Does ERISA Cover My Church-Affiliated Disability Insurance Plan?
Mar 20, 2016 | Blog | ShareIf you work for a religiously affiliated organization, different rules may apply to your disability insurance claim. ERISA does not cover many church plans due to an exception in the law, so it’s important to understand whether your plan qualifies as a church plan before you proceed with a claim. To learn more about church plans and your long-term disability claim, keep reading. What Is a Church-Affiliated Disability or Benefit Plan? Ever since the Employee Retirement Income Security Act (ERISA) was created in 1974, the law has exempted church-affiliated benefit plans from its requirements. However, the definition of what qualifies as a church plan has changed over the years. In 2017, the Supreme Court issued its […]
ERISA Preemption in Case of Liberty Mutual Health Insurance Plan
Mar 20, 2016 | Blog | ShareThe Supreme Court ruled that ERISA pre-empts Vermont’s statute as applied to ERISA plans in Gobeille v. Liberty Mutual Insurance Co., decided on March 1, 2016. Liberty Mutual maintains a self-insured employee health plan and some of those employees reside in Vermont. Vermont maintains a health-claims database (an “all-payor claims database” or APCD) that requires all health insurers and self-insured health plans operating in Vermont to report claims information. That information is then made available to insurers, employers, healthcare providers, and others to review issues such as utilization, cost, and quality with respect to healthcare in Vermont. Blue Cross Blue […]
Congressional Research Service Social Security Primer
Feb 15, 2016 | Blog | ShareCongressional Research Service (“CRS”) has put out a “primer” on SSA: Social Security Primer Congressional Research Service Summary The Social Security program was established in the 1930s and has been modified by Congress many times over the years. Today, Social Security provides monthly cash benefits to retired or disabled workers and their family members, and to the family members of deceased workers. Among the beneficiary population, approximately 82% are retired or disabled workers, and 18% are the family members of retired, disabled, or deceased workers. In November 2015, nearly 60 million beneficiaries received a total of $74 billion in benefit payments […]
Skilled Nursing Facilities Increase Therapy Minutes while Federal Fraud Enforcement Plays Catchup
Jan 27, 2016 | Blog | ShareThe Medicare and Medicaid programs were established to ensure the health and medical needs of our nation’s aging and disabled populations. Unfortunately, a small number of doctors,hospitals,nursing homes,drug companies, and other health care providers have taken advantage of our tax dollars by making false claims to Medicare and Medicaid.Common fraudulent schemes include billing for unperformed services, upcoding,excessive service levels,questionable medical necessity,or referral kick backs. Over the past decade,the federal government, led primarily by the Department of Justice (DOJ) and Department of Health and Human Services (DHHS) has heightened its scrutiny of billing by skilled nursing facilities (SNFs). Some of their […]
Comments Re Claims Procedure Regulations for Plans Providing Disability Benefits
Jan 18, 2016 | News | ShareOn November 18, 2015, the Employee Benefits Security Administration published new proposed regulations for ERISA disability claims (RIN 1210-AB39; Regulation 29 C.F.R. §2560.503-1). The Public Comment period runs through January 19, 2016. I prepared and submitted the following comments regarding two of the most significant proposed changes in claims regulations for plans providing disability benefits: Dear Assistant Secretary Borzi: I write to offer comments on the proposed regulations for amending the claims procedure regulations applicable to disability benefit plans. I am interested in the content of these regulations because I am an attorney whose practice is focused on the representation […]
Dismissal of Medline Industries False Claims Act Case Upheld
Jan 18, 2016 | Blog | ShareThe Seventh Circuit upheld the dismissal of a suit filed in 2011 under the False Claims Act on January 4, 2016, finding the Relator was merely adding details to a prior kickback suit remarkably similar to his own. Bogina v. Medline Industries, Inc., No. 15-1867 (7th Cir. 2016). Thus, Relator Bogina failed the “original source” requirement as he was not “an individual who has direct and independent knowledge of the information on which the allegation [in his complaint] are based.” 31 USC § 3730(e)(4)(B). Defendant Medline Industries, Inc. had previously settled a 2007 suit brought by Sean Mason, an employee […]
Are Workers Compensation Benefits Affected By Other Benefits?
Jan 3, 2016 | Blog | ShareWhenever other benefits are involved in a WC claim, questions arise. If a client gets Vet benefits, is there a reduction? If Service Connected, no. If Non-Service Connected, yes. If client is getting UC & WC, will Social Security deny benefits? Not necessarily. 820 ILS 405 Section 601(b)(1). If client has another WC claim pending in Ohio as well as Illinois, what then? Confusing since Ohio is a reverse offset State. If client is going thru a divorce, does the spouse have an interest in the WC claim proceeds? You betcha. Does CMS require that a Medicare set-aside arrangement […]
Helpful Medicare Resources
Jan 3, 2016 | Resources | ShareCoordination of Benefits & Recovery: http://go.cms.gov/cobro Attorney Services: http://go.cms.gov/attorney Beneficiary Services: http://go.cms.gov/bene Insurer Services: http://go.cms.gov/insurer
Social Security Expedited Disability Claims
Jan 3, 2016 | Blog | ShareSocial Security has several programs that will expedite a claim for disability benefits claims. One is to prevent homelessness. In fact, each Social Security local office has a designated staff member to handle such emergency situations. Relevant POMS is below and available at: http://policy.ssa.gov/poms.nsf/lnx/0302801001. RS 02801.001 Critical Case Criteria and Exclusions A. Policy – critical case criteria SSA’s goal is to pay all benefits due on time. Processing critical cases has priority over all other workloads. Through routine processing, this goal is usually met. However, when a beneficiary is adversely affected because payment is not made timely, our goal is to […]
Medical Search Engine
Jan 2, 2016 | Blog | ShareMedNexus is a medical search engine for patients – think “Google for Medicine”. “Through our search engine, you can find the most relevant content from a variety of sources: medical journals, patient forums, government health sites, etc. We want to empower patients to educate themselves and cut through the noise and pseudo-science of typical online health information. No more WebMD scares, no more endless Googling. Whether you are looking for the latest evidence, or to learn from fellow patients, you can find actionable and reliable answers at MedNexus.”
