ICFAA

Roger Turner, an agent for Optum Health Behavioral Program (OHBP) alleges Dr. Arturo Taca over utilizes drug screen services, opened a substance abuse rehab facility under a different TIN, known as “Insynergy” which operates as cash only or by providing “member’s” financing in the form of signing them up for credit cards. Mr. Turner also alleges Dr. Taca failed to notify OHBP of his affiliation with Insynergy, submits claims for injections for upwards of $2200 per injection as an Out of Network expense and therefore member liability, has three TIN’s operating registered for the same or similar addresses, and is not contracted by OHBP to administer injectable’s to OHBP members, however an audit shows 11 members received services (billed as injectable) from Insynergy.

Husband and wife, Gary and Renna Pehle were infected with HIV at the time they applied for life insurance with Farm Bureau Life Insurance Company. The couple did not know they were infected with HIV at the time. The insurance company ran blood tests from the Pehles. The Pehles then signed a contract form which was given to them by a Farm Bureau agent. A nurse from Farm Bureau watched as the Pehles signed the contract. Blood samples were sent to a third-party laboratory called LabOne. Farm Bureau then sent a notice to the Pehles rejecting them from their life insurance policy, which advised the couple that if they wished to have their application reviewed to contact their physician. The Pehles did not take any action in doing so. Two years past and Renna Pehle is confirmed to have AIDS. The Pehles then sues Farm Bureau, LabOne, and LabOne’s medical director Dr. J. Alexander Lowden for negligence, for failing to tell them they were HIV-positive.

Rather than having the other claims adjusted, the provider insisted that we not look into the matter further because they did not want us to take back any money. Sadly this is just one example of fraud; it is not uncommon to see providers change the coding of claims to get something that they know should not be paid to process for payment. Cracking down on this type of fraud will reduce the amount of money paid out on claims by insurance carriers. Since claims payments directly affect the cost of insurance, this will also help in lowering premiums.

Contrary to the alleged, Dr. Brock refuted the claim, defending that he never established a doctor-patient relationship with Anita, which relieves him of liability. In order to validate his refute, Dr. Brock provided four factual elements that were supported by his counterparts; Dr. Whitfield and Dr. Ketcham. The four elements that were presented in the affidavit included: (1) That there has never been a doctor-patient relationship between Dr. Brock and Anita Oliver, (2) Dr. Brock has never seen or talked to Anita or Cathy Oliver, (3) Dr. Brock was not employed, engaged or requested to serve as a consultant to treat Anita, (4) and Dr. Brock was not employed or engaged to consult with doctors treating Anita, concerning complaints or medical problems. In order to support Dr. Brock’s refute, Dr. Whitfield and Dr. Ketcham provided affidavit’s as

2. Facts: Plaintiff Irene George (P) is filing suit against Defendant Jordan Marsh Co. (D) for mental anguish and emotional distress which resulted in two heart attacks. D sold goods on credit to P’s emancipated son, who purchased them on P’s account. D alleged that P stated in writing that she would pay the debts (which she did not incur), even though it is understood that P did not make this guarantee. D then attempted to intimidate P into paying these debts she did not owe by calling her at late hours, by mailing her bills, by sending her letters stating late charges were being added on and that her credit had been revoked, and by numerous other tactics. P suffered great

Unit 2 AssignmentKelley WhitcombKaplan UniversityHI215-01: Reimbursement MethodologiesProfessor Kathleen SobelJuly 20, 2015Medicaid is one of the biggest insurance plans you can get in any state. In the state of Indiana, it is based off of your income. There is a certain amount (income) you have to make to determine if you will receive Medicaid or Healthy Indiana Plan (HIP). HIP is still a form of Medicaid, but you would have to pay monthly cost for it and have certain set of co-pays for certain services that is needed. HIP Plus is the recommended plan for members as it provides health coverage for a low, predictable monthly cost. HIP Plus also covers dental and vision services. If you do not pay your monthly payment you can be removed from

Although the Stark law does not apply to ASCs, the federal Anti-kickback Statute does apply. The Anti-Kickback statute prohibits any person from “knowingly and willfully” providing any remuneration to induce referrals, or in exchange for referrals, of federal health care program patients or business.2 Accordingly, the Anti-kickback Statute applies to any physician-owned ASC that treats federal health care program patients (including Medicare and Medicaid), in that the potential return on investment, arguably, could be viewed as an inducement for physician investors to refer to the ASC. However, there is an ASC “safe harbor” under the Anti-kickback Statute, which protects various types of physician-owned ASCs as well as hospital/physician ASC

See Electcrostim Med. Servs., Inc. v. Health Care Serv. Corp., 962 F. Supp. 2d 887, 898-99 (S.D. Tex. 2013) (granting motion to dismiss); Encompass Office Solutions, Inc. v. Conn. Gen. Life Ins. Co., No. 3:11-cv-02487-L, 2012 WL 3030376, *8-*9 (N.D. Tex. July 25, 2012) (denying motion to dismiss); Team Healthcare/Diagnostic Corp. v. Blue Cross & Blue Shield of Tex., No. 3:10-cv-1441-BH, 2012 WL 1617087, *6 (N.D. Tex. May 7, 2012) (denying motion to dismiss); Mid-Town Surgical Ctr., LLP v. Blue Cross Blue Shield of Tex., No. H-11-2086 (S.D. Tex. Apr. 11, 2012) (granting motion to dismiss); DAC Surgical Partners, P.A. v. United Healthcare Servs., Inc., No. H-11-1355, 2011 WL 3841946, *6 (S.D. Tex. Aug. 30, 2011) (denying motion to dismiss);

Willfully Harming and Causing Stress and Anxiety to Purposely Frustrate the Court and Ultimately Harm her Client that will likely have very long term

The plaintiffs, A. V. Blount, Jr., Walter J. Hughes, Norman N. Jones, Girardeau Alexander, E. C. Noel, III, and F. E. Davis, are medical doctors (practitioners) licensed to practice and practicing medicine in the City of Greensboro, North Carolina.

Unless you indicate otherwise, I will continue to press forward with the panel issue as we discussed. It is my understanding Illinois Midwest Insurance is generally not amicable to an Agreed Medical Evaluator. Can you let me know if this is true for this case as well?

Healthcare finances does not come without legal and regulatory issues. Issues in healthcare finances are false claims and whistleblower suits. The False Claims Act is a federal law that cover fraud in any federal funded program such as Medicare and Medicaid. This act covers knowing or conspiring to falsify any claim for payment by the federal government. In 2010 alone the government recovered over $7 billion in false claims, healthcare and pharmaceuticals made up 75% of total payment. And since then more than $130 million of claims has been settled.

The following allegation is upon Southwest health alliance who runs under BSA provider network in the region of Amarillo, Tyler, TX who is believed to be respondent under section 5 of Federal Trade Commission Act where the Respondent has exhibited Anticompetitive Conduct in the market and which incurred the reduction of consumer benefits in the healthcare market. Upon being proved guilty of allegations, Federal Trade Commission along with the help of Office of Texas Attorney General purposed few judgements in the form of consent order which involves settlements purposes.

As requested, I have reviewed the facts of the above-captioned file, along with the applicable law and summarized same in this memorandum. Mrs. Mary Smith suffered an injury to her right ankle in an automobile accident on 10/3/95. After surgery and months of rehabilitation, Mrs. Smith still suffers daily. I have researched the facts regarding a personal injury action against Paul Joseph, as well as a medical malpractice action against the medical providers.

"[a]n insurance company has a duty to act in good faith in settling claims and a breach of that duty will give rise to a cause of action by the insured." Pasipanki v. Morton, 61 Ohio App. 3d 184, 185, 572 N.E.2d 234 (1990) (quoting Bean v. Metro. Prop. & Liab. Ins. Co., 9th Dist. No. 13543, 1988 Ohio App. LEXIS 4275, 1988 WL 114464 at *1 (Oct. 26, 1988)). Gekko did not act in good faith to settle Vic’s claim against Donna, and their failure to do so enables Donna has a cause of action against Gekko.