Recently, our clients have seen an increase in insurance claims where an insured, who has previously filed for bankruptcy, subsequently sustains a first-party property loss and seeks indemnification for the loss. There are several important issues to consider when investigating claims of this nature, including whether the insured has fraudulently valued the insurance claim

After he was hired to deliver casing and oversee its installation in an oil well, the insured delivered the casing but removed more, as excess, than he should have. As a result of this error, the well was too shallow. The well owner had the well reworked and sued the insured to recover its

Please click the link below to view Billing for Drug Overfill: New Compliance Risk or Old Prohibition? Adobe Reader is required to view the bulletin. If Adobe Reader is not installed on your PC, click here to download and install.

Billing for Drug Overfill: New Compliance Risk or Old Prohibition?

Building on its successful program that targets and recovers improper Medicare payments, on September 14, 2011, the Centers for Medicare & Medicaid Services issued a final rule to establish a Medicaid Recovery Audit Contractor (RAC) program. The Medicaid RAC program, part of the Patient Protection and Affordable Care Act which expanded the RAC program to

Please click the link below to view When the Government Knows Too Much for its Own Good. Adobe Reader is required to view the bulletin. If Adobe Reader is not installed on your PC, click here to download and install.

When the Government Knows Too Much for its Own Good

In 2004, the American Institute of Certified Public Accountants (“AICPA”) and Prudential Insurance Company of America entered into a group insurance contract through which AICPA members could obtain life insurance on the lives of their dependents. Pursuant to this arrangement, an application was filed with Prudential in the spring of 2004 for life insurance on

Assault And Battery Exclusion Bars Coverage Where Security Guard Allegedly Threw Glass At Plaintiff’s Face

After a fight broke out at the “Beauty Bar” in Manhattan, a woman sued Jinx-Proof Inc., contending that she had been injured when a security guard threw a glass at her face. Jinx-Proof’s commercial general liability insurer asserted

Please click the link below to view the Poor Judgment, Uninsured Loss. Adobe Reader is required to view the bulletin. If Adobe Reader is not installed on your PC, click here to download and install.

Poor Judgment, Uninsured Loss

Copyright © 2011 by A.M. Best Company, Inc.  Reprinted with permission.  All rights reserved.

Beth Abraham Health Services, a non-profit organization located in the Bronx that provides residential and community-based health care services for adults, hired the plaintiff in this case in October 1997 as an Authorization Specialist. The plaintiff’s main duty was to input information obtained from doctors, nurses, and others into a single, electronically-stored document called a

The Center for Medicare and Medicaid Innovation (“Innovation Center”) has extended certain deadlines for its new bundled payment program known as the “Bundled Payments for Care Improvement” initiative (the “Bundled Payments Program”), which was first announced on August 23, 2011.

A bundled payment approach combines payment for hospital, physician, and other provider services into a

Before considering arrangements involving the provision of durable medical equipment, prosthetics, orthotics, and supplies (“DMEPOS”) as part of their practice, healthcare providers must be mindful of not only the Stark Law and Anti-kickback Statute, but also of the CMS standards applicable to DMEPOS suppliers.[1] These standards are contained in 42 CFR § 424.57(c), and all

Palm Beach Grading, Inc., a general contractor on the Moody River Project in Florida, contended that the work performed by one of its subcontractors, A-1 Underground Services, Inc., on a sewer system pipe was defective. Palm Beach hired another subcontractor, RDMC, Inc., to repair the work. As a result, Palm Beach incurred $256,208.01 in

The Centers for Medicare & Medicaid Services (“CMS”) announced today that it is seeking applications from providers to participate in its Bundled Payments for Care Improvement (“BPCI”) initiative (more information about this program can be found at http://innovations.cms.gov/documents/pdf/Fact-Sheet-Bundled-Payment-FINAL82311.pdf). This is a program developed pursuant to the Affordable Care Act to accomplish the goals of

The New York Court of Appeals’ nine significant insurance law rulings last term displayed no discernible theme, evidenced no apparent trend, and reflected no obvious insurance law philosophy. Policyholders were victorious in some of the cases and insurance companies in others – and creditors in another.

The principal cases involved statutory construction, [1] policy construction,

Please click the link below to view New York Places Burden On Design Defect Defendant To Show the Infeasibility of An Alternative Design On Summary Judgment. Adobe Reader is required to view the bulletin. If Adobe Reader is not installed on your PC, click here to download and install.

New York Places Burden On Design