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Managed Care July 2000	HMO Incentives Not Grounds for Suit U.S. Supreme Court Rules Unanimously Use of financial incentives in HMOs' contracts with physicians may be losing favor, but it's not about to be declared outright illegal any time soon. The U.S. Supreme Court ruled unanimously that patients maynot sue a health plan just because it offers physicians incentives intended to limit health care services.
Managed Care November 1999	U.S. Supreme Court To Hear Suit Against HMOs Over Incentives Can HMOs be sued for the practice of offering bonuses to physicians who help them keep the cost of care down?...
Salon.com June 13, 2000 David McGuire	Immune from liability The Supreme Court blocks a potentially important legal path for people who want to sue HMOs. Now, the spotlight is on Congress.
Managed Care July 2000 Neville M. Bilimoria, J.D.	HMOs Continue Losing Ground On Liability Issues at State Level The recent U.S. Supreme Court decision offers a nice breather, but executives should not let down their guard, as an Illinois ruling shows.
Managed Care November 1999 John La Puma, M.D.	Expanding HMO Liability: Ethical, But Not the Point ...Many states are not waiting for the federal debate about expanding HMO liability to play out...
Managed Care August 2000 Michael Levin-Epstein	Will Fifth Circuit's Decision Spur Action on Patient Rights? The recent Fifth Circuit Court decision on Texas's statute allowing patients to sue HMOs for denial of physician-recommended care is helping to clarify where state and federal interests in patient rights lie -- and what Congress could do to spell out those interests.
Managed Care March 2000 Mark D. Abruzzo	Beating Obesity Begins By Expanding Tort Reform It's been suggested that, in order to battle obesity, HMOs should use their collective information and knowledge to change their members' behavior....
Managed Care October 2000 Patrick Mullen	Interview: Steven B. Epstein, J.D. This pioneering medical legal authority says health plans and physicians should stop fighting over scraps the government throws them...
Managed Care August 2001 Edward T. Waters	Administrators Could Be Liable Under Patients' Bill of Rights The Senate version would leave previous state and federal rulings against HMOs intact. Medical directors ignoring external-review boards can be sued...
Managed Care November 1999 Allen Briskin & Gerry Hinkley	HMO Liability Battleground Moving to Courts, Statehouse The adage "all politics is local" may, in the end, become the motto that sinks ERISA. HMO executives should assume protection will evaporate.
Salon.com October 14, 1999 Dawn MacKeen	Woe is HMO Proponents of liability legislation argue that the only way to change managed care's behavior is to threaten it with lawsuits.
Managed Care April 2007 Daniel Y. Patterson	HMO - 21st Century Model The history of HMOs has been one of conflict between plans and physicians. Could global specialty capitation be a better way?
Managed Care April 2000 Mark Abernathy	Avoid Common Problems In Risk-Sharing Contracts These arrangements too often become a hindrance instead of a help. Simple precautions today can help prevent major headaches later on.
Managed Care April 2002	Ruling Makes Class-Action Suit More Plausible The idea of a class-action lawsuit against HMOs was boosted by a recent decision in a federal court in Florida. Meanwhile, the Blue Cross and Blue Shield Association has sounded the alarm that efforts to increase health plan liability may be launched in at least eight states...
Managed Care December 2000 Mark D. Abruzzo	Some States Seek To Close Prompt-Payment Loopholes Many states have laws governing the timeliness of claims payments to physicians, hospitals, and other providers, but few such statutes have any real effect because of lack of enforcement or clarity. Some states are toughening their so-called prompt-payment laws, at the expense of insurers...
Managed Care December 2006	Compensation Monitor More than half of the nation's HMOs use pay-for-performance programs.
Managed Care December 2002	California Puts Doctor Scores On Report Cards The competency of physician groups is often as important as HMO performance in determining patient outcomes, California health regulators have decided
Managed Care July 2001 John Otrompke	Stark Allows Federal Regulators To Review Claims Records Fully HMO executives, as well as the providers and physicians who contract with them, should have by now felt the changes in their daily work lives resulting from the government's increased scrutiny of health plans' operations under the fraud-and-abuse compliance laws...
Managed Care May 2000	Texas-Aetna Incentives Settlement Worries Some Capitated Physicians If the Texas deal ignites a trend away from the use of incentives to keep utilization down, then some capitated physicians worry it will put them in a tight spot.
Salon.com July 17, 2001 Jake Tapper	The healthcare disaster that wasn't When Texas passed its patients' bill of rights law, George W. Bush warned that it would unleash a plague of lawyers and drive up health costs. It didn't...
Investment Advisor April 2008 Melanie Waddell	401(k) Participants Can Sue Advisors should take heed, as a high court rules in favor of 401(k) participants; will a torrent of similar lawsuits ensue?
CFO Kris Frieswick	Prudent Man With A Plan Most 401(k) reforms before congress don't address a critical source of risk: fiduciary duty.
Managed Care August 2001 John Carroll	Info on Questionable Physicians Languishes in National Data Bank A clearinghouse was created that stores details about malpractice suits and disciplinary actions. So how come HMOs don't use it?
Managed Care June 2001 Frank Diamond	HMO/Physician Strain Creates Invisible Costs Perhaps goodwill is too much to ask for. However, peaceful coexistence can certainly help all players reach their mutual goal -- a smooth relationship that helps to get the job done...
Managed Care July 2004	Headlines On Deadline ... In a major victory for HMOs, the Supreme Court voted unanimously on June 21 that patients may not sue health plans in state courts for refusing to pay for medical care recommended by physicians.
Managed Care July 2002 John A. Marcille	Capitation as Whipping Boy: Court Takes on Touchy Issue If plans are to keep coverage decisions reasonable and fair, they'll need tools that involve physicians and patients in the decision-making process. Capitation is one of those.
Managed Care January 2002 Donald Wilcox & Stephanie Kanwit	Debating RICO Suits vs. Health Plans States Failed To Protect Docs From Insurers... Patients Will Suffer; Greedy Lawyers to Blame...
Managed Care March 2001 Frank Diamond	Don't Be Misled by the Hype: Credentialing -- Important, but Difficult HMOs may be trying harder, but PPOs seem less interested. Then there's the whole issue of credentialing's relationship to the licensure process...
Managed Care November 1999 Michael D. Dalzell Senior Editor	HMOs, Physicians Discover They Really Need Each Other Some HMOs may be more willing than you think to help financially troubled medical groups survive. A willingness to cooperate is key.
Managed Care March 2002 Charles Downey	The Department of Managed Care California sets a precedent again, with a bold effort to regulate the HMO industry. While the new Department of Managed Health Care is facing down 50,000 consumer gripes monthly, director Daniel Zingale intends to keep administrative red tape from overwhelming everyone...
Pharmaceutical Executive August 1, 2011 Jill Wechsler	The Supremes Shape Pharma A number of important decisions from the Supreme Court will affect drug marketing, research, and regulation
Managed Care November 1999 Richard Hamer	Goals 2000: For HMOs: Administrative Retooling For MDs: Managerial Competency ...While HMOs retrench, physicians need to become more constructive participants....
Investment Advisor January 2007 Ken Ziesenheim	The Other Fiduciary Issue Many members of company retirement plan investment committees are not fully aware of the nature of their fiduciary responsibilities.
Managed Care August 2001 Frank Diamond	Consumers Dare You to Just Say 'No' The backlash has helped push a Patients' Bill of Rights forward, challenging the very nature of cost containment. Ironically, enrollees may be shortchanged...
Registered Rep. March 1, 2005	Responsibility Issues When is a broker or a financial planner a fiduciary?
Managed Care July 2000	Are Gatekeepers Failing To Control Specialty Costs? The importance of a gatekeeper in keeping costs down has been challenged again -- this time in a study that compares physician utilization for HMOs and point-of-service plans.
Financial Advisor May 2008 Marla Brill	Under Pressure Financial advisors who provide services to businesses with 401(k) plans governed by the Employee Retirement Income Security Act have a new reason to review fiduciary practices and double-check professional liability insurance.
Managed Care November 1999 Karen Ignagni	Health Plans Will Use New Tools To Help Physicians Practice Better For the first time, plans are in a position to work with physicians to improve outcomes, efficiency, and patient safety....
Managed Care February 2007	Quality is Important, But Productivity Rules Despite a rise in the use of quality incentives to determine physician compensation, productivity remains the predominant determinant.
Salon.com July 4, 2001 Alicia Montgomery	Could just anyone get a pacemaker like Cheney's? Not necessarily, HMO critics say. And Bush has already promised to veto a bill that would help patients get care as good as the vice president's...
Managed Care January 2001 Richard B. Dwore	Study An Opportunity for HMOs To Use Marketing To Increase Enrollee Satisfaction...
Managed Care December 2000 Maureen Glabman	Downstream Without a Paddle State legislatures that tackle medical group insolvencies have come up with strategies that sometimes shift accountability to HMOs...
Managed Care January 2007 Maureen Glabman	Will 'Mea Culpa' Work for Health Plans Too? Hospitals and physicians, to varying degrees, are finding that doing the right thing is good business practice.
Managed Care June 2002	Report: Physicians storm Web sites to get information on formularies A study shows a big increase over the course of a year in the number of physician hits on HMO sites to get information on claims status, clinical guidelines, and many other topics.
Managed Care September 2000	Key Texas Lawsuit Against HMO Now Off Court Docket The first lawsuit against an HMO under Texas's health plan liability statute has been settled...
Managed Care August 2000 Bob Carlson	'All Products' Clauses Fade From Physician Contracts All-products provisions in health plan provider contracts are slowly being negotiated, legislated, and regulated out of existence. They are now illegal in at least four states; legislation is pending in several others.
Investment Advisor December 2009	Walking the Fiduciary Line on Retirement Retirement plans and their participants may need to use separate advisors who are separate fiduciaries, devoid of the potential for conflicts.
Managed Care July 2001 Harry L. Leider	HMOs Need To Share Gains of DM Programs Physicians are more likely to buy in if they see better outcomes -- and financial rewards that go with them...
Managed Care May 2000	The latest blow to managed care? The Texas attorney general's decision in the Aetna case is the latest in a long string of events that has gutted the fundamentals of managed care. Many in health care think that some or all of these developments have stripped health plans of their ability to manage care effectively....
CFO August 1, 2012 Vincent Ryan	High Court Upholds Health-Care Reform The Supreme Court's ruling leaves companies with decisions to make.