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…)
Category: California, Subrogation |
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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…)
Category: Attorneys' Fees, ERISA, Florida, Preemption, Subrogation |
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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…)
Category: Ohio, Subrogation |
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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…)
Category: Medicare, New Jersey |
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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…)
Category: Alabama, Subrogation |
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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…)
Category: Claims Procedures, Oklahoma |
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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…)
Category: PPACA |
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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…)
Category: HIPAA |
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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…)
Category: Claims Review, HIPAA, Third Party Administrators |
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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…)
Category: California, Connecticut, Health Care Legislation, Kansas, Louisiana, Maine, Massachusetts, New York, Ohio, Utah, Washington D.C., Wisconsin |
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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…)
Category: HIPAA |
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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…)
Category: News |
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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…)
Category: HIPAA |
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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…)
Category: Health Care Legislation, PPACA |
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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…)
Category: Medicare |
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