Recent Posts

The Trump administration announced a plan Friday that would affect about 40 percent of the payments physicians receive from Medicare. Not everybody's pleased.

The Centers for Medicare and Medicaid Services calls its proposed plan a historic effort to reduce paperwork and improve patient care. But some doctors and advocates for patients fear it could be a disaster.

The CMS plan, published in Friday's Federal Register, is now open for public comment until early September. It would combine four levels of paperwork required for reimbursement, and four levels of payments,...

It appears that the family that commits mortgage fraud together goes to jail together, too.

Three members of a California family who ran a foreclosure company will spend more than 45 years in jail, collectively, after each was found guilty of participating in a $20 million mortgage fraud scheme that preyed on financially distressed homeowners.

According to the Department of Justice, Dorothy Matsuba, her husband, Thomas Matsuba, and her daughter, Jamie Matsuba, each received a sentence of more than 10 years in jail for taking part in the nearly decade-long scheme.


The American College of Emergency Physicians (ACEP) and the Medical Association of Georgia (MAG) today filed suit against Anthem's Blue Cross Blue Shield of Georgia in federal court in an effort to compel the insurance giant to rescind its controversial and dangerous emergency care policy that retroactively denies coverage for emergency patients. To read the lawsuit, click here.

Over the past year, Anthem implemented its policy in Georgia and five other states, leaving patients who sought emergency care responsible for paying their entire bills if the insurance comp...

A controversial policy instituted by Blue Cross Blue Shield of Georgia and parent company Anthem Insurance Cos. denying emergency room claims after the fact faces a legal challenge by two physicians organizations.

The American College of Emergency Physicians and the Medical Association of Georgia have asked a federal judge in Atlanta to compel Blue Cross Blue Shield and Anthem to abandon the policy, which the insurers have also implemented in Missouri, Kentucky, Indiana, New Hampshire and Ohio.

The policy, which the insurers announced last year, allows the companies...

To an outsider, the fancy booths at a June health insurance industry gathering in San Diego, Calif., aren't very compelling: a handful of companies pitching "lifestyle" data and salespeople touting jargony phrases like "social determinants of health."

But dig deeper and the implications of what they're selling might give many patients pause: a future in which everything you do — the things you buy, the food you eat, the time you spend watching TV — may help determine how much you pay for health insurance.

With little public scrutiny, the health insurance industry has...

A federal judge in Newark has granted final approval to a $160 million settlement on behalf of out-of-network ambulatory surgical centers which claimed the insurance company’s policies did not provide adequate reimbursement for services rendered.

U.S. District Judge Kevin McNulty approved the settlement terms and granted $9 million in legal fees on Friday, ending a 12-year litigation saga over claims that New Jersey’s largest health insurer shortchanged ambulatory surgical centers outside its provider network.

The suit that just settled, Edwards v. Horizon Blue Cross...

Cliffside Park, N.J.-based Surgery Center of Cliffside alleges Horizon Blue Cross Blue Shield of New Jersey underpaid the center for a lesion procedure by $58,120.40, court documents show.

Here's what you should know:

1. Surgery Center of Cliffside filed a lawsuit against Horizon Blue Cross Blue Shield of New Jersey and Empire Blue Cross Blue Shield July 3. Empire is a licensee of BCBS.

2. The ASC performed surgery on a patient insured by Empire who had a painful, rapidly growing lesion on the side of her face.

3. In January, prior to the procedure, an Empire represent...

CMS will not make $10.4 billion in payments that were due to insurers under the ACA. 

Here's what you should know:

1. The payments were required under the ACA's "risk adjustment program" to offset costs for insurers whose customers need expensive medical services. They were due to insurers in the fall for expenses from 2017.

2. CMS Administrator Seema Verma said the suspension is based on a legal dispute over the formula used to calculate risk adjustment payments. About three years ago, a New Mexico federal court ruled the formula was flawed, but a Massachusetts judge...

Please reload

Please reload


Please reload


© 2020 by Nordic Star Law. All rights reserved. No Attorney Client Relationship.