The document discusses the importance of acting ethically with patient records. It outlines the key parts of HIPAA including maintaining health insurance and ensuring security of patient information. Violations of HIPAA can result in fines up to $1.5 million, lawsuits, criminal charges, and job termination. It emphasizes respecting patient privacy, only using information for patient care, and treating information as you would want your own treated. Employees must undergo training on HIPAA laws and audits to protect information.
Back end errors at u.s. health website jeopardize sign-up-hCentive newsAlisha North
There’s no way to tell how many people who think they enrolled for health insurance through the U.S. Obamacare exchange actually have, after about 1 in 4 files sent to insurers had garbled and incomplete information.
This document summarizes the journey of prior authorization legislation in Ohio from 2015-2018. It discusses how the author testified in support of bills in 2015-2016 (SB 129) and 2017-2018 (SB 56/HB 72) regarding step therapy. The legislation went into effect in 2017 with additional provisions in 2018. It outlines the new rules for insurers related to prior authorization, including disclosure requirements, timelines for responses, and prohibitions on retroactive denials. Additional rules implemented in 2018 include requirements for web-based prior authorization systems and faster response times.
This document provides information about obtaining medical records, including rights to records, procedures for requesting records, and potential rejections. It discusses who can request and access various types of records according to HIPAA, including one's own records, a designated representative's records, a legal guardian's records, and deceased individuals' records. It also outlines timelines for providers to fulfill record requests and options for appealing rejections. The document marketing Choice Legal, a company that assists with nationwide medical record retrieval for law firms and insurance companies using online systems.
Covered California Calls Collection of Patient Data a Good ThingFreeway Insurance
With 1.4 million people enrolled, Covered California is embarking on an ambitious effort to collect insurance company data on every patient pertaining to prescriptions, doctor visits and hospital stays .
West Virginia AGO - Concerns about new Health Insurance ExchangesRob Jones
Three weeks ago, 13 state attorneys general sent a letter to HHS expressing concerns about protecting consumers' private information under the new health insurance exchanges. HHS did not respond by the requested date of August 28th. The attorneys general are taking additional steps by filing a Freedom of Information Act request seeking information related to their concerns. They are worried about the risk of identity theft if security holes are not addressed before implementation of the exchanges in October. The letter noted that HHS rules do not ensure navigators assisting with enrollment will be properly trained or responsible if identity theft occurs, and do not require background checks of navigators.
The document discusses the importance of acting ethically with patient records. It outlines the key parts of HIPAA including maintaining health insurance and ensuring security of patient information. Violations of HIPAA can result in fines up to $1.5 million, lawsuits, criminal charges, and job termination. It emphasizes respecting patient privacy, only using information for patient care, and treating information as you would want your own treated. Employees must undergo training on HIPAA laws and audits to protect information.
Back end errors at u.s. health website jeopardize sign-up-hCentive newsAlisha North
There’s no way to tell how many people who think they enrolled for health insurance through the U.S. Obamacare exchange actually have, after about 1 in 4 files sent to insurers had garbled and incomplete information.
This document summarizes the journey of prior authorization legislation in Ohio from 2015-2018. It discusses how the author testified in support of bills in 2015-2016 (SB 129) and 2017-2018 (SB 56/HB 72) regarding step therapy. The legislation went into effect in 2017 with additional provisions in 2018. It outlines the new rules for insurers related to prior authorization, including disclosure requirements, timelines for responses, and prohibitions on retroactive denials. Additional rules implemented in 2018 include requirements for web-based prior authorization systems and faster response times.
This document provides information about obtaining medical records, including rights to records, procedures for requesting records, and potential rejections. It discusses who can request and access various types of records according to HIPAA, including one's own records, a designated representative's records, a legal guardian's records, and deceased individuals' records. It also outlines timelines for providers to fulfill record requests and options for appealing rejections. The document marketing Choice Legal, a company that assists with nationwide medical record retrieval for law firms and insurance companies using online systems.
Covered California Calls Collection of Patient Data a Good ThingFreeway Insurance
With 1.4 million people enrolled, Covered California is embarking on an ambitious effort to collect insurance company data on every patient pertaining to prescriptions, doctor visits and hospital stays .
West Virginia AGO - Concerns about new Health Insurance ExchangesRob Jones
Three weeks ago, 13 state attorneys general sent a letter to HHS expressing concerns about protecting consumers' private information under the new health insurance exchanges. HHS did not respond by the requested date of August 28th. The attorneys general are taking additional steps by filing a Freedom of Information Act request seeking information related to their concerns. They are worried about the risk of identity theft if security holes are not addressed before implementation of the exchanges in October. The letter noted that HHS rules do not ensure navigators assisting with enrollment will be properly trained or responsible if identity theft occurs, and do not require background checks of navigators.
What you can do online at the social security administration websitemosmedicalreview
The SSA provides retirement and disability benefits, the latter granted based on a chart review, to applicants. Here is what you can do via SSA’s website.
The document discusses health care technology and privacy risks and regulations. It outlines how electronic health records and computer networks expose private patient information to risks of data breaches and identity theft. It summarizes the Red Flags Rule, which requires health care providers to develop programs to identify potential identity theft. Finally, it recommends risk reduction strategies and offers risk transfer solutions like technology privacy liability insurance.
This document provides an overview of medical billing in the United States. It describes the process where a doctor provides services to a patient, submits a claim to an insurance company, and the insurance company reviews the claim and sends payment to the provider. It outlines the steps involved, including coding the diagnosis and treatment, submitting claims electronically or by mail, following up on denied claims or underpayments, and generating monthly reports.
What is this Marketplace and Why Should I Care?Steve Levine
The document provides information about health insurance marketplaces established under the Affordable Care Act. It explains that marketplaces allow individuals to purchase private health insurance in one centralized location. Plans offered on the marketplace must cover essential health benefits and cannot deny coverage due to preexisting conditions. The marketplace is designed to simplify the process of comparing and enrolling in health insurance plans. It also provides information about financial assistance and important deadlines for signing up. Resources for learning more about the marketplace include Healthcare.gov and state-specific websites.
All information, data, and material contained, presented, or provided on is for educational purposes only.
Company names mentioned herein are the property of, and may be trademarks of, their respective owners.
It is not to be construed or intended as providing legal advice.
Anti-Fraud Challenges for 2013 (Presented at HCCA Managed Care Compliance Con...Mary Inman
This document summarizes anti-fraud challenges for 2013 that health plans may face. It discusses increased audit scrutiny of Medicare risk adjustment payments due to high error rates found in recent audits. It also covers potential issues with fraud under the Affordable Care Act, such as through premium subsidies. Finally, it addresses ensuring compliance programs are prepared to handle new challenges like risk adjustment based on encounter level data and use of electronic medical records.
The Calm Before the Storm: Enforcement Trends in Risk Adjustment: DOJ and the...Mary Inman
This document summarizes trends in risk adjustment enforcement by the Department of Justice and the False Claims Act. It discusses two settled cases - United States v. Janke for $22.6 million and United States et al. ex rel. Swoben v. Scan Health Plan for $320 million and $3.8 million. While some similar cases were dismissed, the document indicates more investigations may be underway based on reports of document requests to several Medicare Advantage plans. Theories of liability discussed include failure to correct provider upcoding and plan upcoding through chart reviews, home visits, and attestations.
The document discusses hiring an attorney to assist with a Social Security disability claim. There are two main types of Social Security benefits for disabled individuals: Social Security Disability Insurance (SSDI) for those who have earned enough work credits, and Supplemental Security Income (SSI) based on financial need. An attorney can help by collecting medical records and guiding the applicant through the legal issues and procedures to improve the chances of an approved claim. A lawyer ensures all paperwork and deadlines are properly handled.
- Medical billing companies handle the process of submitting claims to insurance companies and getting paid for physicians' services, as the process is lengthy, complicated, and involves many rules and regulations.
- There are three main parties in medical billing - the physician, the insurance company, and the patient. Medical billing companies work to maximize collections for physicians while complying with insurance company rules and not penalizing patients.
- The main functions of medical billing companies are to process patient information and file claims with private insurance companies and government programs like Medicare and Medicaid in order to get healthcare providers paid on time.
A comprehensive view of how Medical Billing works. How to prepare medical claims, patient eligibility, example insurance cards, Medicare / Medicade, authorization of services, charge entry, fee schedules, claim submissions, posting ERAs / EOBs, rejected or denied claims (and their correction), secondary claims, cycle of a claim, revenue cycle, provider info needed on a claim, evaluation and management: coding and evaluations and basic components, etc,. By Medwave Medical Billing & Credentialing at http://medwave.io.
This document outlines the basic steps and requirements for setting up a medical billing project between an India-based operations team and a US-based provider. It includes:
1. Necessary infrastructure for the India team such as medical billing software, servers, phones, and internet access.
2. Details on selecting billing software that can track unpaid claims and customized reporting.
3. The process for insurance enrollment including Medicare, Blue Cross, and Blue Shield.
4. Requirements for provider information needed from the US team.
5. Procedures for transmitting patient data from the US to India team through fax and email.
6. Roles for the India and US teams in claim processing, printing,
HOW TO DO BILLING FOR MEDICARE AND MEDICAID?Jessica Parker
When you claim for Medicare and Medicaid, there is no need to go through a clearinghouse for these claims, and it also means that 100% “clean” claims submission. Make sure you’re familiar with the Medicare contractor’s claim submission preference and submit claims accordingly because Medicare is not going to adapt to provider needs; the provider does all of the adapting!
In the uploaded Document, we have shared the some step & process to make a claims against medical negligence for those victims, who have suffered harm due to medical negligence. Look at the Doc for more.
Merck Millipore Peru - Lobby Lcd Energy MonthIvan Hernandez
This document discusses the proposed merger between Merck KGaA and Sigma-Aldrich, noting various risks and uncertainties related to the transaction. It provides cautionary statements regarding forward-looking statements and notes additional risks including regulatory approval, competitive responses, integration risks, and financial and operational performance risks. The document also indicates that a proxy statement will be filed with the SEC providing important information for shareholders to consider regarding the proposed transaction.
July 31, 2013: Companyprofilesandconferences.com added a new company report on "Exterran Holdings, Inc. (EXH) - Financial and Strategic SWOT Analysis Review" which gives in depth information and data about the company and its operations.
The document provides an agenda for the Third Annual Veterans Conference titled "Boots to Business". The all-day conference included presentations on military procurement, starting a business, veteran testimonials, expert panels on legal and accounting issues for small businesses, accessing capital, and information from veteran resource organizations. Keynote speakers were a retired US Air Force Colonel and Congresswoman. The goal was to provide veterans with information and resources to help start and grow small businesses.
Blancas Sandoval & Associates, P.A. provides accounting, tax, financial advisory, and business consulting services to small businesses. The firm has offices in Davie, Florida and Lima, Peru and offers services such as accounting, tax preparation and planning, financial planning, business consulting, and executive recruiting. The document provides details on the various services offered and contact information.
The document provides an overview and analysis of Scott Rich's motivational patterns based on an assessment he completed. It summarizes that Scott is motivated by building and developing tangible results through his preferred processes and methods. He enjoys taking a leading role to initiate and organize efforts, and is strategic in planning the necessary steps to accomplish his goals. Scott finds satisfaction in researching, learning, and interpreting complex concepts in order to effectively communicate and impact others.
The Foundations of Zamolxiana New Religious Movement - Octavian SarbatoareOctavian Sarbatoare
This document provides an introduction to the Zamolxiana religious movement in Romania, which draws from the ancient Dacian religion. It presents Zamolxiana as a new religious movement with characteristics of spiritual and religious revival based on the ancestral mythic culture of the Romanian people. The document outlines some of the key beliefs of Zamolxiana, such as its focus on pre-Christian deities and concepts of divinity derived from pagan roots, as well as its emphasis on esotericism and practices centered around sacred fire. It also discusses Zamolxiana as an emerging social movement promoting nativism and revitalization of Romanian identity and culture.
Matias Valenzuela discusses operationalizing equity to improve Latino health in King County. He outlines frameworks for applying an equity lens to decision making, organizational practices, and community engagement. Lessons from health enrollment efforts emphasize engaging local leaders, collaboration, utilizing existing networks, developing new partnerships, listening to community partners, and continuous improvement. The document also discusses investing early in child development, place-based community work, and advancing equity through leadership, integration, breaking down silos, tools and measurements, communications, and addressing both rational and emotional aspects.
What you can do online at the social security administration websitemosmedicalreview
The SSA provides retirement and disability benefits, the latter granted based on a chart review, to applicants. Here is what you can do via SSA’s website.
The document discusses health care technology and privacy risks and regulations. It outlines how electronic health records and computer networks expose private patient information to risks of data breaches and identity theft. It summarizes the Red Flags Rule, which requires health care providers to develop programs to identify potential identity theft. Finally, it recommends risk reduction strategies and offers risk transfer solutions like technology privacy liability insurance.
This document provides an overview of medical billing in the United States. It describes the process where a doctor provides services to a patient, submits a claim to an insurance company, and the insurance company reviews the claim and sends payment to the provider. It outlines the steps involved, including coding the diagnosis and treatment, submitting claims electronically or by mail, following up on denied claims or underpayments, and generating monthly reports.
What is this Marketplace and Why Should I Care?Steve Levine
The document provides information about health insurance marketplaces established under the Affordable Care Act. It explains that marketplaces allow individuals to purchase private health insurance in one centralized location. Plans offered on the marketplace must cover essential health benefits and cannot deny coverage due to preexisting conditions. The marketplace is designed to simplify the process of comparing and enrolling in health insurance plans. It also provides information about financial assistance and important deadlines for signing up. Resources for learning more about the marketplace include Healthcare.gov and state-specific websites.
All information, data, and material contained, presented, or provided on is for educational purposes only.
Company names mentioned herein are the property of, and may be trademarks of, their respective owners.
It is not to be construed or intended as providing legal advice.
Anti-Fraud Challenges for 2013 (Presented at HCCA Managed Care Compliance Con...Mary Inman
This document summarizes anti-fraud challenges for 2013 that health plans may face. It discusses increased audit scrutiny of Medicare risk adjustment payments due to high error rates found in recent audits. It also covers potential issues with fraud under the Affordable Care Act, such as through premium subsidies. Finally, it addresses ensuring compliance programs are prepared to handle new challenges like risk adjustment based on encounter level data and use of electronic medical records.
The Calm Before the Storm: Enforcement Trends in Risk Adjustment: DOJ and the...Mary Inman
This document summarizes trends in risk adjustment enforcement by the Department of Justice and the False Claims Act. It discusses two settled cases - United States v. Janke for $22.6 million and United States et al. ex rel. Swoben v. Scan Health Plan for $320 million and $3.8 million. While some similar cases were dismissed, the document indicates more investigations may be underway based on reports of document requests to several Medicare Advantage plans. Theories of liability discussed include failure to correct provider upcoding and plan upcoding through chart reviews, home visits, and attestations.
The document discusses hiring an attorney to assist with a Social Security disability claim. There are two main types of Social Security benefits for disabled individuals: Social Security Disability Insurance (SSDI) for those who have earned enough work credits, and Supplemental Security Income (SSI) based on financial need. An attorney can help by collecting medical records and guiding the applicant through the legal issues and procedures to improve the chances of an approved claim. A lawyer ensures all paperwork and deadlines are properly handled.
- Medical billing companies handle the process of submitting claims to insurance companies and getting paid for physicians' services, as the process is lengthy, complicated, and involves many rules and regulations.
- There are three main parties in medical billing - the physician, the insurance company, and the patient. Medical billing companies work to maximize collections for physicians while complying with insurance company rules and not penalizing patients.
- The main functions of medical billing companies are to process patient information and file claims with private insurance companies and government programs like Medicare and Medicaid in order to get healthcare providers paid on time.
A comprehensive view of how Medical Billing works. How to prepare medical claims, patient eligibility, example insurance cards, Medicare / Medicade, authorization of services, charge entry, fee schedules, claim submissions, posting ERAs / EOBs, rejected or denied claims (and their correction), secondary claims, cycle of a claim, revenue cycle, provider info needed on a claim, evaluation and management: coding and evaluations and basic components, etc,. By Medwave Medical Billing & Credentialing at http://medwave.io.
This document outlines the basic steps and requirements for setting up a medical billing project between an India-based operations team and a US-based provider. It includes:
1. Necessary infrastructure for the India team such as medical billing software, servers, phones, and internet access.
2. Details on selecting billing software that can track unpaid claims and customized reporting.
3. The process for insurance enrollment including Medicare, Blue Cross, and Blue Shield.
4. Requirements for provider information needed from the US team.
5. Procedures for transmitting patient data from the US to India team through fax and email.
6. Roles for the India and US teams in claim processing, printing,
HOW TO DO BILLING FOR MEDICARE AND MEDICAID?Jessica Parker
When you claim for Medicare and Medicaid, there is no need to go through a clearinghouse for these claims, and it also means that 100% “clean” claims submission. Make sure you’re familiar with the Medicare contractor’s claim submission preference and submit claims accordingly because Medicare is not going to adapt to provider needs; the provider does all of the adapting!
In the uploaded Document, we have shared the some step & process to make a claims against medical negligence for those victims, who have suffered harm due to medical negligence. Look at the Doc for more.
Merck Millipore Peru - Lobby Lcd Energy MonthIvan Hernandez
This document discusses the proposed merger between Merck KGaA and Sigma-Aldrich, noting various risks and uncertainties related to the transaction. It provides cautionary statements regarding forward-looking statements and notes additional risks including regulatory approval, competitive responses, integration risks, and financial and operational performance risks. The document also indicates that a proxy statement will be filed with the SEC providing important information for shareholders to consider regarding the proposed transaction.
July 31, 2013: Companyprofilesandconferences.com added a new company report on "Exterran Holdings, Inc. (EXH) - Financial and Strategic SWOT Analysis Review" which gives in depth information and data about the company and its operations.
The document provides an agenda for the Third Annual Veterans Conference titled "Boots to Business". The all-day conference included presentations on military procurement, starting a business, veteran testimonials, expert panels on legal and accounting issues for small businesses, accessing capital, and information from veteran resource organizations. Keynote speakers were a retired US Air Force Colonel and Congresswoman. The goal was to provide veterans with information and resources to help start and grow small businesses.
Blancas Sandoval & Associates, P.A. provides accounting, tax, financial advisory, and business consulting services to small businesses. The firm has offices in Davie, Florida and Lima, Peru and offers services such as accounting, tax preparation and planning, financial planning, business consulting, and executive recruiting. The document provides details on the various services offered and contact information.
The document provides an overview and analysis of Scott Rich's motivational patterns based on an assessment he completed. It summarizes that Scott is motivated by building and developing tangible results through his preferred processes and methods. He enjoys taking a leading role to initiate and organize efforts, and is strategic in planning the necessary steps to accomplish his goals. Scott finds satisfaction in researching, learning, and interpreting complex concepts in order to effectively communicate and impact others.
The Foundations of Zamolxiana New Religious Movement - Octavian SarbatoareOctavian Sarbatoare
This document provides an introduction to the Zamolxiana religious movement in Romania, which draws from the ancient Dacian religion. It presents Zamolxiana as a new religious movement with characteristics of spiritual and religious revival based on the ancestral mythic culture of the Romanian people. The document outlines some of the key beliefs of Zamolxiana, such as its focus on pre-Christian deities and concepts of divinity derived from pagan roots, as well as its emphasis on esotericism and practices centered around sacred fire. It also discusses Zamolxiana as an emerging social movement promoting nativism and revitalization of Romanian identity and culture.
Matias Valenzuela discusses operationalizing equity to improve Latino health in King County. He outlines frameworks for applying an equity lens to decision making, organizational practices, and community engagement. Lessons from health enrollment efforts emphasize engaging local leaders, collaboration, utilizing existing networks, developing new partnerships, listening to community partners, and continuous improvement. The document also discusses investing early in child development, place-based community work, and advancing equity through leadership, integration, breaking down silos, tools and measurements, communications, and addressing both rational and emotional aspects.
The document describes World Up's 2011 WU School program, a 7-week educational pilot program combining art, technology, and education for select high school students. The program includes two core projects - The Living Remix Project which teaches hip hop fundamentals through music production, and Hip Hop Hackers which introduces computer programming through music and art. The goal is to empower students and make emerging technologies accessible through a focus on music innovation and collaborations.
Nada Marinovic Eckhardt has over 20 years of experience in the hospitality industry in both the US and Europe. She has worked as an A.M. Supervisor at the 4 Points by Sheraton in Destin West, FL and was the owner and operator of Caffe Italia Inc. in Ft. Walton Beach, FL for over 20 years. She has a background in travel and tourism and holds several certifications related to food safety and hospitality. Customer service and attention to detail are strengths, as evidenced by positive reviews and management recognition of superior performance.
The document discusses the basics of project management including defining goals, creating work breakdown structures (WBS), developing network diagrams and Gantt charts, identifying risks, and learning lessons. It explains that project management can help control goals by planning the time, cost, and quality of a project. It also provides examples of a WBS, network diagram, and Gantt chart.
This document provides information about Genius Consultants, an HR outsourcing and staffing company in India. Some key details:
- Founded in 1993 and has 17 branches across India serving over 900 client organizations.
- Provides various HR outsourcing and staffing services including payroll processing, temporary staffing, HR software, and background checks.
- Has over 300 employees and manages payrolls and places temporary staff for many large companies across various industries in India.
- Aims to provide smart HR solutions while maintaining high standards of client satisfaction, employee welfare, and statutory compliance.
Vipin Srivastava has over 37 years of experience in industrial chemistry with a focus on cellulosic fibre technologies like lyocell and ionic liquid processes. He has expertise in areas like solvent characterization, process development, analytical methods, and pilot plant operations. Currently he is participating in a joint development project with BASF to develop an ionic liquid-based solvent spinning technology as a viable alternative to existing lyocell processes.
The current shellfish industry development strategy and why shellfish could be important in an English aquaculture strategy. Presentation by Dr Tom Pickerell
This document provides information about various tools and tool accessories available for purchase from Channellock Products. It includes details on wet/dry vacuums, extension cords, tape measures, staple guns, tubing cutters, clamps, striking tools, toolboxes, gloves, and more. Many of the products are described as "exclusive" which means they are only available from Channellock Products. The document encourages readers to shop for tools and supplies to outfit their workshop.
Trial Strategy: The Struggle over Perpetuating Testimony Before Litigation B...NationalUnderwriter
Can an insurance company seek a court order to protect evidence before it is sued by a policyholder? A carrier may want to do this to protect its interests in any coverage case that ultimately is filed. Several decisions by federal district courts in Louisiana have explored this topic – and have reached different conclusions.
This new publication, Cyber Claims Insight from Aon Benfield’s Cyber Practice Group, empowers readers with the resources and tools they need to understand the cyber landscape, including legal trends, claims and insurance coverage disputes.
The document summarizes a new False Claims Act lawsuit against Progressive Insurance alleging they violated Medicare Secondary Payer laws. A relator purchased a health-first auto policy online from Progressive despite having Medicare. Progressive's website did not ensure she chose a PIP plan to make auto insurance primary over Medicare. When providers billed Medicare for her claims, Progressive instructed them to bill her health insurance instead of reimbursing Medicare. A court denied Progressive's motion to dismiss, finding the allegations met the elements of an FCA claim by causing Medicare to pay claims it was not responsible for. If successful, the case could establish insurers' responsibility to prevent Medicare beneficiaries from enrolling in plans where Medicare pays primary and to proactively identify Medicare beneficiaries.
This summary provides the key information from 4 documents related to medical malpractice cases:
1) The first document describes a medical malpractice case where an infant's larynx was punctured during surgery and the doctor failed to prescribe antibiotics or keep the infant in the hospital long enough. The court reduced the $2 million jury award to a more reasonable amount.
2) The second document summarizes a wrongful death medical malpractice case where the jury award of $3.9 million was reduced to $2.6 million by the appeals court.
3) The third document describes a medical malpractice case where a man died after being misdiagnosed and sent home from a clinic with a mild antibiotic.
Notice This opinion is subject to correct.docxdunhamadell
The superior court granted summary judgment to the physician and hospital on claims of breach of fiduciary duty and breach of contract related to a physician's alleged promise to contact a patient's insurer to ensure coverage for medical transport and treatment. The court found no fiduciary duty existed regarding insurance matters and no enforceable contract was formed. However, the court determined genuine issues of material fact precluded summary judgment on a claim of promissory estoppel regarding the physician's statement. The appellate court affirmed in part and reversed in part, upholding summary judgment on the fiduciary duty and contract claims but finding promissory estoppel issues required further proceedings.
Notice This opinion is subject to correct.docxhoney725342
Notice: This opinion is subject to correction before publication in the PACIFIC REPORTER.
Readers are requested to bring errors to the attention of the Clerk of the Appellate Courts,
303 K Street, Anchorage, Alaska 99501, phone (907) 264-0608, fax (907) 264-0878, email
[email protected]
THE SUPREME COURT OF THE STATE OF ALASKA
RACHEL L. THOMAS and
STEVEN N. THOMAS, husband
and wife,
Appellants,
v.
SARAH B. ARCHER and
PEACEHEALTH MEDICAL
GROUP d/b/a KETCHIKAN
OB/GYN,
Appellees.
)
) Supreme Court No. S-15372
Superior Court No. 1KE-10-00613 CI
O P I N I O N
No. 7136 – December 2, 2016
)
)
)
)
)
)
)
)
)
)
)
)
)
Appeal from the Superior Court of the State of Alaska, First
Judicial District, Ketchikan, William B. Carey, Judge.
Appearances: C. Keith Stump, Port Angeles, Washington,
for Appellants. Scott J. Gerlach and Donna M. Meyers,
Delaney Wiles, Inc., Anchorage, for Appellees.
Before: Stowers, Chief Justice, Winfree, Maassen, and
Bolger, Justices. [Fabe, Justice, not participating.]
MAASSEN, Justice.
I. INTRODUCTION
A woman was admitted to a hospital emergency room with pregnancy-
related complications. The attending physician recommended that she be transported by
mailto:[email protected]
medivac to a different facility. The woman and her husband informed the physician that
they needed their insurer’s preauthorization for that course of action or they could be
personally liable for the costs. The physician allegedly promised to call the insurer and,
if it would not approve the medivac, have the hospital bear the costs itself. But the
physician failed to contact the insurer until much later, and the insurer declined coverage.
The couple sued the physician and the hospital, alleging that the physician
breached her fiduciary duty by failing to obtain preauthorization as promised; that her
promise created an enforceable contract, which was breached; and that if there was no
contract the physician’s promise should be enforced through the doctrine of promissory
estoppel. The superior court granted summary judgment to the physician and hospital.
The couple appeals.
We hold that the superior court did not err when it ruled in favor of the
physician and hospital on the claims for breach of fiduciary duty and breach of contract,
but that genuine issues of material fact precluded summary judgment on the claim for
promissory estoppel. We therefore reverse and remand for further proceedings.
II. FACTS AND PROCEEDINGS
A. Facts
Rachel Thomas was admitted to the emergency room at Ketchikan General
Hospital in October 2008 for pregnancy-related complications.1 She was seen by Dr.
Sarah B. Archer, who determined that Rachel was at risk of premature delivery and
needed an immediate transfer to a facility better equipped to handle her condition.
Because of weather conditions in Anchorage, Dr. Archer recommen.
Court Says NJ Took Too Long For Subpoenas In FCA ClaimBrian Dickerson
The New Jersey Superior Court ruled that the state attorney general cannot subpoena former employees of a pharmacy benefits company that is the target of a False Claims Act suit because the deadline for the state to intervene had passed. The attorney general failed to declare intent to intervene within 60 days and did not act even after receiving 600 days of extensions. While the attorney general has power to investigate under the NJ False Claims Act, that authority expires when the right to intervene expires. The court found the attorney general's interpretation that investigations could continue indefinitely to be unsupported and absurd.
These legal challenges argue that aspects of the Affordable Care Act are unconstitutional. Specifically, they argue that the individual mandate exceeds Congress's power under the Commerce Clause and violates states' rights. Two key cases discussed are Commonwealth of Virginia v. Sebelius and State of Florida v. U.S. Department of Health and Human Services. The judges in these cases ruled differently on the constitutionality of the individual mandate.
This document is a petition for writ of certiorari filed with the Supreme Court of the United States by Wayne County, Michigan and several Wayne County employees. It seeks review of a Sixth Circuit decision involving a failure to protect claim under 42 U.S.C. § 1983. Specifically, it raises three questions: 1) whether the Sixth Circuit improperly expanded "single-incident Monell liability"; 2) whether the court erred in its qualified immunity analysis; and 3) whether an individual can be found deliberately indifferent without a known victim. The petition provides background on the lower court decisions and argues each issue warrants Supreme Court review.
This document is a petition for writ of certiorari to the Supreme Court from Wayne County, Michigan and several of its employees who are defendants in a lawsuit. The petition asks the Supreme Court to review three questions: 1) Whether the appellate court improperly extended "single-incident liability" to the County in this case; 2) Whether the appellate court ignored an employee's qualified immunity defense; and 3) Whether individuals can be found deliberately indifferent to an unknown victim of a random attack. The petition provides background on the case and argues the appellate court decisions conflict with Supreme Court precedent.
The class-action lawsuit filed against Heartland Payment Systems filed on behalf of credit card holders claiming their private, sensitive data was breached.
HIPAA & OIG Compliance for Medical Billing Company OwnersKareo
The success of your business relies on timely billing and accurate coding. Whether you’re managing the billing for one provider or 50, it’s a complex job that must meet a variety of regulations, making it easy for medical billing companies to be the target of false claims and fraudulent crimes. As healthcare fraud continues to be a growing issue in the industry, medical billers are increasingly being held liable for their role in the submission of fraudulent claims.
Executive Director of American Medical Billing Association, Cyndee Weston, CMRS, CMCS, CPC, will provide an in-depth analysis of what can be considered fraud when submitting medical claims, how the government is enforcing guidelines, and what you can do to help protect your business as well as your practices.
The document summarizes recent legal developments from Supreme Court decisions and appellate court rulings that have implications for healthcare providers. Key points include: the Supreme Court ruling in North Carolina Board of Dental Examiners v. FTC that state licensing boards composed primarily of market participants do not enjoy automatic antitrust immunity; developments in case law around the False Claims Act and what constitutes a "claim"; and implications of cases related to the Anti-Kickback Statute and Stark Law on compensation arrangements between physicians and healthcare entities.
This document provides an overview of key topics related to the federal False Claims Act (FCA) including: the history and purpose of the FCA; common types of false claims; qui tam litigation process; applicable statutory provisions like the first-to-file bar, public disclosure bar, and original source exception; roles of relators, defendants, and the government; and implications of recent case law decisions. It also briefly mentions state false claims acts. The document appears to be an educational aid for FCA lawyers, relators, and defendants.
The 2010 Affordable Care Act has transformed our nation’s
health care system, creating myriad opportunities for
attorneys and professionals along the way. Now more than ever, attorneys in most fields of practice are
destined to overlap with health care law.
Interested in making the switch from another specialty,
or expanding your health law practice?
Cyber security legal and regulatory environment - Executive DiscussionJoe Nathans
What will you do when a breach occurs, and critical, confidential information has been publicly disclosed?
• FBI, Law Enforcement or Reporter Calls
• You become the Top News Story
• Investors need answers
• Regulatory Agencies are asking questions
• Your Customers, Suppliers, and Employees are affected, concerned, and need information
• The Breach becomes your only priority and you don’t know:
o What happened and what was disclosed?
o Who is responsible for resolution and who is on our team?
o What are our legal responsibilities?
o How will we manage the surge volume of communications, discovery and analysis?
o Who will pay?
The following presentation begins to address some of the legal and regulatory issues that are involved. The presentation is for discussion purposes only and should not be considered legal advice.
This order declares a Georgia statute capping noneconomic damages in medical malpractice cases unconstitutional. The order discusses the facts of the case, in which a jury awarded damages to the plaintiffs that exceeded the statutory cap. The court considered motions to strike affidavits submitted by the plaintiffs and denied the motions. In a lengthy analysis, the court found that the statutory cap violates the right to a jury trial guaranteed by the Georgia constitution. The court examined the history and scope of the right to a jury trial and determined that the cap improperly infringes on this right. Therefore, the court declared the statutory cap unconstitutional.
The Supreme Court of Kansas heard a case regarding the constitutionality of a Kansas statute that caps noneconomic damages in medical malpractice cases at $250,000. The Court upheld the statute as constitutional, finding that: (1) the statute and broader medical malpractice legislation further a valid public interest in promoting public welfare and healthcare availability; and (2) the legislature substituted an adequate statutory remedy for any modification of common law rights. The Court also rejected claims that the statute violated separation of powers, equal protection, or other constitutional provisions. While the cap limits damages awards, the Court found it did not prevent reasonable compensation or obstruct the right to a jury trial.
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This document provides guidance for state, local, tribal, and territorial (SLTT) law enforcement on reporting cyber incidents to federal authorities. It outlines types of incidents that should be reported, such as those affecting critical infrastructure, national security, or public safety. The document details the information that should be included in reports, such as technical details about the incident and impacted systems. It also lists several ways for SLTT law enforcement to report incidents, including email, phone, or online portals, and specifies the federal agencies responsible for accepting different types of reports related to cybercrime, national infrastructure, or investigations.
Sample Network Analysis Report based on Wireshark AnalysisDavid Sweigert
This network analysis report examines a packet capture file containing traffic between two internal hosts downloading a file from a remote server. The analysis found that one internal host, with IP ending in 1.119, experienced significant packet loss during the download, as shown by drops in throughput and bursts of TCP errors. This packet loss indicates a potential failure at an infrastructure device, likely causing the observed retransmissions and degradation in performance. Further analysis of ingress traffic is needed to determine if the packet loss is occurring internally or externally to the network.
Department of Defense standard 8570 - CompTia Advanced Security Practitioner David Sweigert
This document provides notes for the CompTIA CASP exam, organized by exam domain:
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National Cyber Security Awareness Month is held each October to promote cybersecurity awareness and education. It is a collaborative effort between the Department of Homeland Security and private partners. There are 5 themes highlighted during the month - simple online safety steps, cybersecurity in the workplace, security of connected devices and the internet of things, cybersecurity careers, and protecting critical infrastructure. Each week focuses on one of these themes and provides resources to help organizations and individuals strengthen cybersecurity. The goal is to engage the public and encourage everyone to play a role in cybersecurity.
California Attorney General Notification Penal Code 646.9David Sweigert
This letter requests assistance from the California Attorney General's office for the District Attorney of San Luis Obispo County. It describes activities of an individual named Nathan Ames Stolpman who broadcasts livestreams on YouTube and videos on Patreon directing "crowd stalking" followers to target and harass private citizens by publishing their personal information. Stolpman issues "bounties" for photos of targeted individuals and provides their intended locations. The letter writer believes the District Attorney has not demonstrated a clear understanding of relevant privacy laws and requests the Attorney General's office provide technical assistance to the District Attorney regarding Stolpman's activities.
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This House resolution expresses support for developing educational programs to better prepare students for cybersecurity careers by promoting ethical hacking skills. It notes the critical shortage of cybersecurity professionals and growing cyber threats facing the US. The resolution states that partnerships between industry, government and academia should collaborate to create programs, competitions and curricula giving students hands-on experience with in-demand cybersecurity skills like ethical hacking to help close this workforce gap.
Application of Racketeering Law to Suppress CrowdStalking ThreatsDavid Sweigert
This document discusses how racketeering and wire fraud laws can be used to combat hoax news sites that engage in "CrowdStalking" to distribute misinformation. These sites target critical infrastructure operators, federal employees, and security advisors. The document provides an example of how social engineering attacks can steal millions from a company. It argues that legal action against hoax news site operators can deter such attacks, and establishes criteria for when racketeering laws may apply to their activities, such as using deception for financial gain. The document identifies specific YouTube personalities like Nathan Stolpman and Jesse Moorefield who operate hoax news sites.
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The document summarizes a study on how Live Action Role Play (LARP) simulations can create cognitive threat vectors using the example of two YouTube conspiracy theorists, Jason Goodman and George Webb. In June 2017, they created a sense of hysteria among their online fans by claiming a container ship was sailing into the Port of Charleston with a dirty bomb onboard, leading to the port's evacuation. The document argues this "crowdsourcing" format can weaponize sensationalized information and represents an emerging threat that critical infrastructure operators need to be aware of. It can potentially lead unwitting participants to engage in criminal acts or attacks in response to implied calls for action by the game's controllers.
Cyber Incident Response Team NIMS Public CommentDavid Sweigert
The Cyber Incident Response Team responds to cyber crises and threats. It is composed of 15 personnel including managers, analysts, specialists in areas like forensics and infrastructure. The team investigates incidents, uses mitigation approaches, and documents actions. It requires equipment like laptops, forensics tools, and communications devices and is deployable for up to 14 days.
Cyber Incident Response Team - NIMS - Public CommentDavid Sweigert
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California supreme court declines to hear data breach cases
1. CA Supreme Court Declines Breach Cases - GovInfoSecurity http://www.govinfosecurity.com/ca-supreme-court-declines-breach-cases...
CA Supreme Court Declines Breach Cases
No Proof in Either Case of Unauthorized Data Viewing
By Marianne Kolbasuk McGee, October 24, 2014. Follow Marianne @HealthInfoSec
The California Supreme Court has declined to hear
appeals in data breach class action lawsuits against
Sutter Health and Eisenhower Medical Center. The
action lets stand previous court rulings that determined the
healthcare providers were not liable for the breaches
under the state's Confidentiality of Medical Information Act
because there was no proof that patients' medical data
was actually inappropriately viewed.
The two separate cases involve 2011 thefts of unencrypted computing devices
from the California-based healthcare organizations.
The Sutter incident, affecting about 4.2 million individuals, involved the theft of an
unencrypted desktop computer from an administrative office. Some 13 class
action lawsuits against Sutter had been consolidated.
The Eisenhower Medical Center incident, which affected 500,000 patients,
involved the theft of an unencrypted desktop computer from the Rancho Mirage,
Calif., hospital.
Each of the healthcare providers faced potential damages of up to $1,000 per
breach victim under CMIA.
Appellate Court Decisions
In both cases, appellate courts ruled earlier this year that the healthcare
providers were not liable under CMIA, and the plaintiffs appealed to the California
Supreme Court. "In both matters, that means the court of appeals decisions
stand," says attorney Beth Diamond, claims team leader at Beazley Group,
which provided breach response insurance coverage to both Sutter and
Eisenhower Medical Center.
The California Supreme Court declined on Oct. 15 to hear an appeal in the
Sutter Health case, which could have resulted in a potential judgment totaling
more than $4 billion under CMIA (see Sutter Health Breach Suit Dismissed).
An appellate court had ruled Sutter was not liable because the plaintiffs did not
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2. CA Supreme Court Declines Breach Cases - GovInfoSecurity http://www.govinfosecurity.com/ca-supreme-court-declines-breach-cases...
allege the stolen information was actually viewed by an unauthorized person.
"The case is effectively over and we are very disappointed that the California
Supreme Court did not choose to review a court of appeals decision that rewrote
the statute and left consumers with no effective remedies in our case," says
attorney John R. Parker Jr., of law firm Kershaw, Cutter & Ratinoff LLP, which
represented plaintiffs in the Sutter case.
"Sutter Health is pleased with the California Supreme Court decision," a
spokesperson for the organization says. "We can't speculate on future legal
action."
The state supreme court also recently declined to hear an appeal of the lawsuit
against Eisenhower Medical Center. An appellate court had ruled in May that the
healthcare provider was not liable under CMIA for the release of patients'
personal information because a patient index backup file on the stolen computer
did not include information about medical histories, conditions or treatments. In
that case, Eisenhower faced a potential total judgment of about $500 million
under CMIA (see Court: Breach Didn't Violate State Law).
"The high court's refusal to hear the Eisenhower and Sutter appeals reflects the
trend toward harmonization of California - CMIA - and federal law - HIPAA -
regarding the consumer's privacy rights in their health information," says attorney
Kathryn Coburn of law firm Cooke Kobrick & Wu LLP, which is not involved in
either case. "The California appellate court noted in the Eisenhower case that
the circumstances of the breach must include 'unauthorized viewing' in order for
the plaintiff to recover nominal damages. HIPAA doesn't even allow for a private
right of action by the consumer."
Although the CMIA-related claims in the Eisenhower case have been decided,
attorney Alan Harris of Harris & Ruble, which is representing the plaintiffs in the
lawsuit, says the legal action will continue on other claims, including complaints
that Eisenhower delayed in notifying law enforcement and plaintiffs about the
theft of the unencrypted computer. A trial date for that part of the lawsuit has not
been set yet, he says.
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3. CA Supreme Court Declines Breach Cases - GovInfoSecurity http://www.govinfosecurity.com/ca-supreme-court-declines-breach-cases...
ARTICLE
DHS Cybersecurity
Recruit Bill Progresses
A bill designed to help
strengthen the cybersecurity
workforce at the Department
of Homeland...
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