Health Plan & Provider Report Index Summary

AARP

– Brand-name drugs, prices up 9 percent in 2008, report, 467
– Indemnity health plans, Grassley (R-Iowa) calls for limits disclosures to policyholders, 486
– PBM, specialty tiering cost shifting effect necessitates biogenerics approval pathway, report, 319

ABUSE

– Drugs and alcohol

See SUBSTANCE ABUSE

ACCESS TO CARE

– Disparities among states shows need for health care reform, report says, 1194
– Medicare

See generally MEDICARE

– Policy options for coverage expansion, Senate Finance Comm. explores, 583
– Underinsured persons, House subcommittee hearing, 2010
– Uninsured

See generally UNINSURED PERSONS

– Universal coverage

See UNIVERSAL HEALTH COVERAGE

– Women's health, barriers would be eased by reform efforts, report, 948

ACCREDITATION AND CERTIFICATION

– NCQA

See NATIONAL COMMITTEE FOR QUALITY ASSURANCE (NCQA)

– URAC

See UTILIZATION REVIEW ACCREDITATION COMMISSION (URAC)

ACQUISITIONS

See MERGERS AND ACQUISITIONS

ADVERSE EVENTS

– Health care information vendor liability, shift to medical providers noted, article, 418

ADVERTISING

– Health care reform, public policy advocacy campaign launched, 965

AGENCIES, FEDERAL

See specific agencies and departments

AHIP

See AMERICA'S HEALTH INSURANCE PLANS (AHIP)

AIDS AND HIV

– MA, 2 charged in 5-state billing scheme for bogus infusion treatments (S.D. Fla.), 590

ALABAMA

– Class action certification denied, uninsured patients allege hospital overcharges violate state law (Ala.), 1131
– PBM, cross-motions for summary judgment denied in TDI Managed Care Services/ Eckerd Health Services reimbursement suit (M.D. Ala.), 346

AMA

See AMERICAN MEDICAL ASSOCIATION (AMA)

AMBULANCE SERVICES

– Air, coverage denial for estate of plan member who died weeks after flight reasonable (S.D. Ohio), 646

AMBULATORY CARE

– LSCs

See LIMITED SERVICE CLINICS (LSCs)

AMERICAN MEDICAL ASSOCIATION (AMA)

– Chronic illness, Medicare disease management pilot shows limited impact of interventions, report, 33; AMA study confirms, 178
– Health insurers

– – Claims processing, improvements noted but efficiency challenges remain, AMA report card, 900
– – Code of conduct, group pushed to create, 899
– – Markets dominated by 1 or 2 insurers, report, 132

– Meetings

See CONFERENCES AND MEETINGS

– Out-of-network reimbursement

– – CIGNA and Aetna databases, medical societies also file class actions alleging knowing underpayment (D.N.J.), 184
– – UnitedHealth system, class action settled (S.D.N.Y.), 57; trial court delays accord approval, 649
– – WellPoint sued over use of Ingenix data (C.D. Cal.), 381

– President's reform plan, AMA House of Delegates supports without reference to public plan option, meeting, 749

AMERICAN RECOVERY AND REINVESTMENT ACT (ARRA)

– COBRA subsidies

See generally COBRA (HEALTH CARE COVERAGE CONTINUATION)

– Electronic health records

– – Adoption incentives outlined, webinar, 410
– – CMS to propose rules in 2009, 525
– – Timetable, national information technology coordinator says adjustment may be necessary, 587

– Health Information Tech. Policy Comm., GAO announces member appointments, 408
– HHS Natl. Coordinator for Health Info. Tech., implementation plans released, 611
– HIPAA

– – Attorneys at conference suggest employers be ready to understand and implement reform changes, 2013
– – Enforcement increase and contract changes required, meeting, 439
– – Information protection from unauthorized use, HHS guidance, 454; groups say more specifics are required to ensure protection, 611

AMERICA'S HEALTH INSURANCE PLANS (AHIP)

– Conferences

See CONFERENCES AND MEETINGS

– Usual, customary and reasonable rates information disclosure to patients, Mitchell testifies at Natl. Ass'n of Ins. Comm'rs hearing, 1173

ANALYSIS AND PERSPECTIVE

– Balance billing and health care reform legislation, 1137
– California

– – Managed care plans, emergency services balance billing banned (Cal.), 41; impact explored, 393
– – Patient privacy statute, ambiguity examined, 751

– CMS subregulatory guidance, compliance risks defined and discussed, 77
– Copayment incentive programs, key to health costs reduction, 542
– Health care reform

– – Administrative costs of public and private plans compared, 509
– – Individual mandate

– – – Constitutionality concerns raised by critics, 1165
– – – Enforcement issues explored, 836

– – Insurance myths explored, 1037
– – Mass. cost containment, key commission report recommendations described, 1011

– Health information

– – Health Information Technology for Economic and Clinical Health Act, policy implications of economic stimulus package provisions explored, 228
– – Privacy, legal framework for protection and state regulation explored, 442

– Medical identity theft

– – Among top 2009 health care issues, 47
– – Red flags and health insurer's compliance obligations, 2038

– Medicare Advantage, compliance programs critical in light of global economic crisis, 470
– Minimally invasive surgery, incentives key to reducing health care costs, 806
– N.Y. managed care, impact of new reform law, 1108
– Privacy legislation among top 2009 health care issues, 47
– Provider data quality, errors and remedies described, 135

ANTITRUST

– Anthem BCBS, competitor insurer claims properly dismissed for deficient pleading (6th Cir.), 9
– Health and medical malpractice insurers exemption

See LEGISLATION, FEDERAL, HR 3596, S 1681

– Health care market regulation essential, hearing, 859
– HMO and PPO markets in 48 states, GAO analysis finds top 3 insurers dominate business, 1054
– Long-term care pharmacy's claims against merged insurance companies dismissed for insufficient evidence (N.D. Ill.), 89; Omnicare to appeal, 89
– MA, more plans entering market increase product proliferation, study, 918
– Mergers and acquisitions

See MERGERS AND ACQUISITIONS

– Minn. health care cooperatives, legislative exemption of activities will reduce competition and increase costs, FTC letter, 384
– Pharmacy benefit managers multidistrict litigation, transferee judge cannot vacate transferor judge's arbitration order (3d Cir.), 1158
– Physicians

– – Multi-specialty independent practice association, FTC proposes settlement, 665
– – Price fixing, FTC settles charges against Colo. and Cal. groups, 7
– – Self-insured employers, proposed joint contracting with Md. physician-hospital organization allowed, FTC advisory opinion, 456

– Tex., Houston hospital system settles suit with state attorney general (Tex. Dist. Ct.), 128
– Workers' compensation insurance fund, Blue Cross network use for claims no violation of laws (Cal. App. Ct.), 1103

ANY WILLING PROVIDER (AWP) LAWS

– BCBS, providers may sue for damages under Ark. statute (8th Cir.), 36

APPEALS

– COBRA subsidy denials, Labor Dep't issues guidelines, 610
– Part D process, CMS draft guidance issued, 1025

ARBITRATION

– Hospitals, hearing set in suit over sale of 3 facilities (Colo. Dist. Ct.), 73; 2 sales disallowed for violation of state nonprofit law but third proceeds, 712; agreement to transfer 2 Exempla properties to Catholic system, 1007
– Medical benefits denied, provision enforceable despite ERISA violations in agreement (8th Cir.), 184; (U.S., rev den), 1186
– Pharmacy benefit managers antitrust multidistrict litigation, transferee judge cannot vacate transferor judge's order (3d Cir.), 1158

ARIZONA

– Medicaid, order upheld requiring state to improve home and community services for disabled recipients (D. Ariz.), 531
– Recovery of medical care costs from state plan participants in third-party recoveries, affirmed (Ariz. Ct. App.), 1072

ARKANSAS

– BCBS

– – Employer did not pay premiums, former employees' claims for medical costs reimbursement denied but money submitted by workers recoverable (W.D. Ark.), 1030
– – Providers may sue for damages under state AWP statute (8th Cir.), 36

– Medicaid expansion, new law, In Brief, 350

ARRA

See AMERICAN RECOVERY AND REINVESTMENT ACT (ARRA)

ATTORNEYS

– Employer-based insurance system, warnings about tax benefit changes, ABA white paper, 537
– Physicians, prison sentence upheld for fraud as court rejects ineffective assistance of counsel argument (C.D. Cal.), 217

ATTORNEYS' FEES

– Breach of contract, award for sponsor upheld when ERISA plan's third-party administrator removed state law action to federal court (6th Cir.), 12
– Qui tam suits, litigant who filed frivolous Medicare cases must pay (E.D. Tenn.), 69

AUDITS

– Employee benefits, eligibility checks expanding to cut costs, report, 225
– Recession, employer health plan cost control methods including eligibility audits explored, letter, 465

AUTISM

– Cal. group seeks changes to policy allowing plans to deny medically necessary treatment, 265; state regulatory clarifies coverage requirements, 316; court order sought to require coverage (Cal. Sup. Ct.), 802
– ERISA, summary plan description does not supersede plan language omitting provisions on administrator's discretionary authority (D. Or.), 313
– Experimental treatments, no ERISA breach of fiduciary duty claim against BCBS over therapy denial (E.D. Mich.), 312; class action status denied, 413
– Mandated benefits

– – Colo., coverage required under new law, 679
– – N.J., screening required under new law, 1033
– – Tex., bill passed requiring coverage, 716; new law, 744

AUTOMOBILE INSURANCE

– Hospital reimbursement

– – Medicare had superior claim and first right before facility's claim to policy covering patient hit by uninsured motorist (N.D. Ind.), 100
– – Medicare Secondary Payer Act, State Farm's motion to dismiss qui tam suit properly granted where insurer did not avoid legal obligation to repay after accident (D. Idaho), 1005

– Medical reimbursement rates, Allstate settles class action (Ill. Cir. Ct.), 1003
– No-fault

– – Abuse of laws by medical services companies alleged, RICO claims proper and motion to dismiss denied (E.D.N.Y.), 1127
– – Insurer bound by 2-year limitations period in ERISA plan contract (E.D. Mich.), 158

– Staged accidents, scam leader sentenced to 14 years in prison for private insurer billing fraud (S.D. Fla.), 894

AVERAGE WHOLESALE PRICE (AWP)

– Database publishers, class action settlements approved (D. Mass.), 345; chain drugstores to appeal, 531; court approves McKesson accord, 951; pharmacy interest groups lose appeal (1st Cir.), 1065
– Pharmacy reimbursement rates under Medicaid, industry groups seek HHS intervention to stop cuts, 1059
– Zoladex pricing for compendiums unfair and deceptive, AstraZeneca appeal of $12.9M judgment denied (1st Cir.), 1128

AWP

See AVERAGE WHOLESALE PRICE (AWP)

AWP (ANY WILLING PROVIDER) LAWS

See ANY WILLING PROVIDER (AWP) LAWS