Latest Entries

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? Read more

A very significant, hidden amendment contained within President Obama’s health care bill – H.R. 3200 is currently being debated in Congress. This amendment will cause severe harm to the health insurance industry and overall health care cost containment efforts nationwide. The amendment will have a devastating effect on health insurance subrogation in all 50 states, and should be taken seriously by subrogation professionals, insurance companies, and anybody who is concerned about holding down the cost of health insurance in our country. Read more

Subrogation Alliance : Statement of Principles
August 5, 2009

The members of the Subrogation Alliance have joined together in support of these principles.

1. Subrogation serves the public interest by enabling insurance to be offered more broadly and less expensively than otherwise would be possible.

• Effectively managed subrogation programs promote cost containment to the benefit of those who pay for insurance – private citizens and taxpayers.

• An effective program of health insurance must entail the prudent conservation of resources, of which subrogation is an important part.

2. The Subrogation Alliance will seek to ensure the preservation of subrogation and to advance the rights of subrogation parties.

3. The Subrogation Alliance will seek to educate and inform those involved in lawmaking, so that the public is well-served by fact-based policy decisions.

4. The Subrogation Alliance will seek to articulate the interests of its clients in achieving a efficient, effective system of health insurance in the United States. Read more

by Janet Adamy and Elizabeth Williamson, The Wall Street Journal, www.wsj.com

Medical-device makers are adamant that U.S. health care needs fixing. They’re equally adamant that they shouldn’t have to pay for it.

“If you’re looking for savings, don’t come at us,” says Tim Trysla, a top industry representative. He has marched into the offices of 120 lawmakers, sometimes with General Electric Co. officials in tow, to argue that the government already provides so little reimbursement for high-tech medical scans that it shouldn’t chop payments further. Read more

As many of you know, Sec. 136 of the H.R. 3200, the underlying House tri-committee bill on healthcare reform, currently contains language requiring the new federal healthcare commissioner to “establish standards for the coordination and subrogation of benefits and reimbursement of payments in cases involving individuals and multiple plan coverage.” Last week, Representatives Braley (D-IA) and Barrow (D-GA) offered an amendment to H.R. 3200. This amendment (which is attached for your review) would significantly limit recovery rights. For those of you that practice in Georgia, the amendment adopts many elements of the Georgia subrogation statute (O.C.G.A. §33-24-56.1). Read more

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 self-insured employers to doctors and other health-care providers.

Under pressure from doctors, Metro Nashville Public Schools and Cookeville (TN)-based trucking company, Averitt Express Inc. asked Health Research Insights to stop sending letters that physicians say assume wrongdoing on their part without a review of related medical records. Read more

Please see the following email fowarded to Attorney Russo by Paul Gitnik:

August 4, 2009

Dear Mr. Grantz:

The amendment as offered by Congressman Barrow and Congressman Braley , specifically the inclusion of the Make Whole Doctrine is countervailing to any health care cost containment effort and in fact benefits the property and casualty insurers, automobile insurers and workers’ compensation carriers. I am certain that this language was crafted by either the American Association for Justice, formerly the Association of Trial Lawyers of America, or the property and casualty insurance industry. For year the American Association for Justice has inaccurately stated that subrogation/reimbursement potentially puts members in the middle of the insurance companies’ bickering or worse litigation. Most importantly, property and casualty insurers, automobile insurers and workers’ compensation carriers do want effective subrogation and injury coordination, because they have been economically benefiting at the cost of health plans, employers and consumers because health payors have been paying these third party accident related claims. Please see my written statement submitted at the Health Forum on June 29, 2009, that goes into detail on this issue. Read more

In Iowa Health Systems v. Graham, 2009 U.S. Dist. LEXIS 63544 (C.D. Ill. July 23, 2009), Iowa Health wants the Court to impose a constructive trust or equitable lien over a portion of specifically identifiable funds over which Graham has possession. Read more

SIIA, www.siia.org

Final House Committee Passes Healthcare Reform Bill
After a tumultuous 2 weeks of negotiations between moderate House Democrats and liberal House Democrats, a deal was finally struck between the two that allowed the healthcare reform bill to pass out of the House Energy and Commerce Committee – the last House Committee of jurisdiction over healthcare reform to pass their bill.

Read more

by Greg Hitt and Naftali Bendavid, The Wall Street Jornal, www.wsj.com

WASHINGTON — Senior House Democrats, seeking a health bill acceptable to rank-and-file lawmakers, are warming to a plan to tax insurers that sell high-end health policies. Read more

by Ezra Klein, The Washington Post, www.washingtonpost.com

The central problem in health-care reform is that good policy and good politics point in opposite directions. Good policy proceeds from the understanding that our health-care system is a fractured, pricey, inefficient mess. Good politics, however, proceeds from the insight that a lot of people rely on this fractured, pricey, inefficient mess and don’t trust Washington to change it. Good politics means, as Barack Obama frequently says, that if you like what you have, you get to keep it. But put those imperatives together and you have a strange problem indeed: How do you reform a system that you’re not allowed to change? Read more

by Robert Weisman, The Boston Globe, www.boston.com

If you want to know how the proposed overhaul of the US healthcare system may play out nationally, talk to top executives at the biggest medical and life sciences companies in Massachusetts. Read more

SIIA, www.siia.org

Senate Finance Committee Nearing Agreement
A team of 6 bi-partisan Members of the Senate Finance Committee are close to reaching agreement on a compromise healthcare reform package. Chairman Baucus’ goal from the start of this process was to introduce a package that was bi-partisan and could garner the 60 votes necessary to pass out of the Senate. The Committee has spent time meeting with various interested parties (including SIIA) and continues to develop cost cutting measures. Read more

Health Research Insights has contacted physicians in several states this year trying to collect alleged overpayments.

by Emily Berry, American Medical News, www.amednews.com  

The Tennessee Medical Assn. has filed a lawsuit against a collections company working in several states to take back reimbursements paid to doctors. The lawsuit alleges fraud and asks a state court to block the company from trying to collect any more money from physicians. Read more

by Andrea Jackson, Times-News, www.magicvalley.com

A Twin Falls lawyer is fighting a lawsuit slapped against him by a former client claiming negligence, and has filed paperwork to dismiss the case in Twin Falls 5th District Court.

William Hollifield, of the Hollifield Law Office in Twin Falls, is being sued by Amanda Fomichev, a former client who hired him as a personal injury lawyer after she lost a leg when she was hit by a vehicle while working as a car wash attendant almost four years ago at Lynch Oil Inc.’s Mr. Wash. Read more