With assistance from Kristi Gauthier, Ed Hammond, Peter Domas and Bishop Bartoni, Kevin Hendrick and Nicole Tersigni successfully defended an insurance priority dispute, resulting in an extremely favorable judgment for firm client, United States Steel Corporation’s ERISA-governed Retiree Benefits Plan. U. S. Steel Retirement Plan was joined as a third-party defendant in a pending dispute by a No-Fault Automobile Insurance carrier, which had been sued by a healthcare service provider for unpaid patient attendant care fees. The No-Fault Carrier claimed that the obligation to pay for these services under Michigan No-Fault law fell to U. S. Steel Retirement Plan, which covered the patient (who was a former U. S. Steel employee). Ed, Bishop, Kristi and Peter lent their expertise to Kevin and Nicole in interpreting alleged conflicting insurance priority provisions and explanations of benefits. Kevin and Nicole crafted a legal argument that ultimately led to summary disposition in favor of U.S. Steel Plan, and against the No-Fault carrier, saving U.S. Steel Plan from payment of the healthcare fees, and also reimbursing U.S. Steel Plan for benefits it had earlier paid by mistake, out of priority. As the No-Fault carrier had rejected the Case Evaluation award prior to the filing of cross motions for summary disposition, it also appears that attorney fees are recoverable for our client. Kristi and Ed on Employee Benefit law, Bishop on Michigan No-Fault law, and Pete on Health Care issues, proved to be unbeatable resources.
Employee Health Plans
Our legal team is skilled in guiding clients on issues related to insured and self-funded group health plans and applicable federal and state laws and regulations. Our experience includes reviewing client plan documents to provide recommendations and best practices pertaining to the Affordable Care Act (ACA), Health Insurance Portability and Accountability Act (HIPAA), Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage, Mental Health Parity and Addiction Equity Act (MHPAEA), Emergency Medical Treatment and Labor Act (EMTALA), Genetic Information Nondiscrimination Act (GINA), Fraud and Abuse Laws, data privacy, and other state and federal laws regarding employee medical and welfare benefit plans. We advise clients on changes in the law to ensure that their medical and welfare benefit plans remain in compliance with these applicable laws and regulations.
Our firm offers a wide variety of services designed to help clients navigate the complex regulatory, security, privacy, and transactional issues that come into play under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. This includes advising clients regarding standards and practices to guarantee HIPAA compliance, developing appropriate policies and procedures and business associate agreements, and reviewing group health plans, documents, and privacy notices to ensure that both patient and recipient rights are protected at every level. We regularly provide HIPAA training to clients and counsel clients on their duties and responsibilities in the event of a HIPAA breach.
We also counsel clients regarding the potential implication of federal and state fraud and abuse laws, including the federal Stark Law and Anti-Kickback Statute, state Anti-Solicitation Statutes, and similarly adopted state-specific statutes or regulations governing relationships in the healthcare industry.