical practices and other providers I represent is whether the HIPAA Privacy Rule prohibits them from providing third-party payors with access to medical records for the purposes of an audit. In other words, does HIPAA prevent third-party payors from conducting post-payment audits? (more…)

State Health Care Reform Update

Posted By bhoffman on August 12, 2010

CCH® BENEFITS, www.hr.cch.com

California

The California Public Employee’s Retirement System (CalPERS) has approved an average increase of more than 9% in health premiums next year for state and local government workers. CalPERS blamed the rate increase on rising costs for hospital care, doctor visits, and prescriptions. The increase will mean higher premiums for public agencies and their 1.3 million employees, dependents, and retirees. For more information, visit http://www.calpers.ca.gov/. (more…)

Withholding Information from Health Plans — What does HIPAA say?

Posted By bhoffman on August 12, 2010

By Norbert F. Kugele of Warner Norcross & Judd LLP, www.wnj.com

If a patient asks you not to report treatment to his or her health plan, are you prepared to carry out that request?

HIPAA privacy regulations have always given individuals the right to request restrictions on how health care providers use or disclose their information, but until recently, health care providers have always had the discretion to say “no” to these requests. (more…)

Executives at Health Insurance Giants Cash in as Firms Plan Fee Hikes

Posted By bhoffman on August 11, 2010

Leaders of Cigna, Humana, UnitedHealth, WellPoint and Aetna received nearly $200 million in compensation in 2009, according to a report, while the companies sought rate increases as high as 39%.

By Noam N. Levey of the Los Angeles Times, www.latimes.com

The top executives at the nation’s five largest for-profit health insurance companies pulled in nearly $200 million in compensation last year — while their businesses prepared to hit ratepayers with double-digit premium increases, according to a new analysis conducted by healthcare activists. (more…)

HHS Withdraws HIPAA Security Rules

Posted By bhoffman on August 10, 2010

CCH® BENEFITS, www.hr.cch.com

An interim final rule under the Health Information Technology for Economic and Clinical Health (HITECH) Act was published in the Federal Register on Aug. 24, 2009, and became effective on Sept. 23, 2009. (more…)

Federal government does not have right to implement universal health care, says attorney Jonathan Emord

Posted By bhoffman on August 9, 2010

CCH® BENEFITS, www.hr.cch.com

Congress is relying on circular reasoning in its attempt to require all Americans to obtain health insurance, and the constitutionality of the Patient Protection and Affordable Care Act (PPACA) is questionable, according based in to attorney Jonathan W. Emord, principal of Emord & Associates, based in Clifton, VA. The following is an excerpt from a two-part interview conducted by CCH with Mr. Emord. The interview will appear in the two August editions of CCH’s Employee Benefits Management Directions newsletter. (more…)

Medicare Savings Projections in Dispute

Posted By bhoffman on August 6, 2010

By Richard Wolf, USA Today

WASHINGTON — Savings projected under the landmark health care law signed by President Obama this year have improved Medicare’s financial projections, but Republican critics and even the program’s chief actuary say the new prognosis is too rosy. (more…)