Posted on March 8th, 2010 by William Jolley
Medicare Secondary Payer or “MSP” refers to circumstances where another entity, usually an insurer, is contractually obligated to pay for covered services before Medicare does, and must do so without regard to a patient’s Medicare entitlement. Since the early 1980s, Centers for Medicare & Medicaid Services (“CMS”) has been empowered to recover any overpayments from the entities which are primarily responsible for payments to Medicare beneficiaries. In order to facilitate these recoveries, Congress imposed reporting requirements beginning in 2009 for “Responsible Reporting Entities” or “RREs.” Notably, RREs include not only insurers, but also companies that self insure their liabilities or health care plans.
Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA Section 111), 42 U.S.C.…
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Posted on March 3rd, 2010 by Kim Winter
On February 11, 2010, the Mississippi Supreme Court overturned the lower court’s grant of summary judgment in favor of the insurer and held that a general contractor’s use of a subcontractor does not necessarily preclude coverage under the general contractor’s commercial general liability (”CGL”) policy for problems that arise once the project is complete due to work performed by the subcontractor. Architex Assoc. Inc. v. Scottsdale Ins. Co., ___ So.3d ___, 2010 WL 457236 (Miss. 2010). This was a major victory for the construction industry.
The policies in question provided coverage for an “occurrence” which was defined as “an accident, including continuous or repeated exposure to substantially the same general harmful conditions.” The policies excluded any property damage or bodily injury that…
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Posted on February 15th, 2010 by Jennifer McAdam
More that five years after the U.S. Supreme Court decided Aetna Health Inc. v. Davila, 542 U.S. 200 (2004), the Eleventh Circuit officially adopted the Court’s ERISA complete preemption test. Conn. State Dental Ass’n v. Anthem Health Plans, Inc., 2009 U.S. App. LEXIS 28773 (11th Cir. Fla. Dec. 30, 2009). The court determined that some of the plaintiff’s state law claims were properly removed pursuant to § 502(a)(1)(B), ERISA’s civil enforcement provision, 29 USCS § 1132(a)(1)(B). Id. at *2.
Dentists Rutt and Egan and Connecticut State Dental Association brought state law claims against Anthem for improper “‘downcoding’ and ‘improper bundling,’ as a means of underpaying participating dentists for services they performed.” Id. at *3. Anthem removed the case to federal court on the basis that the claims…
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