Steven M. Ziegler recently conducted a seminar to the Senior Medical Staff of Molina Health Plan entitled "Liability Exposure and Reduction of Risk". The presentation concentrated on theories of liability being used by MCO subscribers to bring actions against health plans and the ways to reduce exposure to these risks. Mr. Ziegler also discussed the effect of health care reform on subscriber liability issues.
Steven M. Ziegler recently presented a seminar on health care reform to OneBeacon Professional Insurance. Mr. Ziegler discussed all aspects of heath care reform and the expected impact on the health care delivery system in America.
Steven M. Ziegler recently presented at the American Health Lawyers Association Managed Care Law Institute Annual Meeting on the topic entitled "Payment Litigation Other Than UCR". Mr. Ziegler described the current litigation nationwide involving silent PPO's, waiver of patient responsibility and overpayment litigation. Mr. Ziegler also discussed evolving trends in payor provider litigation in the areas of prompt pay, drug formulary issues and third party liens. The annual meeting is attended by in-house counsel and external counsel as well as business representatives from both the payor and provider industries.
Congratulations to Shari Gerson upon being selected as one of Florida's Legal Elite attorneys for 2009. Florida Legal Elite is sponsored by Florida Trend Magazine and attorneys are awarded this honor from votes by other Florida lawyers, their peers. The 2009 list of 918 Legal Elite attorneys represents less than 2% of the nearly 63,000 Florida Bar members practicing in Florida.
Steven M. Ziegler and Bradley M. Seldin recently authored an article for the American Health Lawyer's Association titled, "Medical Tourism: A Risky Business?" published in their August 2009 Issue of the Payors Plans & Managed Care Newsletter. The article focuses on the growing practice of traveling across international borders to obtain medical care primarily due to cost considerations and the concerns Payors face when incorporating this practice into the realm of covered services where Payors can take advantage of the substantial savings. The article describes the considerations and risks Payors need to evaluate before entering this market.
Kenneth White recently presented at the Emergency Practice Management Association Summit XII conference in Miami on issues related to the balance billing of patients for emergency medical services. Mr. White described the Payor's perspective of providers billing patients for amounts not paid by insurers and the impact these practices have on the cost of health care. The Summitt was attended by physicians and practice managers from around the United States.
Steven M. Ziegler participated in a roundtable discussion on liability issues affecting the managed care industry at the 2009 Professional Liability Underwriters Society Professional Liability Symposium. Topics discussed included issues surrounding the current Ingenix litigation and how this will affect health plans and their insurers in the future. Also discussed was the recent regulatory action and litigation in the area of recission of health insurance contracts. The roundtable also advised the participants of the growing business of medical tourism and discussed how this new phenomena will affect both providers and health plans from a business and risk perspective.
Steven M. Ziegler was recently featured in Managed Care Magazine as a commentator on issues related to managed care liability in an article entitled "Managed Care Under Seige". In this national publication, Mr. Ziegler discussed trends in managed care litigation and specifically the issues surrounding the dispute over reimbursment to providers and the Ingenix litigation. Mr. Ziegler provided practical advice to managed care plans in order to avoid class action lawsuits and to reduce liability for claims arising out of usual, customary and reasonable payment disputes.
Steven M. Ziegler recently authored an article entitled "Look Before You Leap: Points to Ponder Before Including an Arbitration Clause in Your Contract" published by the American Health Lawyers Association in the January 2009 Issue of the Payors Plans & Managed Care Newsletter. The article discusses the various factors to be considered in determining if an arbitration clause should be utilized in the context of payor and provider contracts. The article describes both the risks and advantages of an arbitration clause versus traditional litigation.
On December 9, 2008, Steven M. Ziegler conducted a seminar at the corporate offices of Amerigroup Health Plan in Virginia Beach, Virigina on the topics of "Emerging Trends in Managed Care Litigation" and "How a Claim Affects a Health Plan: Before, During and After". Attendees included representatives from all departments of the company and was attended in person by Amerigroup corporate employees and broadcast via Web X to employees in all Plan offices around the country. During the first session, Mr. Ziegler discussed recent developments in the areas of UCR litigation, claim related cases, recission cases and matters involving tiering of providers. The presentation on "How a Claim Affects a Health Plan" centered on the types of theories being used in managed care litigation, the types of discovery plans receive and how to prevent claims from occurring.
On October 13-14, 2008, Steven M. Ziegler presented at the American Health Lawyers Association Managed Care Law Institute Annual Meeting in Boston on the topic entitled "Arbitration and Dispute Resolution-Payor and Provider Perspectives". The annual meeting is attended by in-house and external counsel as well as business executives from both the provider and payor industries. Mr. Ziegler discussed the recent case law regarding disclaimers in arbitration clauses and how the courts view the attempt to limit various causes of actions and damage relief. Mr. Ziegler also discussed the various issues that payors need to consider in determining whether alternative dispute resolution will accomplish their objectives.
Kenneth White recently presented and participated in a round table discussion at the Lockton Companies' Blue Cross/Blue Shield seminar in St. Louis. The annual seminar is for brokers, carriers and risk managers and is designed to update the attendees on business and legal issues affecting healthplans/carriers and their potential exposure. Mr. White presented on current national legal topics affecting healthplans/carriers and the future impact these trends may have on the industry. The presentation included analysis of current regulatory oversight, the "Ingenix" litigation, UCR and non-par class actions and other current litigation trends.
Steven M. Ziegler recently participated as a Panel Member at the Marsh National Conference on Healthcare at the Broadmoor Hotel in Colorado Springs, Colorado. The topics covered during the Panel discussion included issues related to the dispute surrounding reimbursement to providers pursuant to the usual, customary and reasonable methodology; the latest liability issues relating to Medicare Advantage Plans; and an update on case law and trends in the area of recission of individual insurance policies.
Steven M. Ziegler and Arthur Cholodofsky recently presented at the IPA Association of America's Annual National Conference in Las Vegas, Nevada. Mr. Ziegler discussed the latest developments in managed care liability across the nation and effective measures to reduce risk through proactice review of IPA documents. Mr. Ziegler also presented on a topic entitled "Arbitration: Panacea or Pandora's Box" in which he discussed the cost and benefits of arbitration and the various issues to consider before placing an arbitration clause in an MCO contract. Mr. Cholodofsky presented on the latest developments in class action cases and e-discovery.
Karina P. Gonzalez recently made a presentation to Medical Service Directors and Medical Directors of Evercare/Ovations, a United Health Group Company on "The Importance of Documentation Guidelines in Quality Care Management". Areas of discussion included the importance of documentation by nurse practitioners in a long term care setting and for case managers in home health care environment to avoid and reduce adverse events and to maintain the best quality of care.
Shari Gerson, a member of the ABA's Health Law Section, recently presented on prompt pay laws and developments in timely payment litigation throughout the nation. This program, sponsored by the ABA and attended by health care lawyers, focused on rights and remedies under state and federal prompt pay laws, penalties for noncompliance, case law on state prompt pay, and decisions on preemption of state prompt pay statutes.
Steven Ziegler recently gave a presentation at the Willis Group Annual Managed Care Production meeting in Las Vegas, Nevada. Topics covered in this presentation included a discussion of the new theories of law being used to prosecute managed care cases and how they are being applied in the provider payor dispute arena. Mr. Ziegler also provided Risk Management advice designed to reduce or limit risk from this emerging type of litigation against MCO's.
Steven Ziegler and Arthur Cholodofsky recently gave presentations at the AIG Healthcare forum entitled From Provider Disputes to Class Action Lawsuits: Understanding Emerging Risks and How to Minimize Their Impact held at the Roosevelt Hotel in New York City. Mr. Ziegler presented on the topic of Emerging Liability Trends in Provider/Payor Disputes, and Mr. Cholodofsky presented on The Evolution of Class Action Lawsuits and Surving Electronic Discovery.
Ms. Gerson recently participated in a panel discussion hosted by Connecticut General Life Insurance Company on the subject of attorney/client privilege as it applies to the claim files of fiduciaries and what constitutes a privileged communication not subject to the fiduciary exception. Connecticut General annually hosts these panel discussions at the Life, Health, Disability and ERISA Claims Seminars presented by the DRI, and these discussions are presented to attorneys at law firms representing Connecticut General across the nation.
Steven Ziegler presented to Chubb Insurance Company Professional Liability Claims Department and Underwriters on the topic of tort and HMO reform in Florida. The presentation also included a discussion of the recent amendments 3, 7 and 8 to the Florida Constitution, which respectively effect attorney fees in medical malpractice cases, patients' right to access records of adverse medical incidents, and the "three-strike" rule designed to ensure that providers with three adverse final judgement have their licenses to practice revoked. Mr. Ziegler also explained the impact of the recently passed House Bill and Senate Bill which provide implementing direction for amendments 7 and 8.
Steven Ziegler presented at the Florida Association of Health Plans annual meeting on new legal developments in Florida affecting health plans and their affliated providers. Mr. Ziegler discussed the impact of the HMO and tort reform enacted in September 2003 and also provided an analysis of the proposed Constitutional Amendments to the Florida Constitution.