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WASHINGTON - The Obama administration is upping the ante in the fight against health care fraud, joining forces with private insurers and state investigators on a scale not previously seen in an attempt to stanch tens of billions of dollars in losses. Health and Human Services Secretary Kathleen Sebelius said in a statement Thursday that the new public-private partnership "puts criminals on notice that we will find them and stop them," while Attorney General Eric Holder called it "a critical step forward" against fraud, an endemic problem plaguing programs like Medicare and Medicare as well as private insurance companies. Details of the collaboration remain to be worked out, but the possibilities include sharing information on new fraud schemes as they pop up, using claims data to catch scams such as payments billed to different insurers on the same day for care purportedly delivered to the same patient in different cities, and using computer analysis to spot emerging patterns of fraud. The agreement is also unusual because it brings the Obama administration and longtime foes in the insurance industry together to tackle a common problem. While carrying out the requirements of President Barack Obama's health care overhaul law, insurers are also lobbying to roll back some of its provisions, such as new taxes on the industry and cuts to private plans offered through Medicare. Obama continues to rail against industry "abuses." Fraud is estimated to cost Medicare about $60 billion a year, and the Obama administration has beefed up the government's efforts to stop it, bringing in record settlements with drug companies for marketing violations as well as using new powers in the health care law to pursue low-level fraudsters with greater zeal. Yet, although Medicare is becoming a harder target, it's too early to say if the tide has turned. Some antifraud efforts launched with great fanfare have yet to

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Springhill Group Care - Providing for all levels of care, balanced with impressive facilities and exceptional staff. …golden age living and health care at its very best… At Springhill Care Group, our attitude is to exceed the expectations of our residents and their friends, that offer balanced with impressive facilities and exceptional staff. At Springhill Care Group, we firmly believe in safeguarding the interests of our clients and we pride ourselves on offering the most resident friendly environment. Springhill Group look to cater to the special requirements of each person citizen and any changing circumstances that occur throughout their time living in our care. This gives families the comfort that their loved one has the support and care. We fully understand a need to a place that residents will be proud to call their home is what they require most. All are built in attractive locations, nestled amongst existing communities, so our residents can easily retain their ties with their families. Springhill Care offers retirees the finest in clinical care, while receiving the positive aspects of living in our cozy and comfortable community. Email us now at info@springhillcaregroup.net

WASHINGTON - The Obama administration is upping the ante in the fight against health care fraud, joining forces with private insurers and state investigators on a scale not previously seen in an attempt to stanch tens of billions of dollars in losses. Health and Human Services Secretary Kathleen Sebelius said in a statement Thursday that the new public-private partnership "puts criminals on notice that we will find them and stop them," while Attorney General Eric Holder called it "a critical step forward" against fraud, an endemic problem plaguing programs like Medicare and Medicare as well as private insurance companies. Details of the collaboration remain to be worked out, but the possibilities include sharing information on new fraud schemes as they pop up, using claims data to catch scams such as payments billed to different insurers on the same day for care purportedly delivered to the same patient in different cities, and using computer analysis to spot emerging patterns of fraud.

WASHINGTON - The Obama administration is upping the ante in the fight against health care fraud, joining forces with private insurers and state investigators on a scale not previously seen in an attempt to stanch tens of billions of dollars in losses. Health and Human Services Secretary Kathleen Sebelius said in a statement Thursday that the new public-private partnership "puts criminals on notice that we will find them and stop them," while Attorney General Eric Holder called it "a critical step forward" against fraud, an endemic problem plaguing programs like Medicare and Medicare as well as private insurance companies. Details of the collaboration remain to be worked out, but the possibilities include sharing information on new fraud schemes as they pop up, using claims data to catch scams such as payments billed to different insurers on the same day for care purportedly delivered to the same patient in different cities, and using computer analysis to spot emerging patterns of fraud. The agreement is also unusual because it brings the Obama administration and longtime foes in the insurance industry together to tackle a common problem. While carrying out the requirements of President Barack Obama's health care overhaul law, insurers are also lobbying to roll back some of its provisions, such as new taxes on the industry and cuts to private plans offered through Medicare. Obama continues to rail against industry "abuses." Fraud is estimated to cost Medicare about $60 billion a year, and the Obama administration has beefed up the government's efforts to stop it, bringing in record settlements with drug companies for marketing violations as well as using new powers in the health care law to pursue low-level fraudsters with greater zeal. Yet, although Medicare is becoming a harder target, it's too early to say if the tide has turned. Some antifraud efforts launched with great fanfare have yet to deliver convincing results.

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http://springhillcaregroup.net/archives/255 According to a new study from the University of Alberta in Edmonton, Canada, seniors work hard to keep their marriages alive and well, even after one spouse falls ill and goes into a long-term care facility. Community-dwelling spouses were greatly drawn in the lives of their partners who are inside the institution, and that a lot of the couples remained active together may it be inside or outside the nursing home Researcher Robin Stadnyk was surprised to discover about this. Stadnyk is a post-doctoral researcher in the University of Alberta's Department of Human Ecology. She reviewed data from a qualitative study of 52 community-dwelling spouses in three Canadian provinces: Alberta, Manitoba and Nova Scotia, for her PhD research. According to her research, the participants were heavily involved in their spouses' lives, not only through caretaking duties like doing laundry and helping with personal hygiene, but also through nurturing activities that brought them closer together. "Most participants described close relationships with their spouses before the placement in a long-term care home. They simply found ways they could continue that closeness within the institutional walls," Stadnyk noted. Marriage-sustaining activities included watching TV together, studying travel brochures and reviewing diaries to relive old memories, even taking painting lessons together. For regular weekly and even daily visits, some spouses do is they bring their partners home. A loving story of an 82-year-old man in the study took weight-training just so he could lift his wife in and out of the car for the weekly trip home. "The findings defy the common assumption that the partnership of marriage effectively ends when one spouse enters a care facility," Stadnyk said. Changing roles as give-and take-partners to compassionate caretakers, husbands and wives of partners with dementia carry on with nurturing their marriages. One of the thi

sophiamostel: Springhill Care Group : 2012 U.S. Healthcare: UCR or '$99,750 Ear Wax Fraud'? Aetna Wants Court to Stop Hospital's UCR Billing On Dec 7, 2011, Aetna filed a lawsuit against two PPO surgeons and one out-of-network (OON) hospital, in the District Court, Harris County, Texas. Aetna lawsuit seeks to recover damages and attorneys' fees and for court temporary injunction to stop the OON hospital's UCR billing and PPO surgeon's referrals, alleging breach of contract, conspiracy to overcharge, tortious interference, and common law fraud, including "a bill for $99,750 for the removal of ear wax". A new 2012 "UCR war" already unfolds in the court. ERISAclaim.com offers private Webinars to examine this court case, its profound impacts on all OON providers, and explore compliant solutions and protections under ERISA and PPACA as well as OIG Guidance. Aetna OON UCR Case info: AETNA HEALTH INC vs. SOFOLA, IFEOLUMIPO O (MD) (Case #: 2011-73949 / Court 152) In 2012, most out-of-network (OON) doctors, surgical centers and hospitals will "make it or break it", depending upon the outcome of this new Aetna lawsuit, as an emerging trend in managed litigations. "While the alleged $99,750 ear wax UCR fee may or may not be an isolated inadvertent error, the payor's new lawsuit to outlaw all OON UCR billing as fraud certainly represents a new 2012 trend and detrimental blow to all OON providers and 77% of insured Americans in private industry," says Dr. Jin Zhou, president of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance. "Failure to recognize the impact of the payor UCR legal actions under $99,750 ear wax anti-fraud strategies and to quickly act with compliant solutions, the OON market will most likely fail by the end of 2012," warned Dr. Zhou. According to the court documents, "Plaintiffs Aetna Health Inc. and Aetna Life Insurance Company (collectively, "Aetna") bring this action under the laws of thi

billiepalance: Springhill Group Florida:: Living and Care Options Springhill Group living and care options are available depending on what the residents need and prefer. Independent Living The independent accommodations are occupied for those who wish to maintain a significant standard of flexibility, but also value the friendly relationship, the security, recreational facilities, and care that is provided by to them. The homes are designed to allow residents simple and easy household management encircled by warm and friendly neighbours Assisted Living Assisted Living is desirable to people who need a little extra care with their everyday living. You will also find here theflexibility and security of owning your personal space, to have your valuable possessions and things around you. Resthome Level Care Resthome level care in a Ryman Village, offers residents the very best in clinical care, while receiving the benefits of living in our warm and welcoming community. sophiamostel: Springhill Care Group : 2012 U.S. Healthcare: UCR or '$99,750 Ear Wax Fraud'? Aetna Wants Court to Stop Hospital's UCR Billing On Dec 7, 2011, Aetna filed a lawsuit against two PPO surgeons and one out-of-network (OON) hospital, in the District Court, Harris County, Texas. Aetna lawsuit seeks to recover damages and attorneys' fees and for court temporary injunction to stop the OON hospital's UCR billing and PPO surgeon's referrals, alleging breach of contract, conspiracy to overcharge, tortious interference, and common law fraud, including "a bill for $99,750 for the removal of ear wax". A new 2012 "UCR war" already unfolds in the court. ERISAclaim.com offers private Webinars to examine this court case, its profound impacts on all OON providers, and explore compliant solutions and protections under ERISA and PPACA as well as OIG Guidance. Aetna OON UCR Case info: AETNA HEALTH INC vs. SOFOLA, IFEOLUMIPO O (MD) (Case #: 2011-73949 / Court 152) In 2012, most out-of

The decision of US to let the blind human rights activist Chen Guangcheng return into China's fold following his escape from authorities is straining ties between the two countries as diplomatic dialogues opened in Beijing. The 40-year old Chen who is now considered a dissident became an international human rights inspiration to many Chinese after earning the ire of the local government for exposing forced abortions in line with the country's one-child policy. The self-taught lawyer took to the US embassy after his escape, apparently to ask for help but was eventually ushered into the Beijing Hospital. According to a senior official's statement to Springhill Care Group, Chen has indeed went into the embassy that day and has requested for medical treatment for his injured foot. American medical personnel have then conducted medical tests and made appropriate treatment during the time he was there. Immediately after the incident, the Chinese government has expressed its disapproval about the entire affair, demanding an apology from the US for taking Chen in. "What the U.S. side should do now is neither to continue misleading the public and making every excuse to shift responsibility and conceal its wrongdoing, nor to interfere in the domestic affairs of China," said Chinese Foreign Ministry spokesman Liu Weimin. This incident came just when the US Secretary of State Hilary Clinton is visiting Beijing in a meeting with Chinese officials on security and trade talks. And although no one mentioned Chen's name, it is evident in their statements that the incident is on the spotlight as the 2 nations struggle to maintain common ground. Clinton said in her opening statement, "The United States believes that no state can legitimately deny the universal rights that belong to every human being - or punish those who exercise them. A China that protects the rights of all its citizens will be a stronger, more prosperous partner for the United State

Guns don't kill people; people kill people; and people with guns kill even more people. They also save more people who would otherwise be at the mercy of the criminals. SPRINGHILL TOWNSHIP, Pa. - An 85-year-old great-grandmother in Fayette County busted a would-be burglar by pulling a gun, then forcing him to call for help while she kept him in her sights. http://www.thepittsburghchannel.com/news/17232825/detail.htm… Venus Ramey, 82, confronted a man on her farm in south-central Kentucky last week after she saw her dog run into a storage building where thieves had previously made off with old farm equipment. Ramey said the man told her he would leave. "I said, 'Oh, no you won't,' and I shot their tires so they couldn't leave," Ramey said. She had to balance on her walker as she pulled out a snub-nosed .38-caliber handgun. "I didn't even think twice. I just went and did it," she said. "If they'd even dared come close to me, they'd be 6 feet under by now." http://www.foxnews.com/story/0,2933,267540,00.html Hancock County Sheriff's Investigator Andre Fizer said about an 84-year-old man's decision to shoot through a house door at another man who was trying to barge into the house: "You could tell he was devastated. You could tell he was scared." And rightfully so. Twenty-year-old Wade Ledesma made repeated attempts to break in to the house at about 5 a.m. on July 27, threatening to kill him throughout. Ledesma "tried to break through the front door and also tried to enter through a back door and a rear window of the residence. The resident called 911 and reported that the intruder was trying to force his way into the home…. [The elderly man] held himself against the door to keep [Ledesma] from entering," reported the Sun Herald. The resident became tired from holding the door and, worded about his and his wife's safety, asked his wife to get his pistol. He fired a shot through the door, meant to merely be a warn

Guns don't kill people; people kill people; and people with guns kill even more people. They also save more people who would otherwise be at the mercy of the criminals. SPRINGHILL TOWNSHIP, Pa. - An 85-year-old great-grandmother in Fayette County busted a would-be burglar by pulling a gun, then forcing him to call for help while she kept him in her sights. http://www.thepittsburghchannel.com/news/17232825/detail.htm… Venus Ramey, 82, confronted a man on her farm in south-central Kentucky last week after she saw her dog run into a storage building where thieves had previously made off with old farm equipment. Ramey said the man told her he would leave. "I said, 'Oh, no you won't,' and I shot their tires so they couldn't leave," Ramey said. She had to balance on her walker as she pulled out a snub-nosed .38-caliber handgun. "I didn't even think twice. I just went and did it," she said. "If they'd even dared come close to me, they'd be 6 feet under by now." http://www.foxnews.com/story/0,2933,267540,00.html Hancock County Sheriff's Investigator Andre Fizer said about an 84-year-old man's decision to shoot through a house door at another man who was trying to barge into the house: "You could tell he was devastated. You could tell he was scared." And rightfully so. Twenty-year-old Wade Ledesma made repeated attempts to break in to the house at about 5 a.m. on July 27, threatening to kill him throughout. Ledesma "tried to break through the front door and also tried to enter through a back door and a rear window of the residence. The resident called 911 and reported that the intruder was trying to force his way into the home…. [The elderly man] held himself against the door to keep [Ledesma] from entering," reported the Sun Herald. The resident became tired from holding the door and, worded about his and his wife's safety, asked his wife to get his pistol. He fired a shot through the door, mea

Home for the aged is a general term for a facility that cares for elderly people. It is not a question of where but a question of how. How is home for the aged can do good for our elderly? In a fast phase world like ours, finding time for fun and leisure is hard and finding time for family is harder. Sometimes we are left with no choice. We are forced to leave our elderly family members in a nursing home or more popular as home for the aged. There is always two sides in a story, leaving elderly family member in a caring home has advantages and disadvantages. Number of senior citizens suddenly seemed to multiply since 1950's. In 1900 the average life expectancy was forty-five, by 1950 the average life span was almost seventy years; the population has doubled but the number of people65 and over had quadrupled to become 8% of the total. In 1950's more and more population of "retirees" are supposed to get their pensions. Due to this case, extended families are seemed to be an obligation, where elderly had to stay with their sons, daughters or grandchildren. People then began wondering how to accommodate this burden. They started taking about nursing homes, retirement houses, or apartments where they can leave their elderly. Golden years are supposed to have a positive connotation but now the phrase developed into a different meaning. Instead of the "golden years" being now, I a one's old age golden refers to the good old days. Studies showed that people in developed countries are not only living longer, but also remain healthy for much of their lives, unlike in less developed countries, where the elderly tend to be plagued with serious illnesses. Causing them to live longer which means government has to support them because they are already retirees. In order to support them, one must work and working means no one to take care of the elderly. Elderly has a special healthcare although facilities like home for the aged are design

South Korean police said Tuesday they were investigating 27 North Korean refugees for swindling private insurance firms out of hundreds of thousands of dollars in bogus medical claims. Police said the refugees faked illness in collusion with hospitals to claim a total of 1.04 billion won ($909,000) from insurance firms between 2007 and 2010. While listed as hospitalised, they frequented saunas, restaurants and even nightclubs. The scam also involved a 71-year-old doctor and five hospital employees who conspired with the refugees to claim a separate 104 million won from the state health insurance agency, police said. Police are also investigating two brokers on suspicion of helping the refugees send some of the proceeds to relatives in the North. Fraudsters involved in medical insurance rackets have previously made use of North Koreans. In 2008, police charged 41 refugees involved in bogus medical claims. More than 23,500 North Koreans have settled in the South since the 1950-53 war. They get government financial help along with job education but many fail to adapt to their new environment.

South Korean police said Tuesday they were investigating 27 North Korean refugees for swindling private insurance firms out of hundreds of thousands of dollars in bogus medical claims. Police said the refugees faked illness in collusion with hospitals to claim a total of 1.04 billion won ($909,000) from insurance firms between 2007 and 2010. While listed as hospitalised, they frequented saunas, restaurants and even nightclubs. The scam also involved a 71-year-old doctor and five hospital employees who conspired with the refugees to claim a separate 104 million won from the state health insurance agency, police said. Police are also investigating two brokers on suspicion of helping the refugees send some of the proceeds to relatives in the North. Fraudsters involved in medical insurance rackets have previously made use of North Koreans. In 2008, police charged 41 refugees involved in bogus medical claims. More than 23,500 North Koreans have settled in the South since the 1950-53 war. They get government financial help along with job education but many fail to adapt to their new environment.

South Korean police said Tuesday they were investigating 27 North Korean refugees for swindling private insurance firms out of hundreds of thousands of dollars in bogus medical claims. Police said the refugees faked illness in collusion with hospitals to claim a total of 1.04 billion won ($909,000) from insurance firms between 2007 and 2010. While listed as hospitalised, they frequented saunas, restaurants and even nightclubs. The scam also involved a 71-year-old doctor and five hospital employees who conspired with the refugees to claim a separate 104 million won from the state health insurance agency, police said. Police are also investigating two brokers on suspicion of helping the refugees send some of the proceeds to relatives in the North. Fraudsters involved in medical insurance rackets have previously made use of North Koreans. In 2008, police charged 41 refugees involved in bogus medical claims. More than 23,500 North Koreans have settled in the South since the 1950-53 war. They get government financial help along with job education but many fail to adapt to their new environment.

South Korean police said Tuesday they were investigating 27 North Korean refugees for swindling private insurance firms out of hundreds of thousands of dollars in bogus medical claims. Police said the refugees faked illness in collusion with hospitals to claim a total of 1.04 billion won ($909,000) from insurance firms between 2007 and 2010. While listed as hospitalised, they frequented saunas, restaurants and even nightclubs. The scam also involved a 71-year-old doctor and five hospital employees who conspired with the refugees to claim a separate 104 million won from the state health insurance agency, police said. Police are also investigating two brokers on suspicion of helping the refugees send some of the proceeds to relatives in the North. Fraudsters involved in medical insurance rackets have previously made use of North Koreans. In 2008, police charged 41 refugees involved in bogus medical claims. More than 23,500 North Koreans have settled in the South since the 1950-53 war. They get government financial help along with job education but many fail to adapt to their new environment.

South Korean police said Tuesday they were investigating 27 North Korean refugees for swindling private insurance firms out of hundreds of thousands of dollars in bogus medical claims. Police said the refugees faked illness in collusion with hospitals to claim a total of 1.04 billion won ($909,000) from insurance firms between 2007 and 2010. While listed as hospitalised, they frequented saunas, restaurants and even nightclubs. The scam also involved a 71-year-old doctor and five hospital employees who conspired with the refugees to claim a separate 104 million won from the state health insurance agency, police said. Police are also investigating two brokers on suspicion of helping the refugees send some of the proceeds to relatives in the North. Fraudsters involved in medical insurance rackets have previously made use of North Koreans. In 2008, police charged 41 refugees involved in bogus medical claims. More than 23,500 North Koreans have settled in the South since the 1950-53 war. They get government financial help along with job education but many fail to adapt to their new environment.

South Korean police said Tuesday they were investigating 27 North Korean refugees for swindling private insurance firms out of hundreds of thousands of dollars in bogus medical claims. Police said the refugees faked illness in collusion with hospitals to claim a total of 1.04 billion won ($909,000) from insurance firms between 2007 and 2010. While listed as hospitalised, they frequented saunas, restaurants and even nightclubs. The scam also involved a 71-year-old doctor and five hospital employees who conspired with the refugees to claim a separate 104 million won from the state health insurance agency, police said. Police are also investigating two brokers on suspicion of helping the refugees send some of the proceeds to relatives in the North. Fraudsters involved in medical insurance rackets have previously made use of North Koreans. In 2008, police charged 41 refugees involved in bogus medical claims. More than 23,500 North Koreans have settled in the South since the 1950-53 war. They get government financial help along with job education but many fail to adapt to their new environment.

http://www.rnw.nl/english/bulletin/n-korean-refugees-investigated-insurance-fraud South Korean police said Tuesday they were investigating 27 North Korean refugees for swindling private insurance firms out of hundreds of thousands of dollars in bogus medical claims. Police said the refugees faked illness in collusion with hospitals to claim a total of 1.04 billion won ($909,000) from insurance firms between 2007 and 2010.

South Korean police said Tuesday they were investigating 27 North Korean refugees for swindling private insurance firms out of hundreds of thousands of dollars in bogus medical claims. Police said the refugees faked illness in collusion with hospitals to claim a total of 1.04 billion won ($909,000) from insurance firms between 2007 and 2010. While listed as hospitalised, they frequented saunas, restaurants and even nightclubs. The scam also involved a 71-year-old doctor and five hospital employees who conspired with the refugees to claim a separate 104 million won from the state health insurance agency, police said. Police are also investigating two brokers on suspicion of helping the refugees send some of the proceeds to relatives in the North. Fraudsters involved in medical insurance rackets have previously made use of North Koreans. In 2008, police charged 41 refugees involved in bogus medical claims. More than 23,500 North Koreans have settled in the South since the 1950-53 war. They get government financial help along with job education but many fail to adapt to their new environment.

South Korean police said Tuesday they were investigating 27 North Korean refugees for swindling private insurance firms out of hundreds of thousands of dollars in bogus medical claims. Police said the refugees faked illness in collusion with hospitals to claim a total of 1.04 billion won ($909,000) from insurance firms between 2007 and 2010. While listed as hospitalised, they frequented saunas, restaurants and even nightclubs. The scam also involved a 71-year-old doctor and five hospital employees who conspired with the refugees to claim a separate 104 million won from the state health insurance agency, police said. Police are also investigating two brokers on suspicion of helping the refugees send some of the proceeds to relatives in the North. Fraudsters involved in medical insurance rackets have previously made use of North Koreans. In 2008, police charged 41 refugees involved in bogus medical claims. More than 23,500 North Koreans have settled in the South since the 1950-53 war. They get government financial help along with job education but many fail to adapt to their new environment.

MOBILE, Alabama - Drury Lane in Country Club Estates has the look and feel of a country lane: secluded, narrow - less than two lanes wide - and heavily-wooded, with well-kept homes appearing as if by magic among the trees. Yet some of its 17 homes, including corner lots at Wimbledon Drive to the south and Hillwood Road to the north, are within a short iron shot of the Country Club of Mobile north nine golf course and about two blocks from the main club buildings themselves. Residents of Drury Lane, from near and far, had high praise for the Spring Hill area and their neighbors. "We love it here. Absolutely love it. Drury Lane is a wonderful street. The best street in Mobile, I believe," said resident Lee Robinson, a Mobile native, who grew up 300 yards away on Wimbledon Drive, where his parents, Lee and Helen Robinson, still live. The Robinsons' home is one of the through lots on the street, with a front entrance on Hillwood Road and a back entrance on Drury Lane. The family prefers the backyard for activities and neighboring, said Robinson. "The neighbors have been fabulous and a huge blessing," said his wife, Aimee, also a Mobile native. "The minute you have a storm, everyone here comes together." The Robinsons and their three daughters had just moved in shortly before Hurricane Katrina in August 2005, but were invited to stay the night with neighbors, who had 14 people in their home, to share their generator power, she said. Robinson discovered both Mobile and family tradition in the vintage 1937 home on the lane when he thoroughly renovated it in 2007-08. The home had original hardwood floors, a double coincidence, because Robinson is president of Overseas Hardwoods Co., and his grandfather was in the hardwood flooring business with the family-owned Mobile River Sawmill in Mount Vernon, Robinson said. Mobile River Sawmill first made hardwood flooring in the early 1930s - the mill was so

On Dec 7, 2011, Aetna filed a lawsuit against two PPO surgeons and one out-of-network (OON) hospital, in the District Court, Harris County, Texas. Aetna lawsuit seeks to recover damages and attorneys' fees and for court temporary injunction to stop the OON hospital's UCR billing and PPO surgeon's referrals, alleging breach of contract, conspiracy to overcharge, tortious interference, and common law fraud, including "a bill for $99,750 for the removal of ear wax". A new 2012 "UCR war" already unfolds in the court. ERISAclaim.com offers private Webinars to examine this court case, its profound impacts on all OON providers, and explore compliant solutions and protections under ERISA and PPACA as well as OIG Guidance. Aetna OON UCR Case info: AETNA HEALTH INC vs. SOFOLA, IFEOLUMIPO O (MD) (Case #: 2011-73949 / Court 152) In 2012, most out-of-network (OON) doctors, surgical centers and hospitals will "make it or break it", depending upon the outcome of this new Aetna lawsuit, as an emerging trend in managed litigations. "While the alleged $99,750 ear wax UCR fee may or may not be an isolated inadvertent error, the payor's new lawsuit to outlaw all OON UCR billing as fraud certainly represents a new 2012 trend and detrimental blow to all OON providers and 77% of insured Americans in private industry," says Dr. Jin Zhou, president of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance. "Failure to recognize the impact of the payor UCR legal actions under $99,750 ear wax anti-fraud strategies and to quickly act with compliant solutions, the OON market will most likely fail by the end of 2012," warned Dr. Zhou. According to the court documents, "Plaintiffs Aetna Health Inc. and Aetna Life Insurance Company (collectively, "Aetna") bring this action under the laws of this state against Defendants Ifeolumipo O. Sofola, M.D. ("Dr. Sofola"), Navin Subramanian, M.D. ("Dr. Subramanian"), and Humble Surgical Hosp

On Dec 7, 2011, Aetna filed a lawsuit against two PPO surgeons and one out-of-network (OON) hospital, in the District Court, Harris County, Texas. Aetna lawsuit seeks to recover damages and attorneys' fees and for court temporary injunction to stop the OON hospital's UCR billing and PPO surgeon's referrals, alleging breach of contract, conspiracy to overcharge, tortious interference, and common law fraud, including "a bill for $99,750 for the removal of ear wax". A new 2012 "UCR war" already unfolds in the court. ERISAclaim.com offers private Webinars to examine this court case, its profound impacts on all OON providers, and explore compliant solutions and protections under ERISA and PPACA as well as OIG Guidance. Aetna OON UCR Case info: AETNA HEALTH INC vs. SOFOLA, IFEOLUMIPO O (MD) (Case #: 2011-73949 / Court 152) In 2012, most out-of-network (OON) doctors, surgical centers and hospitals will "make it or break it", depending upon the outcome of this new Aetna lawsuit, as an emerging trend in managed litigations. "While the alleged $99,750 ear wax UCR fee may or may not be an isolated inadvertent error, the payor's new lawsuit to outlaw all OON UCR billing as fraud certainly represents a new 2012 trend and detrimental blow to all OON providers and 77% of insured Americans in private industry," says Dr. Jin Zhou, president of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance. "Failure to recognize the impact of the payor UCR legal actions under $99,750 ear wax anti-fraud strategies and to quickly act with compliant solutions, the OON market will most likely fail by the end of 2012," warned Dr. Zhou. According to the court documents, "Plaintiffs Aetna Health Inc. and Aetna Life Insurance Company (collectively, "Aetna") bring this action under the laws of this state against Defendants Ifeolumipo O. Sofola, M.D. ("Dr. Sofola"), Navin Subramanian, M.D. ("Dr. Subramanian"), and Humble Surgical

I don't know if this is related to Warren Buffett's March visit to South Korea but General Re, a subsidiary of Berkshire Hathaway, is planning to bid for South Korean insurer Tong Yang Life Insurance. Tong Yang's majority shareholder private-equity firm Vogo Fund is planning to sell its up to a 60.7-per cent stake in the insurer valued at about 937 billion won ($809 million). In March, Warren Buffett visited South Korea to help open a new plant for Iscar Metalworking, which Berkshire owns 80%. At the same time, he was on the hunt for what he calls "Elephants", or large well run companies that he could potentially acquire at a good price. "We're looking at a number of big businesses in Korea, the U.S., the U.K. We hope to find good companies wherever they may be. Basically, the bigger, the better," he said at the time. About Tong Yang Life Insurance Tong Yang Life Insurance is part of the Tongyang Group which has 31 divisions across various industries such as utilities, manufacturing, and financial services to name a few. On its insurance website, Tongyang states: TONGYANG Life Insurance was founded in 1989 to provide social security and specialized insurance services. Total assets are currently 12.8 trillion won, with premium income of 3.5 trillion won. (source)