4-7-2011; The Greater Oak Brook Chamber of Commerce Presents HFN’s Annual Healthcare Showcase If Health Insurance is Just Pre-paying expenses…How Do I Manage Healthcare Risk Today?

HFN is hosting this event and inviting all of our readers to this interesting and challenging presentation.

 

Topics & Speakers will include:

 

  • Employer Expectations are High for Good Reason!
    • Mary Lynn Fayoumi, CAE, SPHR, GPHR, President/CEO The Management Association of Illinois

 

  • Healthcare Reform and the Rapidly Evolving Self Insurance Market
    • Walter Roland, Senior Vice President, D.W. Van Dyke & Co., Inc.

 

  • Do You Know What You Must Do Now With Your Health Plan? A Checklist to Live By!
    • Ronald Walter, CLU, ChFC, President Professional Benefit Administrators, Inc.

 

  • Why is the Employer’s Opportunity so Significant Today?
    • David Kolb, FACHE, President/CEO HFN, Inc.

 

Date: Wednesday, May 4, 2011

 

Time: 7:15 – 8:15 Health Assessments*

7:30 – 8:15 Full Breakfast

8:15 – 10:00 Presentation & Discussion

 

Location: The Grotto Oak Brook, 3011 Butterfield Rd, Oak Brook, IL 60523 (630) 571-5700

 

RSVP: Please RSVP By April 27, 2011 to Danielle Kolego 630/990-8501 or email kolegod@hfninc.com

 

4-7-2011; Will changes to the Medicare Secondary Payer Statute assist in resolving Medicare issues and finally give us a way to appeal what are sometimes incomprehensible MSA values?

On March 14, 2011, the Strengthening Medicare and Repaying Taxpayers Act of 2011 (SMART Act) (H.R. 1063) was introduced in the U.S. House of Representatives. The SMART Act proposes major amendments to the Medicare Secondary Payer Statute (MSP). Track progress here: http://www.govtrack.us/congress/bill.xpd?bill=h112-1063       

The SMART Act’s reform proposals target multiple areas of MSP compliance including:

       Obtaining CMS’ reimbursable conditional payment amount—this will help the parties confirm amounts which will be owed for past medical. Under CMS’ current process, the parties generally cannot obtain the exact reimbursable conditional payment amount until after the claim settles.

       Requiring CMS to respond  to requests  for conditional payment information within set timelines—finally you won’t be stuck in the purgatory of never knowing when you will receive information you need to resolve past payments, hopefully within 120 days or less;

       MSP appeal rights—when you receive the $100k MSA ruling for a person who hasn’t had a surgical procedure, you may have somewhere to turn as review through an administrative law judge and administrative review board, and access to judicial review in the district court of the United States is proposed in a manner which would be similar to the appeals procedure under regulations for hearing procedures respecting notices of determinations of nonconformance of group health plans.

       MSP threshold exemptions—the SMART Act would require that CMS establish an annual MSP threshold exemption amount below which MSP compliance would not be necessary. The SMART Act’s proposal of a yearly MSP threshold exemption amount replaces the flat $5,000 monetary threshold exemption proposed last year.

       MSP statute of limitations—you would no longer have to worry about someone looking into a claim well after all parties have retired as the SMART Act would establish a Three (3) year Statute of Limitation for MSP Claims.

We will keep you advised of changes as they occur and as previously noted, Shawn R. Biery has completed course work and testing from two sources to obtain his Medicare Set-aside Consultant Certified (MSCC) credential.

 

Please feel free to contact Shawn R. Biery, J.D., M.S.S.C. at sbiery@keefe-law.com with any questions regarding Medicare Set-Aside issues.

             

4-7-2011; Concluding our series of articles by Arik D. Hetue, J.D. taking a look at some of the recent rulings of the Supreme Court of The United States which point toward broad support for...

KC&A styles itself as a “one-stop shop” for employer defense needs. We have successfully defended IDHR suits in Illinois and Title VII suits in the Federal courts at very reasonable rates. In these discrimination settings, there are clearly defined paths for defendant employers to follow in order to limit their potential liability. Earlier this month, the Supreme Court of the United States decided a series of cases involving workers’ rights in the employment law setting. Last week we highlighted Staub v. Proctor Hospital, U.S. No. 09-400. this week we turn to Kasten v. Saint-Gobain Performance Plastics Corp which was decided on March 22, 2011.

 

Kasten v. Saint-Gobain Performance Plastics Corp, decided on March 22, 2011, dealt specifically with the Fair Labor Standards Act (FLSA), but its holding will apply more broadly in the field of retaliatory discharge and OSHA suits generally, as the language of the statutes are similar. Kasten was an employee in Saint-Gobain’s Portage, Wisconsin facility who received repeated warnings for violating a company policy requiring employees to clock in and out of work. He was eventually terminated for these infractions. Kasten subsequently filed suit alleging he was discharged in retaliation for making oral complaints to his supervisors regarding the location of the company’s time clocks in regard to preventing employees from recording their time spent “donning and doffing” protective gear. The fact that these complaints were oral was central to the case and to the holding, as the District court held internal company complaints could constitute protected activity within the meaning of the FLSA, but oral objections were not protected.  The Seventh Circuit affirmed and the Supreme Court took up the issue.

 

Of note is the now somewhat broad language of “filed any complaint” contained in the relevant portion of the FLSA. The Supreme Court essentially held this statutory text can include both oral and written complaints, and reversed the Seventh Circuit and remanded the case for further consideration in light of their holding. The Court focused on the facts surrounding the time of the passage of the FLSA, when a relatively high number of American workers were illiterate. Relying on this, the Court held the phrase “filed any complaint” to include oral complaints, and noted such an interpretation furthered the FLSA’s stated purpose of protecting workers. Also of significant was the fact agencies which enforce the FLSA have consistently interpreted “filed any complaint” to include oral complaints.

 

One striking item missing from the Court’s analysis was the issue of whether complaints made to private employers, rather than government agencies, are protected under the FLSA’s anti-retaliation provision.  This is striking mostly because the complaints at issue in Kasten were made only to a private employer! Always make sure to include the kitchen sink when preserving the issues on appeal - the Court found Saint-Gobain failed to raise the issue in its response to Kasten’s petition for certiorari. There is currently a circuit split on this issue, which may soon be heading back to the Supreme Court.

 

What does this mean for employers generally? The most important thing to take away from this holding is to pay attention to complaints and document them regardless of whether they are oral or written. As noted above, this holding will take effect in at least other OSHA settings, but generally, it is wise to look into any reports of any kind which may lead to litigation or grievance. If you do not yet have a policy of having oral complainants write out their complaints, it would be wise to do so – have them give a recorded statement while you are at it if you want to lock stories in. We would be happy to further discuss such issues with you via email, in person or over the phone, feel free to contact us regarding your investigation process!

 

This article was researched and written by Arik D. Hetue, J.D. If you have thoughts and comments, please send a reply to ahetue@keefe-law.com, or post them later today on the blog at www.keefe-law.com/blog.