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The Necessity of “Medical Necessity”

By Joyce Varughese, Esq. Staff Attorney at Praxis Most health care providers dread one claim denial more any of the other denials, “medical necessity.” Unlike other denials which may be rectified by submitting a corrected claim or requested documentation,...

ERISA CAUSES OF ACTION FOR HEALTH CARE PROVIDERS

by David A. Blakeley, Esq. Senior Staff Attorney, Praxis Healthcare Solutions ERISA is a sweeping federal law that governs employee benefit plans. The law was enacted with two purposes. The first was to protect participants and beneficiaries by setting standards of...

The Power of Why

By: David A. Blakeley, Esq. Praxis Healthcare Solutions, Senior Attorney Let’s face it. Those of us who call insurance payers on a daily basis quickly learn the scripts that the representatives are given to read to us. Before long, we feel that we could have...

Learning from UnitedHealth Group’s Legal Debacle

By: Joyce Varughese, Esq. Praxis Healthcare Solutions, Staff Attorney UnitedHealth Group Inc., the nation’s largest Medicare Advantage Organization (MAO), has been under fire with allegations of overbilling Medicare since February 2017. The Justice Department of the...