Highmark Inc. is based in downtown Pittsburgh.
Kris B. Mamula
Reporter- Pittsburgh Business Times
The enforcement action state regulators are pressing against Highmark over its new Medicare Advantage coverage for seniors is invalid because the plan has already been approved by federal authorities, pre-empting any state action, the health insurer argued in a federal court filing Monday.
Highmark Inc. has asked a U.S. District Court judge to stop Commonwealth Court proceedings against the insurer by declaring the issue is outside the reach of the state Insurance Department, Department of Health and Attorney General’s office. A Commonwealth Court hearing on the regulators’ enforcement action was scheduled Wednesday.
“The Medicare Advantage statute is explicit that it and the implementing regulations adopted thereunder, ‘shall supersede any state law or regulation,’ ” Highmark’s request for injunctive relief said. State regulators cannot “lawfully attempt to prevent the marketing and sale of an Medicare Advantage plan that the federal government has expressly approved.”
State regulators were not immediately available for comment.
The state filed a contempt proceeding Oct. 10 against Highmark over its decision to market Community Blue Medicare Advantage, a limited-network and lower-cost product when compared to similar plans. Highmark began selling the coverage Oct. 15, five days after the state claimed in Commonwealth Court that the sale violated a consent decree reached in July with the state, Highmark and UPMC.
The consent decree requires that Highmark health insurance plans give seniors access to UPMC doctors and hospitals. Highmark also sells Security Blue and Freedom Blue, Medicare Advantage plans that include in-network coverage at UPMC doctors and hospitals.
Kris Mamula covers health care, insurance and employee benefits for the Pittsburgh Business Times. Contact him at email@example.com or 412-208-3825.
For the last several months, our series Legalese From A to Z has been walking you through the sometimes wacky, sometimes confusing world of legalese , the specialized language of law used by those in the legal field.
Letter by letter, we’ve been examining some important, interesting, or noteworthy bits of legalese. This week, we take a look at five legal terms that start with the letter “N”:
A new study examining the link between the amount of money spent on a wedding and the duration of marriage has come to a somewhat surprising conclusion: Couples who spend less on their wedding tend to stay married longer than those who opt for expensive weddings.
In the study, researchers at Emory University looked at over 3,100 married couples, reports the Chicago Tribune. In addition to the amount of money spent on a wedding, the study found several other correlations between wedding ceremonies and duration of marriage that seem to go against conventional wisdom.
What does your wedding say about the odds of your marriage ending in divorce?
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A producer who claims the idea for the Clint Eastwood movie Trouble With the Curve was stolen from his company refiled his lawsuit Monday in Los Angeles Superior Court, demanding at least $5 million. The suit was previously dismissed by a federal court.
In October 2013, Ryan A. Brooks first filed his lawsuit in U.S. District Court for the Central District of California, alleging his company Gold Glove Productions LLC had hired a screenwriter in 2008 and they had developed a script very similar to that of the movie. At that time, Eastwood and Warner Bros. were among those named in the
John Williams (@ShadowStats): Yes, the government removes long-term unemployed who have given up looking for work, also known as “discouraged workers,” from the headline unemployment number. The effect is that the headline unemployment rate drops, while broadest unemployment measure, including all of the long-term discouraged workers, has increased and remains close to a post-Great Depression high.
The avant-garde impressionist Edouard Manet exhibited his scandalous painting of the enigmatic, fictional prostitute Olympia at the very Salon in which The Childlike Kiss was displayed. As in Feyen’s painting, the contrast in skin color denotes the differing occupational and social statuses of the two women. Unlike Feyen’s academic paean to maternal devotion, however, Manet avoided sentimentality altogether, opting instead to frankly put the sensual, reclining naked body of the white courtesan on display. A black woman wearing a headdress similar to that of the nurse in The Childlike Kiss brings a bouquet of flowers to her mistress, a present from one of her admirers. Her face so strongly resembles that of Feyen’s black serving woman that the model for both must be one and the same.
Unfortunately, by law, McCulloch isn’t required to recuse himself for a conflict of interest based on that relationship. But even if there is no plan or collusion to protect Wilson, the mere appearance of it will have haunting effects if Wilson is not charged. And if he isn’t charged, many in the public will consider this McCulloch’s fault—and, quite frankly, it will be. In this case, McCulloch is working, out of the public eye, to decide whether or not a colleague will be prosecuted for murder. Nor is he within earshot of legal professionals who could protect the rights of Brown and his family.