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Recent Blog Posts

Settlement Reached in DeMaria v. Horizon Healthcare Services

On June 20, 2016, Zuckerman Spaeder LLP and Buttaci Leardi & Werner LLC as class counsel for the chiropractic classes in ALPHONSE A. DEMARIA, et al., on their own behalf and on behalf of certified classes v. HORIZON HEALTHCARE SERVICES, INC. d/b/a HORIZON BLUE CROSS BLUE SHIELD OF NEW JERSEY, et al., announced an agreement… Read More »

Third Circuit Holds No "Magic Words" Needed in an Assignment of Benefits to Create Derivative Standing under ERISA

On September 11, 2015, in North Jersey Brain & Spine Center v. Aetna, Inc., the Third Circuit held in a precedential opinion that a patient’s assignment of benefits does not have to directly reference the right to file suit to confer derivative standing upon a health care provider under the Employee Retirement Income Security Act… Read More »

NJ Appellate Division Holds that Continued Employment Demonstrates Consent to an Employer’s Mandatory Arbitration Policy

On July 23, 2015, in Jaworski v. Ernst & Young, a three-judge Appellate Division panels upheld language in Ernst & Young’s employment policy that states that employees were deemed to have accepted a mandatory arbitration policy by remaining company employees. As a result, three former employees of the accounting giant who allege to have been… Read More »

NJ Supreme Court Rules that the Right to a Jury Trial under the NJ Constitution Applies to Private Action Claims under the Insurance Fraud Prevention Act

On July 16, 2015, in Allstate New Jersey Insurance Co. v. Gregorio Lajara, the New Jersey Supreme Court held that the right to a civil jury trial provided by Article 1, Paragraph 9, of the New Jersey Constitution applies to private-action claims seeking compensatory and punitive damages under the New Jersey Insurance Fraud Prevention Act,… Read More »

New OIG Litigation Team To Focus on Fines, Exclusions from Federal Programs

At the American Health Lawyers Association annual meeting this past week, the Department of Health and Human Service’s Office of the Inspector General announced the implementation of an OIG Litigation Team which will focus on Civil Money Penalties and Exclusions. The unit will specialize in assessing civil penalties and excluding providers, drug manufacturers, and others… Read More »

OIG Recommends Steps for Compliance by Health Care Governing Boards

The U.S. Department of Health and Human Service’s Office of the Inspector General (OIG) recently provided health care governing boards with some new points of guidance on how to achieve high levels of compliance throughout their organizations. With federal agencies cracking down on fraud now more than ever, it’s important for these governing boards to… Read More »

Chiropractors Win Class Certification in Lawsuit against Horizon Blue Cross Blue Shield of New Jersey for Improper Benefit Denials

The United States District for the District of New Jersey has certified as a class action a lawsuit brought on behalf of thousands of chiropractic physicians who were denied reimbursement for health benefits by the New Jersey’s largest health insurance company. The three named-plaintiffs, as well as the now certified classes, are represented by the… Read More »

What Will the King v. Burwell Decision Mean for Health Care Providers?

An upcoming U.S. Supreme Court decision could have a major impact on the health care industry. In King v. Burwell, the plaintiffs believe the text of the Affordable Care Act (ACA) only allows for subsidies to be provided to policyholders in state-run exchanges. Additionally, they believe the regulations implemented by the Internal Revenue Service, which… Read More »

Next Round of HIPAA Compliance Audits Still on Hold

The next round of the Health Insurance Portability and Accountability Act (HIPAA) compliance audits is still on hold after a three-year delay, and federal regulators are declining to give any information regarding when that next round will begin. However, one government official did say there is a variety of brand new HIPAA-centric guidance in the… Read More »

Study: 40 Percent of Doctors Opt for Fines Over High-Quality Reporting Compliance

According to a recent report from the Centers for Medicare and Medicaid Services, more doctors are taking part in a reporting system geared toward prioritizing the quality of patient care over the number of patients served. However, the study also revealed that 40 percent of physicians would still rather have their pay slashed by 1.5… Read More »