Posts Tagged ‘Sued’
LOS ANGELES (Reuters) – A medical marijuana trade group and 11 patients sued the city of Los Angeles on Friday, seeking to block enforcement of an ordinance that would shut down most of the city’s storefront pot dispensaries in three weeks.
Hanover Park, IL (PRWEB) January 05, 2012
ERISAclaim.com offers Webinars to examine the recent federal court ERISA ruling in a lawsuit between CIGNA and an out-of network hospital. CIGNA was sued by the hospital for $ 20 million UCR denials under ERISA, CIGNA counter-sued the hospital for “prompt pay discount” (“fee forgiving”) fraud. The new Webinars will evaluate this court case, as the 2012 managed care reimbursement litigation trend by providers and payers: the out-of-network (OON) provider UCR litigation under ERISA; and the payer defense under ERISA preemption, lack of ERISA Assignment and failure to complete ERISA appeals, and more importantly, the payer offensive counter-lawsuit for “prompt pay discount” fraud, medical necessity fraud, self referral or deceptive out-of-network referral fraud.
The Court Case Info: North Cypress Medical Center Operating Co., Ltd. et al v. Cigna Healthcare et al, Case 4:09-cv-02556, Filed: 08/11/2009, United States District Court Southern District of Texas Houston Division.
This $ 20 million UCR ERISA lawsuit in Houston Texas and all other out-of-network provider UCR cases represent a new reimbursement model and new climate in managed care litigation in 2012. The payers nationwide are taking offensive anti-fraud strategies in defending against providers UCR lawsuits, says Dr. Jin Zhou, President of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance.
On August 11, 2009, the plaintiff hospital, an approximately 150-bed general acute care hospital in Houston, Texas, filed a lawsuit against CIGNA for alleged $ 20 million UCR denials under ERISA.
On March 2, 2011, the federal court permitted the hospitals ERISA lawsuit to proceed.
According to the Court documents, the following are the relevant facts:
North Cypress alleges, first, that CIGNA has underpaid North Cypress considerably for out-of-network and emergency services it provided to patients participating in health plans insured and/or administered by CIGNA. North Cypress alleges that this significant underpayment has resulted, in part, from CIGNAs intentional or reckless use of flawed or inadequate data to calculate UCR amounts. Secondly, CIGNA has allegedly failed to promptly pay North Cypress reimbursement claims. Third, North Cypress contends that CIGNA entered into Discount Agreements with North Cypress via a re-pricing agent, through which CIGNA agreed to pay a discounted price of North Cypress invoices for CIGNAs members. According to North Cypress, CIGNA failed to pay even the discounted amount agreed to in the contracts. As a result of CIGNAs acts, North Cypress claims that it has been damaged in the amount of at least $ 20 million. To remedy these alleged violations, North Cypress has brought claims against CIGNA pursuant to the Employee Retirement Income Security Act of 1974 (ERISA), as amended, 29 U.S.C.
Incoming search terms:
- defending ucr against davita
- obama cigna discount
- pros and cons of dollar general selling beer and wine
Asia Day Ahead: Goldman Sued Over Alleged Gender Discrimination
The following are the top Asia stories for the day.
Read more on BusinessWeek
Cornell University Law School Professor William Jacobsen brave launched today his week long "dart board" analysis of HR 3200, the ObamaCare bill on the House. Selecting random sections of the law to analyze each day this week on his …
Wal-Mart Sued For Limiting Employee Medical Care
Wal-Mart Stores Inc. is facing a class-action lawsuit in Colorado accusing the company “of conspiring to limit medical care for injured employees in a bid to save money,” The Wall Street Journal reports. “The lawsuit alleges that Wal-Mart broke state and federal laws by using a subsidiary to control the treatment for employees with workplace injuries. Wal-Mart sent the injured workers to clinics …
Read more on Medical News Today