Federal Judge Presses Pause of Recoupment
On June 28, 2018, a federal judge in Texas held that the Centers for Medicare & Medicaid Services (“CMS”) was not permitted to recoup 7.6 million dollars in alleged Medicare ...
Third Circuit Affirms the Enforceability of Anti-Assignment Clauses in ERISA Plans, While Also Affirming a Provider’s Right to Proceed in Challenging a Benefit Denial on Behalf of a Patient through a Limited Power of Attorney.
On May 16, 2018, the Third Circuit in American Orthopedic & Sports Medicine v. Independence Blue Cross Blue Shield held anti-assignment clauses in ERISA governed health insurance plans are generally ...
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 ...
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 ...
Health Care Providers Slow to Implement Risk-Based Reimbursement Models
With significant changes in the medical field due to the passage of the Affordable Care Act, the current fee-for-service health care model is likely on its way out. However, though ...
New Jersey Doctors Admit to Taking Bribes
Two doctors practicing in Secaucus and Hawthorne, New Jersey recently admitted that they accepted various bribes in exchange for test referrals. The bribery scheme was operated by Biodiagnostic Laboratory Services ...
Hospitals Sue Medicare Over “Two Midnights” Rule Due to Reimbursement Issues
The Einstein Healthcare Network has joined in with Banner Health in Phoenix, Wake Forest Baptist Medical Center in Winston-Salem and Mount Sinai Hospital in New York in lawsuits against administrators ...
Medicaid Expansion in New Jersey
A key feature of the Affordable Care Act (ACA), the loosening of Medicaid eligibility requirements, is aimed at making coverage available to the working poor whose wages are near the ...
Capping Medicare and Medicaid Patients
In an effort to ease some of the medical profession’s trepidation concerning the Affordable Care Act (ACA), many proponents have pointed out that it is likely to bring a new ...
Health Care Reimbursement Obstacles
The insurance system — whether involving private policies or public programs like Medicare and Medicaid — is a double-edged sword for physicians and medical professionals. While it provides a means ...