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Investigating Healthcare Fraud: Its Scope, Applicable Laws, And Regulations, Nicole Forbes Stowell, Carl Pacini, Nathan Wadlinger, Jaqueline M. Crain, Martina Schmidt 2020 William & Mary Law School

Investigating Healthcare Fraud: Its Scope, Applicable Laws, And Regulations, Nicole Forbes Stowell, Carl Pacini, Nathan Wadlinger, Jaqueline M. Crain, Martina Schmidt

William & Mary Business Law Review

Healthcare costs are not only an enormous strain on the U.S. economy but are expected to increase in the foreseeable future. Not surprisingly, clever fraudsters view the healthcare industry as a lucrative and attractive hotspot for illegal activity. Although federal and state governments have increased their funding and prosecution efforts relating to healthcare fraud, this fraud continues to be a major threat to the U.S. economy and every patient and consumer. The impact of healthcare fraud is substantial and far-reaching. Healthcare fraud in the U.S. affects not only the government, but also insurance companies, patients, healthcare providers ...


Saints And Sinners: Is An Insurance Policy Required To Indemnify The Church For The Wrongful Acts Of Sexual Misconduct By Priests?, Cassidy J. Seamon 2020 Boston College Law School

Saints And Sinners: Is An Insurance Policy Required To Indemnify The Church For The Wrongful Acts Of Sexual Misconduct By Priests?, Cassidy J. Seamon

Boston College Law Review

On September 19, 2018, the United States Court of Appeals for the Second Circuit’s holding in Hartford Roman Catholic Diocesan Corp. v. Interstate Fire & Casualty Co. created two circuit splits regarding the interpretation of Interstate Fire and Casualty Co.’s insurance policy provisions, particularly in the context of indemnification for sexual abuse settlements. Hartford held that in insurance policy interpretation the presence of an occurrence is determined by a subjective test of expectation from the standpoint of the insured. The Second Circuit also held that the assault and battery exclusion excluded only those insureds that committed the assault and ...


Comprehensive General Liability Policies Under Maine's Ground Water Protection Act: The Law Court's Extraordinary Definition Of Ordinary Intelligence, Andrew M. Strongin 2020 University of Maine School of Law

Comprehensive General Liability Policies Under Maine's Ground Water Protection Act: The Law Court's Extraordinary Definition Of Ordinary Intelligence, Andrew M. Strongin

Maine Law Review

In Patrons Oxford Mutual Insurance Co. v. Marios, the Supreme Judicial Court of Maine, sitting as the Law Court, joined the current debate in the state and federal judiciaries as to whether comprehensive general liability (CGL) insurance policies obligate the insurer to indemnify the insured for cleanup costs incurred pursuant to governmentally mandated cleanup of hazardous substances. In that decision, the court held that cleanup costs incurred pursuant to court order authorized by the Maine Underground Oil Storage Facilities and Ground Water Protection Act are not covered by such policies. The explicit basis of the court's decision was that ...


Comprehensive General Liability Policies Under Maine's Ground Water Protection Act: The Law Court's Extraordinary Definition Of Ordinary Intelligence, Andrew M. Strongin 2020 University of Maine School of Law

Comprehensive General Liability Policies Under Maine's Ground Water Protection Act: The Law Court's Extraordinary Definition Of Ordinary Intelligence, Andrew M. Strongin

Maine Law Review

In Patrons Oxford Mutual Insurance Co. v. Marios, the Supreme Judicial Court of Maine, sitting as the Law Court, joined the current debate in the state and federal judiciaries as to whether comprehensive general liability (CGL) insurance policies obligate the insurer to indemnify the insured for cleanup costs incurred pursuant to governmentally mandated cleanup of hazardous substances. In that decision, the court held that cleanup costs incurred pursuant to court order authorized by the Maine Underground Oil Storage Facilities and Ground Water Protection Act are not covered by such policies. The explicit basis of the court's decision was that ...


Oh Captive! My Captive! New York’S Qui Tam Provision For Tax Is Validated In The Captive Insurance Context, Nicholas M. Coppola 2020 Boston College Law School

Oh Captive! My Captive! New York’S Qui Tam Provision For Tax Is Validated In The Captive Insurance Context, Nicholas M. Coppola

Boston College Law Review

On August 30, 2018, in Anonymous v. Anonymous, the Appellate Division of the New York Supreme Court, First Judicial Department held, for the first time, that a plaintiff-relator had sufficiently alleged that the defendants had violated the New York False Claims Act by using a captive insurance company for the sole purpose of evading taxes. The tax evasion scheme was brought to light by a former employee who utilized the New York False Claims Act’s qui tam provision. A qui tam provision allows a private citizen to stand in the shoes of the government when bringing an action. This ...


The Cost Of Legal Restrictions On Experience Rating, Levon Barseghyan, Francesca Molinari, Darcy Steeg Morris, Joshua C. Teitelbaum 2020 Cornell University

The Cost Of Legal Restrictions On Experience Rating, Levon Barseghyan, Francesca Molinari, Darcy Steeg Morris, Joshua C. Teitelbaum

Georgetown Law Faculty Publications and Other Works

We investigate the cost of legal restrictions on experience rating in auto and home insurance. The cost is an opportunity cost as experience rating can mitigate the problems associated with unobserved heterogeneity in claim risk, including mispriced coverage and resulting demand distortions. We assess this cost through a counterfactual analysis in which we explore how risk predictions, premiums, and demand in home insurance and two lines of auto insurance would respond to unrestricted multiline experience rating. Using claims data from a large sample of households, we first estimate the variance-covariance matrix of unobserved heterogeneity in claim risk. We then show ...


The Paradox Of Insurance, Gideon Parchomovsky, Peter Siegelman 2020 University of Pennsylvania Law School

The Paradox Of Insurance, Gideon Parchomovsky, Peter Siegelman

Faculty Scholarship at Penn Law

In this Article, we uncover a paradoxical phenomenon that has hitherto largely escaped the attention of legal scholars and economists, yet it has far-reaching implications for insurance law: loss-creation by uninsured parties caused by the presence of insurance. Contrary to the conventional wisdom, we show that insurance can create significant negative externalities by inducing third parties to engage in antisocial, illegal and unethical activities in order to extract money from insureds or insurers. Moreover, as the amount and scope of insurance grows, so does its distortionary effect on third parties. We term this phenomenon the paradox of insurance. The risk ...


Private Equity Value Creation In Finance: Evidence From Life Insurance, Divya Kirti, Natasha Sarin 2020 International Monetary Fund

Private Equity Value Creation In Finance: Evidence From Life Insurance, Divya Kirti, Natasha Sarin

Faculty Scholarship at Penn Law

This paper studies how private equity buyouts create value in the insurance industry, where decentralized regulation creates opportunities for aggressive tax and capital management. Using novel data on 57 large private equity deals in the insurance industry, we show that buyouts create value by decreasing insurers' tax liabilities; and by reaching-for-yield: PE firms tilt their subsidiaries' bond portfolios toward junk bonds while avoiding corresponding capital charges. Previous work on affiliated or "shadow" reinsurance and capital management misses the important role that private equity buyouts play as recent drivers of these phenomenon. The trend we document is of growing importance in ...


Uncertainty > Risk: Lessons For Legal Thought From The Insurance Runoff Market, Tom Baker 2020 University of Pennsylvania Law School

Uncertainty > Risk: Lessons For Legal Thought From The Insurance Runoff Market, Tom Baker

Faculty Scholarship at Penn Law

Insurance ideas inform legal thought: from tort law, to health law and financial services regulation, to theories of distributive justice. Within that thought, insurance is conceived as an ideal type in which insurers distribute determinable risks through contracts that fix the parties’ obligations in advance. This ideal type has normative appeal, among other reasons because it explains how tort law might achieve in practice the objectives of tort theory. This ideal type also supports a restrictive vision of liability-based regulation that opposes expansions and supports cutbacks, on the grounds that uncertainty poses an existential threat to insurance markets.

Prior work ...


Insurance, Bradley S. Wolff, Maren R. Cave, Thomas D. Martin 2020 Mercer University School of Law

Insurance, Bradley S. Wolff, Maren R. Cave, Thomas D. Martin

Mercer Law Review

During this survey period, the courts in Georgia seemed to take a respite from the usual litany of automobile and uninsured motorist (UM) cases, the summaries of which typically populate this annual update. Instead, the courts seemed to focus more on liability insurance issues, rendering many decisions on well-known principles of law and a few important decisions concerning offers of settlement, counteroffers, notice, and the use of intervention in coverage disputes. Particularly noteworthy were two cases involving offers of settlement, one where an offer was deemed inadequate as a time-limited demand and another where acceptance of an offer was deemed ...


Phishing For Computer Fraud Insurance Coverage, Stephen Swanson 2020 Georgia State University College of Law

Phishing For Computer Fraud Insurance Coverage, Stephen Swanson

Georgia State University Law Review

Accordingly, the following note discusses the disparity between the federal circuit courts regarding the proper insurance coverage for phishing-type attacks. Part I examines the cyber threats companies face when handling sensitive transactions and customer data, as well as the coverage gap between traditional crime insurance policies and the targeted cyber insurance policies that help prevent, detect, and ultimately mitigate the damages resulting from a cybersecurity breach. Part II analyzes the current circuit split and the various contract interpretation strategies, policy considerations, and tests employed in reaching a coverage decision. Part III proposes a resolution to the overarching circuit split that ...


The Specific Consumer Expectations Test For Product Defects, Clayton J. Masterman, W. Kip Viscusi 2020 Vanderbilt University

The Specific Consumer Expectations Test For Product Defects, Clayton J. Masterman, W. Kip Viscusi

Indiana Law Journal

In this Article, we propose that courts adopt an amended version of the consumer expectations test that we call the “specific consumer expectations test.” The specific consumer expectations test would apply to any product or product component for which consumers have clear, articulable ex ante expectations about the function of the product. Under the specific consumer expectations test, a defendant is liable if consumers expected such a product to reduce a particular risk, and the product in fact increased that risk. Similarly, if a product was intended to convey a particular benefit, but in fact harmed consumers along the same ...


Disappropriation, Matthew Lawrence 2019 Penn State Dickinson Law

Disappropriation, Matthew Lawrence

Matthew B. Lawrence

In recent years Congress has repeatedly failed to appropriate funds necessary to honor legal commitments (aka entitlements) that are themselves enacted in permanent law. The Appropriations Clause has forced the government to defy legislative command and break such commitments, with destructive results for recipients and the rule of law. This Article is the first to address this poorly-understood phenomenon, which it labels a form of “disappropriation.” 

The Article theorizes recent high-profile disappropriations as one probabilistic consequence of Congress’s decision to create permanent legislative payment commitments that the government cannot honor without periodic, temporary appropriations. Such partially-temporary programs include Medicaid ...


Concussions And Contracts: The National Football League's Limitations To Protecting Its Players From Chronic Traumatic Encephalopathy, Julia Wolpert 2019 California Western School of Law

Concussions And Contracts: The National Football League's Limitations To Protecting Its Players From Chronic Traumatic Encephalopathy, Julia Wolpert

Journal of Law and Health

Chronic Traumatic Encephalopathy (CTE) is a neurodegenerative brain injury that has become prevalent among high-contact professional sports, especially American football. More and more retired players are exhibiting symptoms of CTE and being diagnosed with CTE post-mortem. While the neuroscience community constantly releases studies showing a causal connection between brain trauma and CTE, the National Football League (NFL) continues to deny that any brain injury can arise from playing football. The NFL must implement provisions in their contracts to fully inform and protect players from this lethal brain injury. This article examines the repercussions of CTE, how players’ contracts do and ...


Sb 18 - Direct Primary Care, Valentin H. Dubuis, Juliana Mesa 2019 Georgia State University College of Law

Sb 18 - Direct Primary Care, Valentin H. Dubuis, Juliana Mesa

Georgia State University Law Review

This legislation allows physicians to offer specified care for a specific time pursuant to a fixed fee. The physician cannot require more than one year’s payment upfront, and the agreement has to be terminable by either party with thirty days’ notice. Physicians do not have to provide care if the fee has not been paid or the patient has committed fraud, failed to adhere to treatment, or is in physical danger.


Sb 106 - Patients First Act, Jasmine Nicole Becerra, Leanne E. Livingston 2019 Georgia State University College of Law

Sb 106 - Patients First Act, Jasmine Nicole Becerra, Leanne E. Livingston

Georgia State University Law Review

The Patients First Act amends both Title 49 and Title 33 of the Official Code of Georgia Annotated, which allows the state to apply for two federal waivers. One being the Section 1115 waiver to the Social Security Act. The second being the Section 1332 waiver to the Affordable Care Act. Section 1115 waivers apply to Medicaid and may be sought to include a maximum income threshold up to 100% of the Federal Poverty Level. The Section 1332 innovation waiver applies to insurance coverage generally.


Insurance--Liability Of Insurer For Unauthorized Act Of Soliciting Agent, H. G. U. 2019 West Virginia University College of Law

Insurance--Liability Of Insurer For Unauthorized Act Of Soliciting Agent, H. G. U.

West Virginia Law Review

No abstract provided.


Lovewell V. Physicians Insurance Co.: Personal Liability For Prejudgment Interest , Karin Mika 2019 Cleveland-Marshall College of Law

Lovewell V. Physicians Insurance Co.: Personal Liability For Prejudgment Interest , Karin Mika

Karin Mika

This article discusses the Ohio Supreme Court's decision in Lovewell by walking through the case from trial court to the final Supreme Court decision. The case raises many issues regarding the future of litigation involving parties who refuse to settle pursuant to a contractual right. Although, on the surface, it would appear that the court clarified what entity would ultimately be responsible for paying a prejudgment interest award, its failure to address other issues left open the potential for future litigation concerning the traditional relationship between the insurer and the insured. While Lovewell does not necessarily mean the death ...


Law School News: A Busy, Busy Time In Admiralty Law 10-18-2019, Michael M. Bowden 2019 Roger Williams University School of Law

Law School News: A Busy, Busy Time In Admiralty Law 10-18-2019, Michael M. Bowden

Life of the Law School (1993- )

No abstract provided.


Law School News: Inside Rwu Law's Small 'Admiralty Empire' 10-18-2019, Michael M. Bowden 2019 Roger Williams University School of Law

Law School News: Inside Rwu Law's Small 'Admiralty Empire' 10-18-2019, Michael M. Bowden

Life of the Law School (1993- )

No abstract provided.


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