Before September 11 the Third Circuit Court of Appeals had been out of step with its sister federal circuits when it came to the right of hospitals, physicians and other health providers to sue health insurers that failed to cover patient obligations. So back in 2014 when North Jersey Brain & Spine Center …
Hospital Chain Pays Heavy Price for Being Too Clever
August 12, 2015 Leave a Comment
Finding that Community Hospital Systems had been “too clever by half” in negotiating a global settlement agreement for seven whistleblower suits, a federal judge ordered the chain to pay the attorneys’ fees of all the whistleblowers—not just the first to file. That’s on top of the $97 million Community …
Court Adopts Tough Interpretation of 60-Day Repayment Rule
August 4, 2015 Leave a Comment
New York’s Mt. Sinai Hospitals can’t seem to catch a break in its long-running battle with whistleblower Bob Kane. First, the government joined the case and wanted not just the $1,000,000 in Medicaid overpayments, but an additional $13,000,000. Why $13,000,000? Well, $1,000,000 trebled is $3,000,000; the …
District Court Holds That Michigan Tax on Benefit Payments is Not Preempted By ERISA
September 11, 2012 Leave a Comment
We previously addressed the passage of Michigan’s Health Insurance Paid Claims Assessment Act (“Act”), which imposes a 1% tax on claims paid by health insurance carriers, and the subsequent legal challenge to that law by the Self-Insurance Institute of America (“SIIA”) in SIIA v. Snyder. On August 31, …
ERISA Preemption of Michigan Paid Claims Assessment Act
January 26, 2012 Leave a Comment
We previously posted regarding Michigan’s Paid Claims Assessment Act (the “Act”) which assesses carriers a 1% surcharge on paid health claims. The Act defines carriers to include group health plan sponsors, along with insurance companies and also assesses third party administrators. Thus, it is likely that …
Michigan Creates Health Insurance Paid Claims Assessment Act
September 16, 2011 Leave a Comment
Michigan has become the newest state to institute an assessment on paid health care claims. Michigan Senate Bill No. 348, effective August 24, 2011, creates the “Health Insurance Claims Assessment Act” and initiates a 1% assessment on paid health claims. Employer-sponsored group health plans may be wondering …