Keyword: RICO

PFHSE Physician Survey on TMA Web Site 8/18/2009 2:01:35 PM The Physicians’ Foundation for Health Systems Excellence (PFHSE) national survey of physicians can now be accessed through the TMA Web site. Blue Cross Settlement Checks on the Way 7/31/2009 1:04:54 PM Physicians who filed claims in the $131 million settlement of organized medicine's antiracketeering lawsuit against Blue Cross Blue Shield should receive their checks by mid-August, said Joe R. Whatley, Jr., JD, one of the attorneys representing physicians in the lawsuit BCBS Settlement Money Coming This Summer 6/16/2009 9:26:13 AM The final appeal surrounding the settlement of the antiracketeering lawsuit against the Blue Cross Blue Shield plans and Blue Cross Blue Shield Association have been resolved and the more than $130 million in settlement funds will be distributed this summer, says Texas Medical Association General Counsel Donald P. Wilcox, JD. TMA's Legal Action Against Health Care Payment Plans 6/2/2009 3:37:16 PM Countless meetings with health insurers and insurance regulators early this decade and in the late 1990s failed to resolve the avalanche of downcoding,bundling,and slow pay/no pay. That’s why,TMA joined other state medical associations and individuals in a class action lawsuit alleging that insurers engaged in racketeering by maintaining claims processing practices and systems that lowered physician reimbursement. Make Insurers Keep Their Promises 5/14/2009 2:27:47 PM The nation's largest for-profit health insurers have agreed to change the way they do business because of the class-action federal lawsuits that the Texas Medical Association and other medical societies across the country filed against them. Insurance Watchdog Needs Testers 3/2/2009 2:12:49 PM The Physicians Advocacy Institute (PAI) has a new database that gives you the tools to tell exactly how insurers are processing the claims you file, and allows you to keep an eye on them to make sure they are keeping their promises to change the way they do business. The database lets you know whether the insurer paid the claim at the correct fee schedule, and paid promptly in compliance with state laws and contract terms. BCBS Coding Provisions in Effect 3/2/2009 2:11:07 PM Several coding provisions of the Blue Cross and Blue Shield settlement agreement, which provide for greater transparency in claims processing and payment practices, took effect Jan. 21. Patients' Right to Know 3/2/2009 2:09:18 PM Health insurance reform is TMA's main priority in the 2009 legislative session and the association is taking bold steps to convince lawmakers to make insurers' business practices more transparent and accountable to physicians and patients. Choose or Lose: Physicians Must Be Careful in Filing CIGNA Settlement Claims 12/11/2008 10:38:32 AM Physicians must be care when filing claims to recover underpaid and denied reimbursement from CIGNA HealthCare and its subsidiary health plans. Blue Cross Compliance Process Announced 9/15/2008 9:23:11 AM Physicians can file a Compliance Dispute Form if they believe Blue Cross and Blue Shield is not complying with the terms of its settlement of organized medicine's lawsuit against it and other for-profit HMOs. Any physician who did not opt out of the settlement can file a complaint. Page: 1 of 8