Category: Blog

Dismissal of Medline Industries False Claims Act Case Upheld

Jan 18, 2016 | Blog |

The Seventh Circuit upheld the dismissal of a suit filed in 2011 under the False Claims Act on January 4, 2016, finding the Relator was merely adding details to a prior kickback suit remarkably similar to his own.  Bogina v. Medline Industries, Inc., No. 15-1867 (7th Cir. 2016).  Thus, Relator Bogina failed the “original source” requirement as he was not “an individual who has direct and independent knowledge of the information on which the allegation [in his complaint] are based.”  31 USC § 3730(e)(4)(B).  Defendant Medline Industries, Inc. had previously settled a 2007 suit brought by Sean Mason, an employee […]

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Are Workers Compensation Benefits Affected By Other Benefits?

Jan 3, 2016 | Blog |

Whenever other benefits are involved in a WC claim, questions arise.   If a client gets Vet benefits, is there a reduction?  If Service Connected, no. If Non-Service Connected, yes. If client is getting UC & WC, will Social Security deny benefits?  Not necessarily. 820 ILS 405 Section 601(b)(1). If client has another WC claim pending in Ohio as well as Illinois, what then?  Confusing since Ohio is a reverse offset State. If client is going thru a divorce, does the spouse have an interest in the WC claim proceeds?  You betcha. Does CMS require that a Medicare set-aside arrangement […]

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Social Security Expedited Disability Claims

Jan 3, 2016 | Blog |

Social Security has several programs that will expedite a claim for disability benefits claims. One is to prevent homelessness. In fact, each Social Security local office has a designated staff member to handle such emergency situations.  Relevant POMS is below and available at: http://policy.ssa.gov/poms.nsf/lnx/0302801001. RS 02801.001 Critical Case Criteria and Exclusions A. Policy – critical case criteria SSA’s goal is to pay all benefits due on time. Processing critical cases has priority over all other workloads. Through routine processing, this goal is usually met. However, when a beneficiary is adversely affected because payment is not made timely, our goal is to […]

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Medical Search Engine

Jan 2, 2016 | Blog |

MedNexus is a medical search engine for patients – think “Google for Medicine”. “Through our search engine, you can find the most relevant content from a variety of sources: medical journals, patient forums, government health sites, etc. We want to empower patients to educate themselves and cut through the noise and pseudo-science of typical online health information. No more WebMD scares, no more endless Googling. Whether you are looking for the latest evidence, or to learn from fellow patients, you can find actionable and reliable answers at MedNexus.”

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The Inside Insurance Track

Dec 9, 2015 | Blog |

Insurance contracts are not drafted with the goal of providing clarity to the insured/policy holder.  The “accept” button you push when you update licensing agreements with Apple or other software providers do not give you the ability to negotiate the terms of the agreement.  These are called contracts of adhesion or unilateral contracts.  Insurance contracts fall into the same categories.  The critical terms or words in these contracts are given their own definitions and can be described as a term of art .    As a result, these unique definitions are often dissimilar to the words common meaning.  This leases even […]

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Social Security Dependent Benefits and Child Support

Nov 11, 2015 | Blog |

In a case of first impression before the Appellate Court of Illinois, a marital settlement agreement requiring the respondent to pay 32% of his net income for guideline child support of three minor children was found unconscionable.  In re Marriage of Ruth Mitter, 2015 IL App (1st) 142695.  The husband challenged the settlement agreement arguing the trial court erred in denying him a credit of Social Security Retirement dependent benefits of $1,083 a month toward the child support payments.  The court agreed with the husband that the benefits were earned and should be considered part of his overall child support […]

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7th Circuit Court of Appeals Critical of Vocational Evidence in Social Security Disability Case

Aug 24, 2015 | Blog |

The Seventh Circuit Court of Appeals takes yet another opportunity to criticize the Social Security Administration’s disability claim adjudication process in Alaura v. Colvin, decided August 18, 2015 (decision written by Judge Richard Posner).  The plaintiff, a 22-year old man was struck in the back of his head by an assailant wielding a bar stool as a weapon.  The blow shattered his skull, necessitating emergency surgery.  Still suffering after surgery two months later Alaura was examined by a neurologist who diagnosed post-traumatic headaches and cognitive impairment caused by the injury to his brain.  In addition to daily headaches the Claimant was found to be […]

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Medicare Secondary Payer Act

Jan 17, 2015 | Blog |

REMINDER: Pursuant to 42 USC Section 1395y(b)(2), commonly known as the Medicare Secondary Payer Act, Medicare may not make payment for medical benefits where payment has been made or can reasonably be expected to be made under a workers’ compensation law or plan of the United States or a state, or under an automobile or liability insurance policy or plan (including a self-insured plan), or under no fault insurance. By law, Medicare has a priority right of recovery from the primary payer as well as from parties in receipt of third-party payments, such as a beneficiary, provider, supplier, physician, attorney, […]

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