On June 11, the New York Court of Appeals, in Andrew Carothers, M.D., P.C. v. Progressive Insurance Company, 2019 NY Slip Op 04643, decided that an insurer may withhold payment for services provided by a medical services corporation improperly controlled by non-physicians whether or not the medical services corporation acted fraudulently or with fraudulent intent.

The Court of Appeals
Continue Reading New York Court of Appeals Rules that an Insurer May Withhold Payments to a Medical Service Corporation Improperly Controlled by Non-Physicians without A Finding of Fraud

(This post was authored by Heather Harrison, an associate in the Labor & Employment practice at Farrell Fritz)

Although key provisions of the Patient Protection and Affordable Care Act (ACA) have been delayed until 2015, one important notice requirement is just around the corner. By October 1, 2013, virtually all employers must provide written notice to their employees

Continue Reading Affordable Care Act Employer Notice Deadline Nears

The U.S. Department of Health and Human Services (HHS) has issued final rule stating the future health insurance exchange (“Exchange”) and insurance issuer standards related to coverage of essential health benefits (EHB) and actuarial value. The final rule further establishes a timeline for when qualified health plans (QHPs) should be accredited in federally facilitated Exchanges.

Beginning January 1, 2014, non-grandfathered

Continue Reading Essential Health Coverage Benefits – The ACA Final Rule

As Chris Kutner explained in his January 4, 2013 post, the Patient Protection and Affordable Care Act of 2010 (“PPACA” or “Obama Care”) requires, beginning in 2014, that employers with 50 or more full-time employees (“large employers”) offer “affordable” health insurance to their employees. Failure to do so will subject the employer to penalties. Recently published IRS proposed regulations

Continue Reading “Affordable” Health Coverage Under Obama Care

Historically, health care services have been paid for by health insurance companies which accept monthly premium payments from employer groups and individuals.  The premium for defined health care services is due whether the insureds under the policy use the benefits or not.  Built into the premiums are additional administrative costs including fees paid to insurance brokers and general agents who

Continue Reading Health Systems as Providers and Insurers