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Saturday, April 30, 2016

Shark Attacks—Not So Deadly After All | Callagy Law

Humans are terrified of sharks. Many beachgoers are afraid to swim in the ocean because they are worried a shark might be nearby. Statistically, however, shark attacks rarely occur. One in 3.7 million people die of a shark attack, according to the International Shark Attack File of the University of Florida’s Museum of Natural History. A human is at a much higher risk of dying of heart disease, of cancer, or in a car accident than of being the victim of a shark attack. Even less common things, like balloons, beds, and sand, are more detrimental to a human’s safety than are sharks.

During this recent surge of “taking selfies,” it has been proven that a human is at a greater risk of dying while taking a selfie than while swimming in shark-infested water. There have been dozens of deaths related to tourists taking selfies, according to Condé Nast research, versus only eight shark attacks occurring in the same year. In 2014, a couple visiting Portugal fell off a cliff while taking a selfie to send to their family. Unrelated to tourism, people risk their lives every day as they take selfies at times and in places that cause them to be distracted from something they should be firmly focused on, such as driving an automobile. As humans clearly pose a greater risk to themselves than sharks pose to humans, what explains people’s continuous fear of the “deadly” shark?

Studies show that it is not about the shark attack itself or the likelihood of encountering a shark that make people afraid, but more about the consequences of it. How unfortunate is it to be attacked by a shark when the odds are so low? Christopher Bader, a professor of sociology at Chapman University in California, reported that people living in Florida, where shark attacks are more likely, are less afraid of sharks than people living in Maine, where shark attacks almost never occur. Clearly, the more familiar a person is with the low risk of an incident occurring, the less likely that individual is to fear the event.

The bottom line is sharks have much more to fear from humans than humans do from sharks.

The team at Callagy Law hopes the information in this article was helpful in either your personal or professional life. Businesses and people are multi-dimensional and at times may need a guiding light. The legal world pertains to all walks of life and businesses, therefore, we aim to provide information which will help you navigate through your life. Callagy Law, is a multidisciplinary law firm, headquartered in Paramus, NJ owned and operated by Sean Callagy. We are committed to providing legal representation and advice to our clients at our law offices located in New York, New Jersey and Arizona. Please note that the information posted here should not be used as a legal argument of defense. If you find yourself needing legal advice pertaining to your unique situation, you can contact us at by writing us here. Feel free to connect with us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube.

Learn More About Callagy Law Here:

Shark Attacks—Not So Deadly After All | Callagy Law

Friday, April 29, 2016

Are MRI’s Reimbursable | Callagy Law

MRIs can be performed within five days of the insured event under certain circumstances

The purpose of this post is to help assist those with questions they have concerning their business or medical practice. The Callagy Law team is knowledgeable in many law practice areas and will frequently post topics ranging from Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance. We hope to have this blog shed a light on many common questions.

Magnetic resonance imaging (MRI) is a test not normally performed within five days of the insured event. As a result, some insurance carriers will attempt to argue that these tests are not medically necessary and therefore, not reimbursable. However, clinically supported indication of neurological gross motor deficits, incontinence or acute nerve root compression with neurologic symptoms may justify MRI testing during the acute phase immediately post injury

In N.J. Coal. of Health Care v. Dept. of Banking & Ins., 323 N.J. Super. 207 (App. Div. 1999) at 247, the Court found that “[f]or cervical, thoracic and lumbar-sacral spine injuries, the first step in treating a patient involves, and logically so, a clinical evaluation by the appropriate health-care provider. Such an evaluation may include x-rays, CT scan, and an MRI, if necessary.”

Moreover, N.J.A.C. 11:3-4.5 (b) (5) states that these tests have been determined to have value in the evaluation of injuries, the diagnosis and development of a treatment plan for persons injured in a covered accident, when medically necessary and consistent with clinically supported findings, when used in accordance with the guidelines contained in the American College of Radiology, Appropriateness Criteria to evaluate injuries in numerous parts of the body, particularly the assessment of nerve root compression and/or motor loss.

The MRI test uses a magnetic field and pulses of radio wave energy to make pictures of organs and structures inside the body. The area of the body being studied is placed inside a special machine that contains a strong magnet. Pictures from an MRI scan are digital images that can be saved and stored on a computer for more study. The images also can be reviewed remotely, such as in a clinic or an operating room. In some cases, contrast material may be used during the MRI scan to show certain structures more clearly.

In many cases, MRI gives different information about structures in the body than can be seen with an X-ray, ultrasound, or computed tomography (CT) scan. MRI also may show problems that cannot be seen with other imaging methods.

According to the American College of Radiology, MRI testing should be reserved for cases of known or suspected soft tissue injuries such as disc herniations, ligament tears, epidural hematoma and spinal cord edema or hematoma, especially in the presence of a neurological deficit.

In Care Paths 1 and 5 for soft tissue injuries to the cervical spine and lumbar-sacral spine, respectively, though, an MRI may be administered if there are abnormal neurologic findings (i.e.: radiculopathy) and typically following a course of four weeks conservative treatment with no improvement in symptoms. In Care Paths 2 and 6 for soft tissue injuries to the cervical spine and lumbar-sacral spine with symptoms of radiculopathy, a minimum of two weeks conservative treatment without improvement in symptoms is recommended before administering an MRI.

As the MRI testing is appropriate during the clinical and diagnostic evaluation of injuries to the cervical and lumbar spine, especially if there are abnormal neurologic findings; these tests are in fact reimbursable if performed within five days of the insured event.

We hope you found the information provided in this article helpful to various questions you may have had concerning the healthcare industry. For information pertaining to our services for medical providers, please click here. Please note, Callagy Law has recovered over $200,000,000 for medical providers, and that number grows daily. Please free to reach out to Sean Callagy of Callagy Law at any time for questions you may have concerning personal and business matters. Callagy Law offices are located conveniently in Paramus, NJ. Beyond the scope of information, Sean Callagy has developed multiple areas of our healthcare legal practice and business coaching. Feel free to connect with us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube.

Learn More About Callagy Law Here:

Are MRI’s Reimbursable | Callagy Law

Tuesday, April 26, 2016

Reimbursement for Hospital Anesthesia Services is appropriate for dates of service prior to 2013.

Many Insurance companies attempt to deny reimbursement to Hospitals for anesthesia provided during surgical encounters for a variety of reasons. When faced with these situations, Hospitals should be aware that prior to 2013 there was no fee schedule for Hospitals, therefore Hospitals are entitled to payment for anesthesia.

Separate Billing

It is common and, in fact, standard practice for Hospitals as the host of the surgical procedures performed on any given date of service, to supply the anesthesia and necessary supplies that the surgeon will use.

Insurance companies argue that Hospitals improperly submit what constitutes duplicate billing of anesthesia for these surgeries. This is based upon the fact that the anesthesiologist, who administered the anesthesia services on the date of service in question, has many times already submitted his independent bills for the “same” instance of anesthesia services.

However, it must be emphasized that the Hospital’s bills for anesthesia represent a separate request for compensation for the anesthesiologist physician’s services provided during surgery. Rather, the Hospital’s bill represents the Hospital’s treatment in connection with the anesthesia provided to the patient during surgery. As such, it is billable and reimbursable to the Hospital.

Anesthesia Materials

Insurance companies also argue that pursuant to N.J.A.C. 11:3-29.5(o) (7) anesthesia materials, including the anesthetic itself, and any materials, whether disposal or reusables, necessary for its administration are not entitled to a separate charge.

A Hospital however is not the same as an Ambulatory Surgical Center (“ASC”) that is “separate and apart from any other facility license” nor a single operating room. As such, Hospitals clearly does not fall within the definition of an ASC under N.J.A.C. 11:3-29.2 and are not subject to N.J.A.C. 11:3-29.5(o) (7) and are entitled to reimbursement at the Hospital’s usual and customary rate.

It should be noted that several Forthright DRPs have agreed with these positions:

DRP Odell agreed with the Claimant’s position in NJ-1547190 stating:

Here, I find that neither the ASC, Physician’s Fee Schedule nor the HOSF rate which would be applicable to determine a UCR fee under the case and DOBI guidelines. I do find the UCR rate would properly apply to this charge.

Further, in an Appellate Award NJ-1430014 finding:

The DRP analyzed all the factual evidence and relevant law and came to a supportable finding that the Respondent is incorrect in asserting that the physician’s fee schedule would apply to the Claimant, Holy Name Hospital

The Appellate Pane of DRPs Reynolds, Tamburino, and Knuetter, further supported Miller’s finding that:

There was clearly a loophole in the regulations that permitted hospitals that provided outpatient “ASC” type services to bill at UCR rates rather than being covered by either the physicians of ASC fee Schedules

Additionally in NJ-1542934, DRP George C. Nardella stated:

The billing of Meadowlands hospital is for facility fees in connection with the services rendered. As the claimant notes, the charges are in addition to the charges of the primary provider and represent the separate billing of the hospital. (emphasis added).

The claimant renders separate billing which on many occasions includes the same CPT code as the primary physician. (emphasis added)

This respondent has not directed this DRP to any authority evidencing that there is a difference between other CPT codes that are billed by a primary physician and the hospital and the anesthesia charges billed by the primary physician and the hospital in this case.

Based on the above the hospital billing for anesthesia is not duplicate billing and represents the hospital charges. (emphasis added).

Based on the foregoing, Hospitals should be confident in receiving full reimbursement for anesthesia services via the arbitration process.

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Reimbursement for Hospital Anesthesia Services is appropriate for dates of service prior to 2013.

Monday, April 25, 2016

What To Do Prior To Hiring A Lawyer

Hiring a lawyer is never an easy or pleasant task. It usually means there is something occurring in your life that has taken you outside of your normal routine and interests. It is likely to cost you money and time you might not have expected. At a minimum, it means you are entering an arena in which you will have little understanding and will be dependent on the expertise of someone else. For these reasons, choosing the right one to fit your needs is critical. With some due diligence, the process can be simple and straightforward. Without some research, however, the wrong choice could be made with consequences ranging from bad to dire.

Seeking the right attorney must include an investigation and understanding of attorneys’ levels of expertise in the matter presented. Some attorneys are specialized in one or two fields of law, and therefore would not be very helpful in other areas. It is important to hire an attorney familiar with the ins and outs of the area of law implicated by your situation or circumstances. The internet makes these types of investigations simpler and easier these days, but you should not simply rely on web sites and on-line ratings. They are a good starting point, but only a starting point.

Referrals are a good second step in your research process. Referrals not only can confirm or disavow what is claimed on-line, but can help with the other elements of the attorney-client relationship beyond expertise in the field. Characteristics like trustworthiness, dedication, responsiveness can often only be measured by those who have experienced the intimacy of working closely with legal counsel on a problem.

Next, whatever happens regarding the two steps mentioned above, it is always helpful to receive a second opinion. Choosing the first attorney you meet would be like buying the first car you saw in the lot, or the first suit or dress you came across on the rack. To be fully informed about the options, a would-be client must shop around, and obtain a sense of not only the attorneys’ credentials, qualifications and expertise, but also their demeanor, sensitivity and personalities. These all bear on the quality and success of your experience with the legal system.

Finally, and for some the most important consideration, is how much it is going to cost. Sometimes, addressing a problem with the law can be very expensive. When we have a health problem, we can feel relieved that we have health insurance to cover the brunt of the expenses. We have no such safeguard with legal problems. Attorneys are not cheap, and legal issues very often are not easily resolved. A would-be client must carefully balance the need for competent and qualified legal counsel with ability and willingness to pay.

After all is said and done, and you hired someone you believe is qualified and has the temperament that suits your needs as you see them, and it is at a price you find reasonable and understandable, as well as affordable, it is important to remember that the attorney works for the client, not vice versa. A lawyer will advise the client, but the client makes the decisions. You are the decision-maker, even though the attorney is the one with the expertise. And that says it all in terms of how important it is to find the right attorney—you need to trust and believe in their advice.

We hope you found the information provided in this article helpful to your everyday life and business. Please free to reach out to Sean Callagy or the Callagy Law team at any time for questions you may have concerning personal and business matters. Callagy Law’s headquarters is located conveniently in Paramus, NJ. Beyond the scope of information, Sean Callagy has developed multiple areas of business legal practice and business coaching, if you need help with anything, please reach out to us by calling 201-261-1700 or by emailing us here. Feel free to connect with us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube by clicking here.

Learn More About Callagy Law Here:

What To Do Prior To Hiring A Lawyer

Arizona Jury Awards $27.6 Million To Company Founder in Retaliation Suit

FOR IMMEDIATE RELEASE

PHOENIX, ARIZ. – April 25, 2016 – An Arizona federal jury has awarded $27.6 million to a healthcare staffing company founder who claimed his allegation of internal medical billing fraud led to a retaliation plan with a highly unusual method to oust him.

The total awarded on April 20 to Marc A. Wichansky, former president of Zoel Holding Co. Inc. of Phoenix, includes $14.375 million in punitive damages against his former partner, David T. Zowine.

Wichansky alleged that Zowine, then the company vice president and a co-owner, breached his fiduciary duty by engaging in or concealing the fraud and leading a campaign to take control of the company after Wichansky began his investigation.

“Zowine initiated destabilizing and abusive conduct, which included harassment, intimidation, private and public humiliation, a death threat, and physical violence,” said Wichansky’s lead counsel, Sean R. Callagy, founder and owner of Callagy Law, P.C., of Paramus, N.J.

“Zowine carried this out by enrolling others in his campaign. We are grateful the jury saw through this behavior,” Callagy added.

Sean Callagy suffers from a degenerative eye disease called Retinitis Pigmentosa (RP). Notwithstanding this severe impairment, Callagy and his trial team were able to secure this jury verdict after an intense 13-day trial.

Wichansky, who eventually was ousted from his ownership of Zoel, which is now called Zoe Holding Company Inc., was chairman and president. He and Zowine were 50 percent shareholders.

Before the dispute broke out in early 2011, Zoel had gross revenues of over $40 million, offices in five states and hundreds of hospital clients that hired thousands of workers through the company, according to the complaint.

Wichansky alleged that irregular billing practices had led to the submission of false bills to the government and government payors by a Zoel subsidiary, MGA Home Healthcare LLC.

Wichansky later claimed that those practices were part of a fraud scheme by Zowine and other employees and that Zowine tried to suppress the internal investigation and oust him.

At one point, according to the complaint, Zowine grabbed Wichansky by the neck, threw him across the room and punched him. At other times, Wichansky allegedly was the target of verbal and written abuse, threats and disparagement before employees.

Zowine allegedly told employees that Wichansky was engaging in tax fraud, would be going to jail and had a drug problem.

In addition, according to the complaint, Zowine and his co-conspirators stole and accessed Zoel’s server and computers and set up a secret satellite office.

Wichansky sought to terminate Zowine but an Arizona state court said he lacked that authority. Later, the state court ruled that Zowine could buy Wichansky’s shares. Wichansky claimed that he sustained damages as a result of this sale and that Zowine misrepresented financial information to the court.

In addition to breach of officer, director and shareholder fiduciary duty, the jury also found that Wichansky was assaulted and battered by Zowine. Moreover, the jury awarded compensatory and punitive damages against several other defendants who aided and abetted Zowine’s breach of fiduciary duty, including punitive damages of $1.5 million against Charles Johnson, $750,000 against Patrick Shanahan and $500 against Martha Leon.

Michael J. Smikun, a partner of Callagy Law, has worked closely on the case since 2011 and was a critical contributor to this verdict. Supporting attorneys from the firm were Christopher R. Miller, Samuel S. Saltman and Robert J. Solomon. The trial team was also supported by Taylor Gallo and Dally Shala.

The complaint in the case, Wichansky v. Zowine, is attached.

The Callagy firm has now won two $27-million-plus jury verdicts in less than two years. In 2014, a New Jersey state jury awarded more than $33 million to The Law Funder LLC, which alleged fraud by its in-house counsel and others. The total in that case, Prussin v. Sheldon, included $8 million in punitive damages.

About Callagy Law, P.C.:

The firm, based in Paramus, N.J., and Phoenix, Ariz., concentrates on commercial and business litigation, healthcare law, and family law.

Alissa Imperatore

Media Contact, Callagy Law

203.909.0252

aimperatore@callagylaw.com

Arizona Jury Awards $27.6 Million To Company Founder in Retaliation Suit

Tuesday, April 19, 2016

Callagy Law and the 33 Million Dollar Verdict

The total amount includes $8 million in punitive damages

Paramus, N.J. (Sept. 22, 2014) – A three-week civil trial at the Bergen County Superior Court of New Jersey recently ended with a jury awarding The Law Funder, LLC $33.5 million dollars. The amount is payable by, among others, defendant Matthew Sheldon, who in 2013 pleaded guilty in the United States District Court for the District of New Jersey to the same unlawful conduct.

“This verdict is a victory for my clients,” said Sean Callagy of Callagy Law, who represented The Law Funder in the case. “While this does not represent a complete recovery for them, we will continue to pursue the payment due for the rest of Sheldon’s life so that he may repay some of what my clients have lost.”

Sheldon is currently incarcerated and is serving a sentence of 30 months in prison after having pled guilty to conspiracy to commit wire fraud in 2013. He admitted to engaging in a kickback scheme that resulted in him and a number of other defendants being paid improper referral fees by the litigation funding company The Law Funder, LLC.

Sheldon had served as an attorney and chief underwriter for The Law Funder of New York, a company that he co-founded in 2004 with three other individuals.

His fraudulent activity began in 2005, when Sheldon started to work with a New Jersey broker to garner referral fees, which the two split. The fees collected amounted to at least $870,000 in profit for Sheldon.

His indiscretions were uncovered in 2009 after The Law Funder had dismissed Sheldon. An investigation by Callagy Law uncovered other fraud that was also included in the civil complaint.

The case alleged wrongdoing beyond the criminal charges, including claims that Sheldon purposefully overvalued some cases and approved funding for bad cases for his own personal benefit.

Sheldon was also accused of transferring $750,000 for fictitious cases to Jessica Escobar in Houston, who posed as both attorney and paralegal and was alleged to have had an intimate relationship with Sheldon.

The suit named 20 defendants, including Gregory Krasovsky, an attorney who previously represented The Law Funder and was aware of Sheldon’s fraud but did not alert the company, according to the complaint.

The verdict was released on June 24, 2014, with the jury awarding a total of $24.5 million in compensatory damages – $22.9 million against Sheldon, $2.2 million against Krasovsky, and $375,000 against another defendant. On June 25, 2014, the jury awarded an additional $8 million in punitive damages against Sheldon for a total of $33.5 million against him and the remaining defendants.

See More: http://callagylaw.com/bergen-county-fraud-case-33-5-million-dollars/

Original Post: http://www.njlawjournal.com/id=1202661606677/NJ-Litigation-Funding-Business-Wins-33M-Award-in-Fraud-Case

Callagy Law and the 33 Million Dollar Verdict

Callagy Law - Our Practice Areas

Callagy Law, PC is a multidisciplinary law firm committed to providing legal representation and advice to our clients at our law offices located in New York and New Jersey and Arizona in the areas of Healthcare Recovery, Business Law, Commercial Litigation, and Family Law. To learn more about Callagy Law and what inspires us to fight for you, continue reading below.

Our Why: “Fundamentally changing the way people feel about lawyers, one client at a time.”

We have several practice areas. For medical providers they include:

-Medical Revenue Recovery

-PIP Litigation and Arbitration

-Workers Compensation

-Commercial Insurance Litigation

Other practice areas include:

-Commercial Litigation (Complex commercial litigation, qui tam, whistle blower, corporate fraud, business fraud, in-house counsel support)

-Business Law (business formation, business contracts, agreements, business divorce, insurance fraud, investor fraud, financial fraud).

-Family Law (child custody, child support, divorce law, prenuptial agreements)

Call, email, or visit us today!

201-261-1700

inquiries@callagylaw.com

www.callagylaw.com

Callagy Law - Our Practice Areas