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Managed Care September 2001 Bob Carlson	Plan-Provider Posturing Draws State Regulators' Ire Network instability is what happens when providers and health plans part company, or threaten to. Lately, many ugly rifts have been the result of contract disputes, invariably conducted in public...
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 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...
CFO March 15, 2006 Tim Reason	The Spitzer Backlash As state attorneys general clamp down on corporate wrong-doers, companies fight back.
Managed Care May 2002 David Humiston & Stephen M. Crane	Will Your State's Privacy Law Be Superseded by HIPAA? Careful interpretation required: Health plans operating in multiple states have a challenge sorting out where the federal law trumps state statutes
Commercial Investment Real Estate Sep/Oct 2009 Andrew Dick	Understanding Federal Healthcare Laws Commercial real estate professionals who work with medical office development must be aware of the federal healthcare fraud and abuse laws.
BusinessWeek December 9, 2010 Carter Dougherty	Elizabeth Warren Rounds Up Her Deputies Consumer finance watchdog Elizabeth Warren hopes state prosecutors will help her detect fraud and enforce new rules.
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...
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 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 October 2000 Michael Levin-Epstein	How We Got It Anyway: The Clinton Health Plan Never Died As a whole, the plan unceremoniously crashed and burned. But it still frames state and national debate about health policy, thus affecting the evolution of managed care...
Managed Care April 2005 John Carroll	Can Managed Care Programs Rein in Medicaid's Runaway Budgets? Cadillac or Yugo care for the poor? Fee-for-service or managed care? The states have a lot on their minds as the Medicaid monster grows and grows.
Foundation News & Commentary May/Jun 2006 Kosaras & Biemesderfer	Partners for Public Good Building relationships between state charity regulators and the charitable sector is important. Here's how it can be done.
BusinessWeek July 14, 2003 Robert J. Barro	Medicare: Forget the Drug Benefit, and Face Up to Real Reforms Washington seems poised to make a major error on Medicare. The program's costs are out of control, and the situation will deteriorate further as the population ages. We should be considering basic changes to the structure of the health-care market.
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....
Managed Care February 2002 Mick L. Diede & Richard Liliedahl	Getting on the Right Track Converging forces are an economic train wreck waiting to happen. Avoiding a disaster requires an understanding of the interconnection of health care's stakeholders and the global consequences of their actions...
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 August 2002	24 States Hope Pharmacy Plus Helps Medicaid Twenty-four states may gamble that providing a prescription drug program to low-income elderly who do not qualify for Medicaid could save them money in the long run.
Searcher April 2001 Carol Ebbinghouse	You Have Been Misinformed - Now What?: Attacking Dangerous Data If you have already been the victim of fraudulent information, omission of information, misinformation, or fraud on the Internet, it is small consolation that there were ways to have prevented damages -- even if only to your pride...
BusinessWeek February 17, 2011	Taking a Scalpel to Medicaid A look at eight key states whose governors want to cut costs for Medicaid.
Insurance & Technology August 26, 2004 Babcock & McGee	Filter Out the Frauds Health insurers fight back against fake claims with fraud-detection software.
Bank Director 1st Quarter 2010	Banks in the Crosshairs & Finding the Best Leaders for Banking's Next Phase States are increasingly taking aim at banking institutions for fees, discrimination, and more. Is banking the next "big tobacco"? How can banks find strong leadership in the new decade?
Financial Planning April 1, 2007 Elizabeth O'Brien	Are Your Clients Covered? Today's healthcare system demands vigilance from consumers and planners alike. Some financial planners are taking on the complex, expensive market for individual health insurance. And they're finding solutions.
Managed Care November 2000	Rights Bill Inaction Spurs Clinton To Act Without Congress Health care issues generated political brinkmanship as the 106th Congress skidded toward Election Day -- capped by President Clinton's declaration of a limited series of patient rights regulations following Congress's failure to pass a patient rights bill...
Managed Care January 2005 Ed Silverman	The Comeback Kid: Harvard Pilgrim Health Care The health plan was listing badly when Charles Baker boarded it in 2000. Since then, the ship has been righted and the way is clear.
Managed Care May 2000	Arizona Nixes Doc Incentives, OKs Plan Liability The publicity given to the Texas attorney general's agreement with Aetna overshadowed a more sweeping edict in Arizona regarding financial incentives to physicians....
Managed Care February 2005	Medicare's Drug Coverage Seeks To Strike Compromise Health plan officials are still trying to determine just how the final rules for the new Medicare prescription drug benefit will affect them, because it appears that government officials tried their best to address the competing concerns of all players.
Financial Advisor November 2005 Gail Liberman	Annuities May Cause Problems With Medicaid Medicaid, the state and federally funded public assistance program, might be off the radar screen for financial advisors selling annuities to senior clients for retirement planning, but it shouldn't be.
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.
Financial Advisor April 2008 Gail Liberman	Power Of Attorney: A Can Of Worms? As the population ages, a power of attorney is becoming a more critical element to any client's financial plan. But this document can be riddled with pitfalls.
Managed Care August 2002 Madeleine A. Estabrook	Regulators Take More Interest In Role of PBMs in Health Care In a highly regulated industry such as health care, it is just a matter of time before every component of the industry comes under scrutiny and review. Pharmacy benefit managers are taking center stage now.
Managed Care July 2000 Michael Levin-Epstein	Congress Asked To Take Action As HMOs Flee Managed Medicare Thanks mainly to the increasing cost of providing a prescription drug benefit, HMOs are exiting Medicare+Choice, the system that was supposed to manage the health of the nation's senior citizens, in droves. Only an act of Congress can save Medicare+Choice, but is seems doubtful that will happen.
Managed Care May 2000	Physicians Fudge Insurance Forms To Help Patients A study confirms what has long been considered common but is rarely discussed: Physicians often lie about patients' conditions to gain or improve coverage for their treatment.
Managed Care September 2000	Any way you cut it, employers appear to save if Medicare adopts drug benefit A new analysis suggests that a prescription drug benefit in Medicare would reduce employer expense for health coverage--which, in turn, could encourage more employers to offer some form of drug coverage and thus reverse this erosion...
Managed Care March 2001	Privacy Up, Liability Down In State Houses This Year Privacy proposals will be one of the most prevalent -- though not the most hotly debated -- issues related to health coverage in state houses this year, according to a survey by the Health Insurance Association of America...
HBS Working Knowledge July 13, 2009	Diagnosing the Public Health Care Alternative With deep experience in health insurance reform, HBS faculty describe how improved competition in insurance plans could improve value for patients.
Managed Care March 2000	Aetna Chief Quits Amid Share Price, Quality Concerns Aetna U.S. Healthcare CEO Richard Huber quits... Fate of Harvard Pilgrim Health Care unknown...
InternetNews May 11, 2005 Jim Wagner	Suit Filed Against Spam Ring The Massachusetts' Attorney General files suit against seven alleged spammers with operations around the world.
Investment Advisor May 2007 Marlene Y. Satter	Swept Away? Congressional action could mean major changes ahead for the insurance industry.
Managed Care September 2000	Countdown Begins for Compliance With HIPAA Electronic Standards If you thought a lot of time and money was spent on Y2K readiness, you ain't seen nothin' yet. Complying with the new rules for electronic transaction standards under the Health Insurance Portability and Accountability Act is expected to exceed Y2K in terms of dollars and work hours...
InternetNews December 5, 2006 Andy Patrizio	Washington Settles First Spyware Suit The Attorney General's office for the state of Washgington has its first notch under a new law designed to punish spyware makers and, in this case, make them pay.
CIO June 15, 2001 Angela Genusa	Blood, Sweat and Systems Integration When Harvard Pilgrim Health Care's new CIO came on board, the HMO was fading fast. It's out of ICU now, but it's going to be a long time to full recovery.
Managed Care May 2006	Headlines On Deadline . . . Health plans appear to be having some trouble fulfilling a federal mandate that 80 percent of questions from Medicare beneficiaries about pharmacy coverage be answered within 30 seconds.
Managed Care June 2001 Michael Levin-Epstein	Health Plans, Insurers Unsure About Likely Effect of Gramm-Leach-Bliley Insurers and financial institutions are flooding customers' mailboxes about their rights to protect medical and financial information under what's better known as the Gramm-Leach-Bliley Act. But just how GLB will affect health plans isn't totally clear...
BusinessWeek October 6, 2010 Cronin-Fisk & Howley	The Foreclosure Mess Could Last for Years Faulty foreclosures will lead to a flood of lawsuits that may haunt lenders, title insurers, and home buyers for years to come.
Managed Care February 2008 John Carroll	Move to Mandatory Coverage Wouldn't Ensure Universality Compared to the existing state of affairs, there's a lot to like in mandatory coverage, but the Massachusetts experiment is a lesson to not expect miracles.
Managed Care September 1999 Frank Diamond Senior Editor	Florida Medicaid Moves Toward Direct Contracting Florida will soon test a program that could provide competition for HMOs serving the Medicaid population. Other states are watching.
Pharmaceutical Executive December 1, 2008 Jill Wechsler	Challenge and Challenges Expanded healthcare coverage also fits the goals of pharma manufacturers.
Managed Care January 2007	Headlines on Deadline ... State budgets got an unexpected gift last year... Mortality rates for hospitals ranked high... It looks likely that Massachusetts Gov. Mitt Romney will run for president... etc.
Managed Care November 2007	Patient Advocates Want Part D Changes A Medicare-administered drug benefit would be more affordable and comprehensive than the current private insurance-run drug benefit, say patient advocate groups.