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Koenig et al v. Aetna Life Insurance Company

RESPONSE in Opposition to 230 MOTION for Leave to File Annotated Supplemental Counterclaim

14 Cited authorities

  1. Matter of Southmark Corp.

    88 F.3d 311 (5th Cir. 1996)   Cited 348 times
    Holding a court, when determining whether to grant leave to amend, may consider the failure to cure deficiencies by amendments previously allowed and futility of the proposed amendment

  2. Rule 15 - Amended and Supplemental Pleadings

    Fed. R. Civ. P. 15   Cited 90,200 times   91 Legal Analyses
    Finding that, per N.Y. C.P.L.R. § 1024, New York law provides a more forgiving principle for relation back in the context of naming John Doe defendants described with particularity in the complaint

  3. Section 1320a-7b - Criminal penalties for acts involving Federal health care programs

    42 U.S.C. § 1320a-7b   Cited 1,438 times   312 Legal Analyses
    Prohibiting the solicitation or receipt of "remuneration" in exchange for referrals

  4. Section 164.053 - Unprofessional or Dishonorable Conduct

    Tex. Occ. Code § 164.053   Cited 12 times   1 Legal Analyses
    Providing that failing to adequately supervise "the activities of those acting under the supervision of the physician" constitutes "unprofessional or dishonorable conduct likely to deceive or defraud the public"

  5. Section 102.001 - Soliciting Patients; Offense

    Tex. Occ. Code § 102.001   Cited 11 times   3 Legal Analyses
    Criminalizing accepting money for patient referrals

  6. Section 1204.055 - Contractual Responsibility for Deductibles and Copayments

    Tex. Ins. Code § 1204.055   Cited 4 times   1 Legal Analyses

    (a) The payment of benefits under an assignment does not relieve a covered person of a contractual obligation to pay a deductible or copayment. (b) A physician or other health care provider may not waive a deductible or copayment by the acceptance of an assignment. Tex. Ins. Code § 1204.055 Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. 4/1/2005.

  7. Section 105.002 - Unprofessional Conduct

    Tex. Occ. Code § 105.002   Cited 3 times   2 Legal Analyses

    (a) A health care provider commits unprofessional conduct if the health care provider, in connection with the provider's professional activities: (1) knowingly presents or causes to be presented a false or fraudulent claim for the payment of a loss under an insurance policy; (2) knowingly prepares, makes, or subscribes to any writing, with intent to present or use the writing, or to allow it to be presented or used, in support of a false or fraudulent claim under an insurance policy; or (3) knowingly

  8. Section 102.006 - Failure to Disclose; Offense

    Tex. Occ. Code § 102.006   Cited 2 times

    (a) A person commits an offense if: (1) the person, in a manner otherwise permitted under Section 102.001, accepts remuneration to secure or solicit a patient or patronage for a person licensed, certified, or registered by a state health care regulatory agency; and (2) does not, at the time of initial contact and at the time of referral, disclose to the patient: (A) the person's affiliation, if any, with the person for whom the patient is secured or solicited; and (B) that the person will receive

  9. Section 101.203 - Overcharging or Overtreating

    Tex. Occ. Code § 101.203   Cited 2 times

    A health care professional may not violate Section 311.0025, Health and Safety Code. Tex. Occ. Code § 101.203 Amended by Acts 2001, 77th Leg., ch. 1420, Sec. 14.011(a), eff. 9/1/2001. Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. 9/1/1999.

  10. Section 102.003 - Federal Law; Construction

    Tex. Occ. Code § 102.003   Cited 2 times

    Section 102.001 permits any payment, business arrangement, or payment practice permitted by 42 U.S.C. Section 1320a-7b(b) or any regulation adopted under that law. Tex. Occ. Code § 102.003 Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. 9/1/1999.

  11. Section 552.003 - Charging Different Prices; Offense

    Tex. Ins. Code § 552.003   Cited 1 times   2 Legal Analyses

    (a) A person commits an offense if: (1) the person knowingly or intentionally charges two different prices for providing the same product or service; and (2) the higher price charged is based on the fact that an insurer will pay all or part of the price of the product or service. (b) An offense under this section is a Class B misdemeanor. Tex. Ins. Code § 552.003 Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. 4/1/2005.