On April 12, 2012, State Governor Andrew M. Cuomo issued an Executive Order to establish the New York State Health Benefit Exchange (the “Exchange”), in conformity with the federal Affordable Care Act.  The Order calls for the establishment of the Exchange within the Department of Health and to be funded entirely with federal funds until

CMS has included in the final rule for the 2012 Medicare Physician Fee Schedule the long awaited new policy relating to the so-called “three-day window”.  Simply stated, the new policy will wrap or bundle a patient’s payments for inpatient stays to include all services provided within three days of admission by a hospital wholly owned

In an era of evolving health care and advanced communications technology, there is room for participation by not only health professionals, but also business entities seeking to partake in the redesign of care processes and delivery of quality services. 

Instead of providing medical or clinical services, many have opted to become health supporters or concierge

As has been highlighted in this column on a number of occasions,[1] insurance fraud in connection with New York’s no-fault automobile insurance law[2] is a tremendously large problem that affects both automobile insurance companies and policyholders, leading to millions of dollars in losses and increased premiums. In an effort to combat no-fault insurance fraud, insurance

Insured’s Failure To Notify Insurer Of Arbitration Settlement Dooms SUM Claim

After the insured was involved in a car accident, he settled an arbitration with the alleged tortfeasor and then sought supplementary uninsured/underinsured coverage under his auto policy. The insurer denied the claim, asserting that it had not received written notice of the insured’s

A competitor of C.R. Bard, Inc., which manufactures urological medical products, alleged that Bard unlawfully had disparaged a catheter it manufactured by intentionally misrepresenting to prospective purchasers that nitrofurazone, an anti-microbial agent released into the catheter/urethra interface to protect the urethral tract and bladder tissues from infection, was an “antibiotic when it is in

Crystal Mandall started working as a dental assistant for a New Jersey dental center in November 2007. On April 20, 2010, she was arrested on criminal charges. She kept in touch with the dental center through a relative, promising to return to work as soon as she was released. She remained incarcerated until May 1.

Please click the link below to view the Claim Tossed Under the Bus. Adobe Reader is required to view the bulletin. If Adobe Reader is not installed on your PC, click here to download and install.

Claim Tossed Under the Bus

Copyright © 2012 by A.M. Best Company, Inc.  Reprinted with permission.  All rights reserved.

Please click the link below to view Should Healthcare In the United States be Considered a Public Utility?. Adobe Reader is required to view the bulletin. If Adobe Reader is not installed on your PC, click here to download and install.

Should Healthcare In the United States be Considered a Public Utility?

Reprinted with permission. 

Lawyers are not immune from the call of the Internet and the growing marketing opportunities that it represents. Lawyers who provide services to small businesses and individuals are particularly attracted to Internet applications that enable them to target potential clients before the client walks in the firm’s door.  Lawyers that use these Internet applications are

Statute of Limitations Begins to Run When Insurer Could Seek Payment of Adjusted Premiums, Not When It Later Issued Invoices

Hahn Automotive Warehouse, Inc. obtained insurance policies that required regular adjustments of premiums based on actual claims experience. An insurer discovered in 2005 that it had not billed Hahn for years of adjusted premiums

Joel and Evelyn Hirschhorn owned a vacation home in Wisconsin that was covered by a homeowners insurance policy that insured the home, along with structures and personal property located at the insured property, against “accidental direct physical loss.” It also contained a pollution exclusion clause that excluded from coverage any loss “resulting directly or

The plaintiff in this case began working at a senior living facility operated by Brookdale Senior Living Communities, Inc., in Pompano Beach, Florida, on October 5, 2008. She was terminated 11 months later, in September of 2009. In June 2009, the plaintiff advised Brookdale that she was pregnant and would be requesting leave under the

In its ongoing efforts to address the “rapid growth of the Internet, including social media tools and other emerging technologies,” and its use by medical professionals, consumers and drug and medical device manufacturers and distributors, the Food and Drug Administration (FDA) recently issued a draft guidance proposing ways that a drug or device company may

More and more automobile insurance companies seek to combat no-fault insurance fraud by suing health care providers and others for fraudulently obtaining or seeking to obtain benefits[1] under New York’s no-fault law.[2] These lawsuits often combine claims to recover monies paid to the providers with a declaratory judgment action as to claims denied and/or not yet