Attack on ERISA Preemption Continues…

By: Chris Aguiar, Esq. ERISA preemption seems like such a simple concept; further proof that reasonable minds can disagree.  In just the past 10 days we have received mixed messages from some of the highest courts in the country.  First it was the 8th Circuit’s unanimous pro-preemptio
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Hospitals’ billion-dollar pension dispute heads to Supreme Court

By Ayla Ellison The U.S. Supreme Court agreed on Friday to take up appeals filed by Christian-affiliated hospital systems that are accused of underfunding their employee pension plans. In the three lawsuits, which were consolidated into one case, the high court will decide whether the
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“Recoupment or Embezzlement? Cross-plan offsets in the crosshairs”

By Andrew Silverio When a self funded employee benefit plan, or indeed any payer of health benefits, overpays a benefit claim to a medical provider, it is often a tall task to later secure refunds.  This is especially true when the payment, even if clearly an “overpayment” pursuant to
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Federal Judge Denies United Healthcare’s Motion to Dismiss in Case Brought by Texas General Hospital for Unpaid & Underpaid Claims

By Brado Bizarro, Esq – The Phia Group, LLC Background Texas General Hospital is a private, acute care facility located in Grand Prairie, Texas. It is outside of UnitedHealthcare’s (“United”) provider network. In January of 2015, Texas General was the subject of intense scrutiny
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ERISA Plan Cannot Recover Settlement Funds That Have Been Spent

MyHealthGuide Source: William H. Payne IV and René E. Thorne Case: Montanile v. Board of Trustees of the National Elevator Industry Health Benefit Plan, Supreme Court Ruling The U.S. Supreme Court has narrowed, ever so slightly, the ever-changing definition of “appropriate equit
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Anti-Assignment Clauses Bar Provider’s ERISA Claims

By Carmen Castro-Pagan An out-of-network health-care provider can’t continue with her claims under the Employee Retirement Income Security Act for unpaid benefits, fiduciary breach and failure to disclose documents against four health benefit plans, the U.S. Court of Appeals for
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Supreme Court Ponders Scope of ERISA Plan Recovery Rights

MyHealthGuide Source: Todd Leeuwenburgh, 11/11/2015, Thompson Blog Case: Montanile v. National Elevator Industry Health Benefit Plan, No. 14-723 (U.S., March 30, 2015) . Supreme Court Document U.S. Supreme Court Justices questioned parties in a case that could further clarify when an
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The Road to Recovery: Subrogation Gets Its Day In Court … Again

By Christopher M. Aguiar, Esq. (As published within The Self-Insurer)  In a country with a seemingly infinite amount of regulation and concerns regarding benefit plan compliance following the passage of the Affordable Care Act in 2010, one would expect much attention from courts in th
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Be Smart When Self-Funding

By Adam V. Russo, Esq. (As published in Thompson Information Services’ Employer’s Guide to Self-Insuring Health Benefits)   Introduction While we are seeing record growth across the country, self-funding is a topic that few are familiar with, even though many participate i
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Texas Prompt Pay Law Not Preempted; Enforceable Against Self-Insured Health Plan TPAs

EBIA Weekly A federal district court has ruled that ERISA does not preempt the Texas Prompt Payment Act as it applies to TPAs of self-insured benefit plans. The state law generally requires “insurers” to pay benefit claims within 30 or 45 days (depending on the claim’s format), or fac
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