Health Plan & Provider Report Index Summary

DATABASES AND DATA BANKS

– Electronic health records, potential negative impact of private sector collections on biomedical research, article, 448
– Fraud, former PBM Medco worker sentenced to prison for attempted destruction of network system (D.N.J.), 69
– MA collection and analysis, CMS seeks improvement to Part D level, meeting, 574; risk adjustment data requirements increased, 905
– Medical records

See generally ELECTRONIC HEALTH RECORDS

– Medicare claims data sharing, final rule permits to identify safety issues, 572
– PPOs, NCQA database to include, 880
– Prescription drug data mining

See PRESCRIPTION DATA MINING

– Specific medical questions, Aetna and Healthline launch online search program, 326
– Wis. health claims data repository, groups creating to improve treatment, 699

DECEPTIVE PRACTICES

– Maternity health insurance, state attorney general sues firm over fraudulent policy sales (Tex. Dist. Ct.), 505

DELAWARE

– Mandated benefits

– – Anesthesia for colonoscopies, 837
– – Hair prostheses, 808

DEMONSTRATION PROJECTS

– Chronic illness, Medicare pilot ends, 143
– Clinical laboratories, Part B competition pilot enjoined (S.D. Cal.), 429
– E-prescriptions, BCBS of N.C. expands initiative, 841
– Electronic health records

– – Ariz. and Utah, Medicare personal health records pilot, 908
– – Medicare primary care physicians, over 30 applicants, 574
– – Microsoft Health Vault pilot for Kaiser employees, 655

– Florida Medicaid

– – Changing plan for cause, patients unaware of option (S.D. Fla.), 127
– – Mental health providers, reform pilot problematic, report, 607

– Hospitals, positive results for value-based Medicare purchasing program, 694
– Medical home

– – Medicare pilot

See LEGISLATION, FEDERAL, S 2785

– – Primary care, Wash. bill passed, 324; new law, 423

– N.C. clinic pilot program, free prescription drugs, 527
– Pay-for-performance programs

– – Diabetes, Medicare pilot assessed, report, 201
– – Implementation of models, problems predicted, forum, 15
– – Minn. health system reform, among task force recommendations, 203
– – Timely CMS feedback lacking, GAO report, 233

DENTAL CARE

– Coverage decisions, new N.J. law, 91
– Medi-Cal and Denti-Cal reimbursement, provider class action to block cuts remanded to state court (Cal. Super. Ct.), 725

DEPENDENTS

– Cancer, ADA claims of couple fired during son's treatments proceed under ERISA (10th Cir.), 531
– College students, health coverage continuation

See LEGISLATION, FEDERAL, HR 2851

– FEHBP coverage age limit, witnesses urge increase from 22 to 29, hearing, 492
– Fraud, plan can recover medical expenses paid for woman who was not participant's legal spouse (W.D. Wash.), 130
– Mental health

– – Disabled son, educational and psychiatric coverage arbitrarily denied due to treatment center's billing codes (D. Colo.), 156
– – Eating disorders

– – – ERISA preempts state claims over Aetna coverage denial for daughters (D.N.J.), 269; settlement, 659
– – – Horizon BCBS of N.J., coverage claims for daughters barred (D.N.J.), 896
– – – Participant's state law claims for daughter's residential treatment coverage proceed (D. Utah), 130

– – Residential treatment coverage for daughter, ERISA does not preempt participant's state law claims (D. Utah), 130

– Out-of-network care, ERISA claim against HMO over daughter's bulimia treatment coverage reinstated (9th Cir.), 213
– Reconstructive plastic surgeon, ERISA preempts state reimbursement claims for BCBS participant's child (D. Conn.), 534
– Sexual orientation discrimination, community college violated state law by denying same-sex marriage partner health coverage (N.Y. App. Div.), 216
– Son not enrolled, self-funded plan administrator did not abuse discretion by denying heart defects treatment coverage (U.S., rev den), 247
– Special needs trust, employer-sponsored plan can seek medical expenses from conservator mother (11th Cir.), 98

DIABETES

– BCBS, provider institute entitled to payment for treatment of members with advanced disease (Cal. Ct. App.), 757
– Drug spending growth rate, disease treatment one leading cause of increase, report, 680
– Pay-for-performance programs, Medicare pilot assessed, report, 201
– SNFs, proposed class action over glucose test claim denial based on invalid local coverage determination dismissed (D.D.C.), 214

DIALYSIS

See END-STAGE RENAL DISEASE (ESRD)

DISABLED PERSONS

– ADA

See AMERICANS WITH DISABILITIES ACT (ADA)

– Dependent son, educational and psychiatric coverage arbitrarily denied due to treatment center's billing codes (D. Colo.), 156
– Ga. Medicaid, state must pay for medically necessary skilled nursing in-home care for child (N.D. Ga.), 683
– Health insurance, no benefits for worker laid off after disability leave where premiums were not paid (D.N.J.), 127

DISCIPLINARY ACTIONS

– Hostile provider behavior, Joint Comm'n alert and standards revision, 779
– Tex. medical board misconduct, physicians sue (E.D. Tex.), 61
– Wash. providers, new law, 372

DISCLOSURE

– Fiduciary duty breach, ERISA no bar to state claim against human resources worker who released sensitive health information (E.D. Mo.), 181
– HIPAA, counseling center worker indicted for illegal release of patient information (W.D. Okla.), 270
– Hospitals, no duty to disclose to patients availability of discounts (Cal. Ct. App.), 301
– Imaging services, Medicare physicians financial ties disclosure

See LEGISLATION, FEDERAL, S 3343

– Malpractice, HMO cannot compel arbitration because language was not obvious on Kaiser enrollment form (Cal. Ct. App.), 301
– Medical records, new Wis. law, 345
– PBM conflicts of interest, collateral estoppel doctrine no bar to D.C. disclosure law challenge (D.C. Cir.), 451

DISCOUNTS

– Hospitals

– – Notice, plan forfeited reduction where administrator did not advise facility of preexisting condition exclusion (S.D. Tex.), 330
– – PPOs, acute care facility's rate suit proceeds against insurer over withdrawal from network without notice (S.D. Fla.), 355
– – Special rates availability, no duty to disclose to patients (Cal. Ct. App.), 301
– – Uninsured patients not entitled to offers for insured (S.C.), 329

– Maternity health insurance, state attorney general sues firm over fraudulent policy sales (Tex. Dist. Ct.), 505
– Medical cards, consumer protection suit against Tenn. firms settled (Wis. Cir. Ct.), 782
– N.C. clinic pilot program, free prescription drugs, 527
– Ohio prescription drug card, 499
– Or. Prescription Drug Program, 2007 enrollment up, 60
– Physicians, appropriation of identity claims over PPO use of names and practice information on medical cards proceed (11th Cir.), 377
– Wal-Mart, $4 prescription program expanded as Kroger and Target cut prices, 530

DISCRIMINATION

– ADA

See AMERICANS WITH DISABILITIES ACT (ADA)

– ADEA

See AGE DISCRIMINATION IN EMPLOYMENT ACT (ADEA)

– Genetic information

See generally GENETICS AND BIOTECHNOLOGY

– Minorities

See MINORITY HEALTH CARE

– Racial disparities in treatment

See RACIAL OR ETHNIC DISCRIMINATION

– Sexual orientation

See SEXUAL ORIENTATION DISCRIMINATION

DISEASE MANAGEMENT

– Bulimia, claim against HMO over daughter's out-of-network treatment coverage reinstated (9th Cir.), 213
– Cancer

See BREAST CANCER

– Chronic

See CHRONIC AND TERMINAL ILLNESS

– Diabetes

See DIABETES

– ESRD

See END-STAGE RENAL DISEASE (ESRD)

– Insomnia and depression, Aetna tests HealthMedia online behavior-change programs, 705

DISTRICT OF COLUMBIA

– Hospital charity care inadequate, interim attorney general sues CareFirst (D.C. Super. Ct.), 728
– PBM conflicts of interest, collateral estoppel doctrine no bar to disclosure law challenge (D.C. Cir.), 451

DRUGS AND PHARMACEUTICALS

– AWP

See AVERAGE WHOLESALE PRICE (AWP)

– Industry gifts, health care providers

See generally GIFTS

– Medication errors

See MEDICATION ERRORS

– MMA

See MEDICARE PRESCRIPTION DRUG, IMPROVEMENT, AND MODERNIZATION ACT (MMA)

– Off-label use

See OFF-LABEL USE

– Prescription drugs

See PRESCRIPTION DRUGS

DUAL ELIGIBLES

– Ill. owes millions, IG report, 724
– Immediate availability of drug benefits, Natl. Senior Citizens Law Center settlement (N.D. Cal.), 709; new CMS guidance on best available evidence policy, 906
– Special needs plans, care coordination goal not realized, report, 260

DUE PROCESS

– Part D, beneficiaries' claims over premium withholding errors proceed against HHS (D. Mass.), 444

DURABLE MEDICAL EQUIPMENT (DME)

– BCBS

– – Antitrust, PPO network agreement with suppliers legal (6th Cir.), 535
– – Right to counsel, billing fraud trial postponement denial deprived supplier (Ala.), 452

– Hair prostheses, Del. mandated benefit, 808
– Prosthetics

– – Arm, backup not medically necessary (8th Cir.), 376
– – N.J., new law also requires orthotic devices coverage, 90
– – Vt., new law requires Medicare coverage parity, 469