Publications
Despite earlier decisions concluding that downcoding of provider's bills for TMR treatment was appropriate, it's still necessary for insurer to demonstrate compliance with procedural requirements in §127.207 of medical cost containment regulations.
This is a case involving multiple fee review applications that were dismissed by a hearing officer on the basis of prior decisions from another hearing officer that upheld identical downcoding by the insurer in previous challenges from East Coast
Case Law Alerts, 3rd Quarter 2013
A claimant who settles his claim by final and binding C&R Agreement cannot later petition to expand the nature of the work injury, arguing that the employer is precluded from denying causation by voluntarily making a medical bill payment.
The claimant settled his indemnity claim by Compromise and Release Agreement (C&R). The C&R that was approved by the Workers’ Compensation Judge described the injuries as "[a]ny and all injuries . . .
Case Law Alerts, 3rd Quarter 2013
CMS Issues Program Integrity Guidelines for Marketplace
This law alert was written for, and previously distributed by, the American Health Lawyers Association. © 2013 American Health Lawyers Association, Washington, DC. Reprint permission granted.
D.C. Circuit Joins Sixth Circuit in Decision Regarding DSH Exhausted Part A Days: Catholic Health Initiatives v. Sebelius, D.C.Cir.
This law alert was written for, and previously distributed by, the American Health Lawyers Association. © 2013 American Health Lawyers Association, Washington, DC. Reprint permission granted.
Florida Bans Texting While Driving
In late May 2013, Florida Governor Rick Scott signed into law the Florida Ban on Texting While Driving Law.
Pennsylvania Supreme Court Decides to Hear Appeal in Patton v. Worthington Construction
In an appeal handled by John J. Hare and Kimberly Boyer-Cohen of Marshall Dennehey's appellate practice group, the Pennsylvania Supreme Court has agreed to hear a general contractor's appeal in the case of Patton v.
E/M Update: DOJ Targets Improper Use of Modifier 25
Evaluation and management (E/M) services are visits to patients by physicians and non-physician practitioners to assess and manage a patient's health.[i] E/M services are grouped into visit
Asbestos Litigation Alert: Bill Aimed at Preventing Claimants' "Double-Dipping" Takes Step Forward
John Hare, Chairman of the Post-Trial and Appellate Advocacy Practice Group at Marshall Dennehey Warner Coleman & Goggin, recently testified before the Pennsylvania Legislature in support of a bill he co-drafted that seeks transparency in the
Increased "HEAT" on Physician Contracts Leads to Criminal Charges Against Hospital, Owner, Executive and Physicians
The United States Attorney's Office for the Northern District of Illinois announced that it has arrested the senior executive of Sacred Heart Hospital in Chicago and four physicians for alleged violations of the Anti