Insurer Group Health Inc. To Refund $500,00+ & Change Claims Practices To Settle NY AG Charges It Wrongfully Denied Coverage

June 18, 2012

Health insurer Group Health Inc. (“GHI”) must send reimbursement checks expected to approach $500,000 and change its claims handling practices to settle charges brought by the New York Attorney General Eric T. Schneiderman  that its mishandling of certain out-of-network claims wrongfully denied coverage to its members.  Schneiderman charted that GHI violated New York law by processing claims and caused patients to be billed wrongfully for covered physician services — sometimes in amounts reaching thousands of dollars — when they should have been shielded from any expense by applying standard out-patient coverage schedules even though the GHI health insurance policy was required to cover certain key medical providers who might be out-of-network — including anesthesiologists, pathologists, and radiologists — at a higher rate and with no member cost-share.

Under the terms of the agreement with GHI, the insurance company will send reimbursement checks to affected members. Because of the Attorney General’s investigation, GHI has already returned $162,000 to New York consumers and that number is expected to approach $500,000 in restitution for three years of claims. GHI will retain an auditor to ensure all eligible members are given refunds. In addition to providing reimbursement to eligible members, the agreement provides that GHI train its employees, pay a penalty, and assist consumers with resolving any debt collection activity.  See here.

GHI is part of Emblem Health, and provides insurance to consumers to 28 counties across New York State.

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NLRB Moves To Promote Non-Union Employee Use of Collective Action Rights By Launching Webpage

June 18, 2012

The National Labor Relations Board is launching a new website page focused on promoting awareness and encourage the exercise of rights to employees to act together for their mutual aid and protection, even if they are not in a union, under the National Labor Relations Act (NLRA). 

As part of its aggressive commitment to promote and support union organizing and other collective action by employees under the Obama Administration, the NLRB in recent years has stepped up investigatory and enforcement activities on behalf of non-union employees.  The right to engage in certain types of concerted activity was written into the original 1935 National Labor Relations Act’s Section 7, which states that:  “Employees shall have the right to self-organization, to form, join, or assist labor organizations, to bargain collectively through representatives of their own choosing, and to engage in other concerted activities for the purpose of collective bargaining or other mutual aid or protection, and shall also have the right to refrain from any or all such activities.”

Non-union concerted activity accounts for more than 5% of the agency’s recent caseload.

The new webpage launched June 18, 2012 here seeks to promote awareness and use of these and other collective action rights under the NLRA by sharing stories of more than a dozen recent cases involving protected concerted activity.  Examples of these cases include stories of A construction crew fired after refusing to work in the rain near exposed electrical wires; a customer service representative who lost her job after discussing her wages with a coworker; an engineer at a vegetable packing plant fired after reporting safety concerns affecting other employees; a paramedic fired after posting work-related grievances on Facebook; and poultry workers fired after discussing their grievances with a newspaper reporter.  

“A right only has value when people know it exists,” said NLRB Chairman Mark Gaston Pearce. “We think the right to engage in protected concerted activity is one of the best kept secrets of the National Labor Relations Act, and more important than ever in these difficult economic times. Our hope is that other workers will see themselves in the cases we’ve selected and understand that they do have strength in numbers.”

In addition to the new webpage, the NLRA also has undertaken efforts to promote employee awareness of NLRA rights by imposing new employer poster requirements, has attacked the use of mandatory arbibtration provisions by employers as prohibited under the NLRA, and has pursued a wide range of regulatory and enforcement policy changes that seek to strengthen the power of organized labor.  In light of this growing activism, employers should continue to strengthen their labor-management policies and practices to mitigate the growing labor exposures that result from this activist agenda.  

For Help or More Information
If you need help with labor and employment or other human resource, performance management, internal controls or compliance and risk management matters, please contact the author of this article, Cynthia Marcotte Stamer.  Board Certified in Labor & employment Law by the Texas Board of Legal Specialization,management attorney, author and consultant  Ms. Stamer is nationally and internationally recognized for more than 24 years of work helping private and governmental organizations and their management; employee benefit plans and their sponsors, administrators, fiduciaries; employee leasing, recruiting, staffing and other professional employment organizations; schools and other governmental agencies and others design, administer and defend innovative compliance, risk management, workforce, compensation, employee benefit, privacy, procurement and other management policies and practices. Her experience includes extensive work helping employers carry out, audit, manage and defend worker classification,union-management relations, wage and hour, discrimination and other labor and employment laws, procurement, conflict of interest, discrimination management, privacy and data security, internal investigation and discipline and other workforce and internal controls policies, procedures and actions. 
Widely published on worker classification and other workforce risk management and compliance concerns, the immediate past-Chair of the American Bar Association (ABA) RPTE Employee Benefits & Other Compensation Committee and current Co-Chair of its Welfare Plan Committee, Vice Chair of the ABA TIPS Section Employee Benefits Committee,  a Council Representative of the ABA Joint Committee on Employee Benefits, Government Affairs Committee Legislative Chair for the Dallas Human Resources Management Association, and past Chair of the ABA Health Law Section Managed Care & Insurance Interest Group, Ms. Stamer works, publishes and speaks extensively on management, worker classification, re-engineering, investigations, human resources and workforce, employee benefits, compensation, internal controls and risk management, federal sentencing guideline and other enforcement resolution actions, and related matters.  She also is recognized for her publications, industry leadership, workshops and presentations on these and other human resources concerns and regularly speaks and conducts training on these matters. Her insights on these and other matters appear in the Bureau of National Affairs, Spencer Publications, the Wall Street Journal, the Dallas Business Journal, the Houston Business Journal, and many other national and local publications. For more information about Ms. Stamer and her experience or to access other publications by Ms. Stamer see here or contact Ms. Stamer directly.

Other Resources

If you found this update of interest, you also may be interested in reviewing some of the other updates and publications authored by Ms. Stamer available including:

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