Beneficiaries

News & Analysis as of

OIG Reports Limited Compliance with Face-to-Face Certification Requirement for Home Health

The OIG recently released a report summarizing the details of its study regarding compliance with the requirement that physicians (or certain practitioners working with them) who certify beneficiaries as eligible for Medicare...more

ERISA (7th Cir.): Beneficiary and Attorney Who Ignore Subrogation Lien for Medical Bills Paid by ERISA Plan “Better Call Saul”

You have seen this one before: The ERISA plan pays hundreds of thousands of dollars in medical bills and secures an equitable lien. Then, the ERISA plan beneficiary settles a tort claim, but refuses to reimburse the ERISA...more

ERISA: 1st Circuit — Statute of Limitations Bars “Years of Benefit Underpayment” Claims

A new lawsuit hits your desk asserting that for the past seven (7) years the ERISA plan has been incorrectly underpaying the beneficiary....more

Important Changes Proposed to New York Estate Tax and New York Income Taxation of Trusts, Grantors and Beneficiaries

Important legislation has been introduced by New York Governor Andrew Cuomo that, if passed, would substantially change the New York estate tax regime and would also significantly change the income tax rules regarding certain...more

Marketing to Medicaid Beneficiaries: Texas Proposed Rule Highlights Pitfalls for Providers

Earlier this month, the Texas Health and Human Services Commission (Commission) released a proposed rule, 1 TAC § 354.1452 that prohibits certain marketing activity by Medicaid and CHIP providers. The proposed rule has been...more

What Stipulations Can Be Included in a Premarital Agreement?

Just as there are many reasons why a couple may choose to enter into a premarital agreement, the issues they cover can vary significantly. California law has relatively few limitations for these contracts, as long as they do...more

5 Estate Planning Mistakes You Should Try to Avoid

In your experience, what’s the most costly mistake people make when preparing estate plans, and what can they do to fix them? That’s the question we recently put to attorneys writing on JD Supra....more

Government Imposes Moratorium on Medicare Hearings and Appeals

The Federal Office of Medicare Hearings and Appeals (OMHA) was established in July 2005 to administer the Medicare appeals program. OMHA adjudicates appeals regarding Medicare entitlement and Medicare provider reimbursement....more

Avoid the Retirement Plan Soap Opera by having Participants update their beneficiary forms

Yes, I will admit it, I love soap operas. My favorite show of all-time is Dallas and when I was a senior in high school and I was at home around 12:30 pm, I watched in succession, Young and The Restless, Bold and The...more

Motion to Strike Under Anti-SLAPP Statute Erroneously Granted in Connection With Conversion, Unjust Enrichment and Breach of...

A motion to strike under California’s anti-SLAPP statute was filed in response to a lawsuit initiated by beneficiaries against a trustee and executor of an estate. The United States Court of Appeals for the Ninth Circuit...more

Misprint in Beneficiary Copayment Amount for Hospital Clinic Visits

CMS has reportedly erred in publishing a 40 percent beneficiary copayment amount for hospital outpatient clinic visits beginning in CY 2014. According to information provided by CMS to one of our clients, the beneficiary...more

How the New Washington Trust Act and its 2013 Amendments Affect You and Your Clients - December 2013

In 2011, the legislature adopted a new Washington Trust Act (the “2011 Act”). The 2011 Act took effect on January 1, 2012, and codified many changes to the duties of trustees and the rights of trust beneficiaries. Within 18...more

Ontario Introduces PBA Amendments in Response to Carrigan Case

Last year, the Ontario Court of Appeal surprised many in the pension industry with its decision in Carrigan v. Carrigan Estate, which essentially established a new priority scheme for the payment of pre-retirement death...more

Wealth Management Update - December 2013

The December § 7520 rate for use with estate planning techniques such as CRTs, CLTs, QPRTs and GRATs is 2.0%, which is unchanged from last month. The December applicable federal rate ("AFR") for use with a sale to a defective...more

What Is a Pooled Trust and How Does It Protect My Family Member?

Because beneficiaries of programs like Supplemental Security Income (SSI) and Medicaid must be quite poor to qualify, they can lose their benefits when they come into an inheritance, receive money in their own names from an...more

Valid Assignment Confers Beneficiary Status on Chiropractor

A federal district court in Illinois recently issued a pair of rulings in cases where insurers sought to recoup payments from practitioners. Pennsylvania Chiropractic Association v. Blue Cross Blue Shield Association, 2013...more

Beneficiary Designations and Spouse Definitions Need to be Updated - 16th State Approves Same Sex Marriage While 3rd Circuit...

Yesterday Hawaii adopted the Hawaii Marriage Equity Act of 2013 recognizing same sex marriages as of December 2, 2013 and permitting persons in civil unions in Hawaii to apply to be married without first requiring dissolution...more

Another One Bites the Dust – U.S. Supreme Court Rules that ERISA Plans May Chase Funds Outside the Control of a Beneficiary

On November 12, the United States State Supreme Court denied cert in ACS Recovery Services, Inc., v. Griffin 723 F.3d 518 (5th Cir. 2013), preserving a 5th Circuit Court ruling which closed the door on another means of...more

Now, How Do I Decant a Trust?

Decanting has been Texas law for almost three months and several articles have discussed what can be accomplished by decanting (e.g., Bill Pargaman’s 2013 Legislative Update). This article will discuss the documents needed...more

Federal District Court Rules that Provider Can Challenge Recoupment Activity Under ERISA

The United States District Court for the Northern District of Illinois recently granted summary judgment in favor of a chiropractor who alleged that Anthem VA, a Virginia-based subsidiary of WellPoint, Inc., violated the...more

Best To Save Plan Documents Until All Retirees And Beneficiaries Are Dead

As a result of industry consolidation over the years, employers can find themselves responsible for pension plans of companies long out of existence. A recent federal district court decision imposed a penalty of $4,470 on a...more

CMS Issues Guidance On Medicare Coverage of Items and Services Furnished to Beneficiaries in Custody Under a Penal Authority

In October 2013, CMS issued a Fact Sheet outlining its policy regarding beneficiaries who are incarcerated or in custody. Pursuant to 42 C.F.R. §§ 411.4, 411.6 and 411.8, where a beneficiary is in custody on the date items or...more

Recent Court Decisions Concerning Unclaimed Life Insurance Benefits Can Assist Insurers in Defending Regulatory Audits and Future...

Perhaps the most significant litigation, regulatory and compliance issues facing life insurance companies can be found in the unclaimed property audits, multi-state regulatory settlements and class action lawsuits surrounding...more

Wealth Management Update - November 2013

Federal Exclusion from Gift, Estate and Generation-Skipping Transfer Taxes Increases to $5,340,000 in 2014 - In Revenue Ruling 2013-35, the IRS announced certain inflation adjustments to tax exemptions and deductions....more

The Uniform Trust Code’s stealth attack on the Trustee’s time-honored duty to defend his trust

One of the critical duties of a trustee traditionally has been to defend his trust against internal attacks. By that I mean to defend the trust against those who, in contravention of the settlor’s intentions as expressed in...more

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