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December 08, 2023 | New York Law Journal

Torts: The Death of Duty of Care

A discussion of a health insurer's ability to overrule a doctor's prescription/plan via the "prior authorization" process, and whether or not this triggers the most fundamental concept in torts: the duty of care.
11 minute read
October 05, 2023 | Law.com

'That's Just Asking for Trouble, Isn't It?': Mass. Justices Mull Unemployment Benefits for Employee Fired Over Refusing COVID Vaccine

At oral arguments Wednesday regarding whether a home health aide who was fired for violating her employer's COVID-19 vaccination policy is owed unemployment benefits, several Massachusetts Supreme Judicial Court justices appeared wary of denying benefits to employees who express sincerely held religious beliefs.
5 minute read
October 02, 2023 | Connecticut Law Tribune

Updated: Cigna to Pay $172 Million to Settle False Claims Act Allegations

"Medicare Advantage plans that submit false information to increase payments from CMS show blatant disregard for the integrity of these vital federal health care funds," Christian J. Schrank, deputy inspector general for investigations with the Office of Inspector General for the Department of Health and Human Services, said. "Such actions are an affront to the Medicare program and the millions of patients who rely on its services. Working with our law enforcement partners, our agency will continue to prioritize investigating alleged fraud that targets the Medicare Advantage program."
3 minute read
September 01, 2023 | Daily Business Review

Top 10 Tips for Businesses to Prepare for Peak of Hurricane Season

With the impact from Hurricane Idalia, it should be a reminder to businesses in other hurricane-prone areas to be prudent in reassessing their preparedness plans as well.
7 minute read
August 30, 2023 | Texas Lawyer

Susman Godfrey Dismantles Federal Medical Billing Scheme

Referring to the plaintiffs' first claim, U.S. District Judge Jeremy D. Kernodle put an end to "ghost rates," a term used for calculating rates based on services providers have no intention to provide.
4 minute read
Law Journal Press | Digital Book Health Care Fraud: Enforcement and Compliance Authors: James F. Barger, Jr., J. Elliott Walthall, Elise May Frohsin, Benjamin P. Bucy View this Book

View more book results for the query "US Department of Health and Human Services"

February 01, 2023 | Connecticut Law Tribune

Judge Issues Preliminary Injunction, Restoring Medicaid Benefits to Nationwide Class

"We were pleased that the court recognized the need to grant relief, both because of the illegality of the rule, and because of the impact, and the court specifically found irreparable harm, for the entire class as defined," counsel for the plaintiffs Sheldon V. Toubman of Disability Rights Connecticut said.
3 minute read
December 12, 2022 | Law.com

In Closely Watched Ruling, Ohio Supreme Court Sides With Insurers on COVID-19 Business-Interruption Issue

Attorneys from Reed Smith, who filed an amicus brief on behalf of nonprofit United Policyholders, said the case "well demonstrates some of the inappropriate major hurdles that policyholders had to clear in litigating claims for loss from loss or damage from SARS-CoV-2 and COVID-19 and consequent orders of civil authorities."
8 minute read
September 01, 2022 | Connecticut Law Tribune

A Connecticut Legal Dispute Has Morphed Into a National Fight Over Medicaid

Attorneys say they realized this issue is affecting citizens across the United States. An amended complaint included two new plaintiffs from Delaware and Nebraska.
3 minute read
April 22, 2022 | New York Law Journal

2nd Circuit Sides with Health Insurer in Lawsuits Regarding Brand-Name Coverage, Individual Limit

The three-judge panel said a Department of Health & Human Services rule aligned with plaintiffs' argument over who should pay for medications, but it did not apply retroactively, thus denying her relief.
3 minute read
January 06, 2022 | New York Law Journal

An Insurance Fraud Year in Review

It is not difficult to understand why insurance fraud remains such a key area of focus for government officials, carriers and attorneys.
10 minute read

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