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Paul Zimmerman

Showing 18 posts from September 2015.

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FCC Brings “Contest Rule” into 21st Century with Update

The FCC “Contest Rule,” requires broadcast licensees to disclose on air the material terms of contests that they broadcast. In September, 2015, the FCC updated that rule to permit broadcast licensees to comply with their obligations to disclose material contest terms either by broadcasting those terms or by making them available in writing on a publicly accessible Internet website. In particular, the FCC amended the Contest Rule to allow licensees to satisfy their disclosure obligation by posting material contest terms on the station’s website, the licensee’s website, or, if neither the individual station nor the licensee has its own website, any Internet website that is readily accessible to the public. (Read more)

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Hong Li  ©

70,000 More Obstacles In The Way Of Getting Providers Paid

Providers devote countless hours and resources to obtain the training and understanding necessary to assign the proper diagnostic code to the services provided when submitting claims for reimbursement.  On October 1, 2015, the number of codes for doctors is increasing from 14,000 to 70,000, through the roll out of the latest version of the International Classification of Diseases, or ICD-10.  (Read more)

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UnitedHealthcare Services Denied Injunction Against Out-of-Network Physician Seeking to Bar Balance Billing of the Patient

In UnitedHealthcare Servs., Inc. v Asprinio (2015 NY Slip Op 25298), decided on August 31, 2015, in the Supreme Court of Westchester County, UnitedHealthcare suffered a set-back against attempts to prevent balance billing by an out-of-network physician.  (Read more)

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Landmark Supreme Court Decision: Just The Tip Of The Iceberg?

It has been nearly three months since the United States Supreme Court decided Obergfell v. Hodges, the landmark decision that ruled state bans on same sex marriage, were unconstitutional.

A 5-4 decision with Justice Kennedy authoring the majority opinion, the Obergfell ruling hinges on the conclusion that the fundamental liberties guaranteed by the Due Process clause of the Fourteenth Amendment “extend to certain personal choices central to individual dignity and autonomy, including intimate choices defining personal identity and beliefs.” (Read More)

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Adventist to Pay $118.7 Million Settlement in Whistleblower Lawsuit

On Monday, September 21, 2015, the Department of Justice announced a settlement with Florida-based Adventist Healthcare, whereby the company will pay $118.7 million to settle a whistleblower lawsuit. $115 million, the bulk of the settlement, will go to the federal government with $3.4 million going to the state of Florida, and the rest to be divided between North Carolina, Tennessee and Texas. The genesis of the allegations stemmed from a qui tam lawsuit initiated by three former Adventist employees, who claimed that the healthcare company improperly compensated physicians in exchange for referrals, in addition to submitting miscoded claims to obtain excess payments from the federal government. These alleged violations led to potential liability for Adventist under the False Claims Act, a broad law that prohibits any person from knowingly presenting, or causing to be presented, a false claim to the government for payment or approval.  It also prohibits the retention of any overpayments that resulted from past false claims, even if those “false claims” were accidental at the time they were made.

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Mike Flippo ©

CA Appeals Court Orders Defendant to Pay Plaintiff’s Expenses in Proving Negligence

On September 15 the California Court of Appeal ordered publication of its previously unpublished opinion in Grace v. Mansourian. This opinion awarded costs to the plaintiff in a personal injury action based upon the defendant’s unreasonable denial of a request to stipulate liability.  (Read more)

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DOJ Will Not Be Challenging Expedia-Orbitz Merger

Despite the American Hotel & Lodging Association’s (AH&LA) public denouncement of Expedia, Inc.’s (“Expedia”) $1.6 billion acquisition of Orbitz Worldwide, Inc. (“Orbitz”), as well as staunch opposition from the hotel industry, the U.S. Department of Justice (“DOJ)”) issued a statement on September 16, 2015 that it would not challenge the deal. The DOJ gave three reasons for its decision: (Read more)

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ACA Survives a Second Legal Challenge

The Affordable Care Act is frequently referred to as ACA or Obamacare.

  • “ACA” is an acronym based on its initials.
  • Obamacare started out as a pejorative label coined by political rivals, but the President famously noted during a 2012 debate that he liked the name.

If it keeps fending off political and court-based challenges, the infamous Molly Brown may not be the only one known as “unsinkable.” (Read More)

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EmCare Challenges Sex Harassment Jury Verdict

EmCare Inc., a Dallas-based company that specializes in providing physician medical services, asked a federal court in Texas last week to reverse a $500,000 jury verdict awarded to three former employees who were terminated after reporting instances of sexual harassment in the workplace. In August 2011, Gloria Stokes, Bonnie Shaw and Luke Trahan filed a claim with the U.S. Equal Employment Opportunity Commission (“EEOC”) accusing EmCare of violating Title VII of the Civil Rights Act of 1964. In its post-trial motion, EmCare alleged that the jury lacked an evidentiary basis for its findings. (Read more)

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Client Alert: AB 533 Defeated

Controversial AB 533 did not obtain the necessary votes for approval and failed to pass. (Read more)