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Healthcare Fraud › Employee Benefits

Fennemore

Lessons Learned from ERISA Health Plan Representation and Recommendations for Plan Design and Oversight

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ERISA Health Plan clients are engaged in nearly every industry in the United States. There are nearly 139 million Americans covered by ERISA Health Plans and 2.5 million Health Plans. Yet, operating a health plan has become...more

Rivkin Radler LLP

High-Profile Sports Insurance Fraud Rings: A Recent Conviction

Rivkin Radler LLP on

No health insurance benefit program, no matter how high profile, is immune to the temptations of insurance fraud. In the past, multiple former NFL players pleaded guilty to defrauding the NFL Player Health Reimbursement...more

Keating Muething & Klekamp PLL

Benefits Monthly Minute - November 2023

Keating Muething & Klekamp PLL on

The November Monthly Minute digs into the new proposed LTPT regulations, 2024 benefit limits, and the NBA health plan fraud verdict. Indigestion from Turkey and Stuffing or the IRS’ Proposed LTPT Regulations? ...more

Robinson+Cole ERISA Claim Defense Blog

Second Circuit Addresses Limitations Periods Governing Fraudulent Billing Claims Against Non-Participating Labs

Robinson+Cole ERISA Claim Defense Blog on

In Connecticut General Life Ins. Co. v. BioHealth Labs., Inc., No. 20-2312-CV, — F.3d –, 2021 WL 476111 (2d Cir. Feb. 10, 2021), Cigna, as administrator of employee health plans, sued six out-of-network lab companies for...more

Seyfarth Shaw LLP

Fraud In Your Healthcare Plan? It’s Probably There

Seyfarth Shaw LLP on

Seyfarth Synopsis: Employer subsidized healthcare is one of the largest cost centers for small and large businesses.  This post provides a primer on what to do if you suspect that your healthcare costs are rising because your...more

Seyfarth Shaw LLP

Vindication! Fifth Circuit Reverses Notorious District Court Health Care Fraud Decision

Seyfarth Shaw LLP on

Seyfarth Synopsis: In a major victory for ERISA plans and other payors, the Fifth Circuit recently overturned a district court’s notorious decision in favor of a healthcare provider and reinstated a plan administrator’s...more

Seyfarth Shaw LLP

Fourth Circuit Affirms Health Care Fraud Convictions for Billing Insurers for Medically Unnecessary Services

Seyfarth Shaw LLP on

Seyfarth Synopsis: The Fourth Circuit found that the medical necessity of a given service constitutes a material element of representations regarding submissions for payment, potentially providing payors with another legal...more

Burr & Forman

2016 Health Care Year in Review

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Since I began writing this year-end review in 2013, there have been some common themes – a shift to pay for quality and away from fee-for service, much of which has been brought about by the Affordable Care Act (ACA): efforts...more

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