Health Plan & Provider Report Index Summary

MAINE

– Hospital charity care, constitutionality of state law requiring treatment upheld (1st Cir.), 951
– State-subsidized Dirigo health plan, tax assessments revised to fund, 715

MALPRACTICE

– Antitrust laws exemption for insurers

See LEGISLATION, FEDERAL, HR 3596, S 1681

– Reforms would save federal government $41B over 10 years, CBO says, 2016
– Treatment authorization denied, ERISA preempts stroke patient's state law claims against plan (N.J. Super. Ct. App. Div.), 293

MAMMOGRAMS

– Cal. passes health insurance coverage mandate bill, 1102

MANAGED CARE

– HMOs

See HEALTH MAINTENANCE ORGANIZATIONS (HMOs)

– MA

See MEDICARE ADVANTAGE (MA)

– Medicaid

See MEDICAID MANAGED CARE

– Physicians participation in plans, survey findings, 1076
– State issues

See specific states

– Timely nonemergency, Cal. rules issued, 188

MANDATED BENEFITS

– Autism

– – Coverage required under new Colo. law, 679
– – Tex., bill passed requiring coverage, 716; new law, 744

– Brain injuries, new Or. law requires treatment coverage, 746
– Cal. passes bills covering particular medical conditions and treatments, 1102
– Children's health care, hearing aids covered under N.J. law, 43
– Congenital jaw deformity, corrective surgery may be required by state law despite lack of coverage under ERISA plan (D. Or.), 1029
– Developmental screenings for infants and toddlers, Del. governor signs bill, 1073
– Employer health coverage, large job losses would result, study, 132
– Health insurance coverage, federal requirements

See generally HEALTH CARE REFORM, FEDERAL

– Included in House Democrats' legislative framework, 697; business groups to halt negotiations absent affordable proposals, 804
– Individual

See HEALTH CARE REFORM, FEDERAL

– Lymphedema, new N.C. law, In Brief, 897
– Oregon

– – Hearing aids for children, In Brief, 803
– – HPV vaccine for young women, In Brief, 803
– – Tobacco use cessation programs, In Brief, 803

MARKET TRENDS

– Antitrust, more MA plans entering market increase product proliferation, study, 918
– High-deductible plans, 17 percent with private insurance in 2007, report, 297
– LSCs

See LIMITED SERVICE CLINICS (LSCs)

– Medical tourism

See MEDICAL TOURISM

– PPOs, value-based benefit designs improve outcomes, study, 196
– Small group carriers, largest increased median market share in 2008, GAO study, 391

MARKETING

See also ADVERTISING
– Deceptive

See DECEPTIVE PRACTICES

– Long-term care insurance, model marketing disclosures

See LEGISLATION, FEDERAL, S 1177

– Medicare Advantage

– – Fair market value sales agent compensation rates also set for Part D, 7; rule may discourage independent agent assistance, 64
– – Funding cuts possible under health care reform legislation, CMS tells Humana to stop mailing letters to enrollees, 1095; HHS nominations, Senate Republican leaders warn of delays unless CMS rescinds order, 1124; Sebelius defends CMS action, 1181; mailings allowable only with enrollee opt-in prior authorization, CMS says, 2011
– – Guidance, CMS revises, 609; final guide released, 971
– – Markets not competitive, study, 973
– – Strict guidelines needed to protect beneficiaries, advocacy groups say, 737
– – Surveillance, CMS to increase activities during enrollment period, conference, 763
– – WellCare, CMS orders suspension, 211; CMS lifts suspension, keeps corrective action plans, 1058

– Prescription drugs

– – Data mining

See PRESCRIPTION DATA MINING

– – Discount cards, company settles deceptive practices charges (Pa. Commw. Ct.), 192
– – Part D

– – – CMS revises guidance, 609; final guide released, 971
– – – Sales agent compensation

See Medicare Advantage, this heading

– – – Surveillance, CMS to increase during enrollment period, conference, 763

– Unauthorized health insurance, Fla. regulators order 3 companies to stop sales, 1071

MARYLAND

– Antitrust, proposed self-insured employer joint contracting with physician-hospital organization allowed, FTC advisory opinion, 456
– Electronic health records, provider incentives bill passed, 502; new law, 625
– Health insurance, lawmakers pass bill to tighten individual market regulation, 463; new law, 625
– Telemedicine, Price Frederick hospital links to Wilmington, Del., tertiary care facility, 682

MASSACHUSETTS

– BCBS

– – Physician reimbursement, alternative pay system contract with Atrius signed, 896
– – Zoladex pricing for AWP compendiums unfair and deceptive, AstraZeneca appeal of $12.9M judgment denied (1st Cir.), 1128

– Claims processing errors alleged, third party administrator not liable as “functional” fiduciary, “named” fiduciary status unresolved (D. Mass.), 2020
– Health reform law

– – Catholic hospital affiliation, agency approves subsidized plan affording family planning services, 315; facility ends affiliation with insurer subsidizing coverage, 779
– – Cost containment, key commission report recommendations described, BNA Analysis, 1011
– – Diversion of funds to finance, hospital sues state (Mass. Super. Ct.), 865
– – Initial success, affordability gains eroded, study, 651
– – Insurance coverage mandate, tax penalties schedule for noncompliance issued, 294
– – Over 97 percent of residents insured, report, 15
– – Payment system, special commission recommends revision, 865; global payment system transition, providers cite difficulties in meeting timetable, 2024
– – Reliance on private plans hinders spending control, report, 350
– – Single-payer advocates criticize potential use as model, report, 222
– – Spending distribution unchanged, BCBS report, 437
– – Subsidized care, $794 million in 2008, report, 417

– Hospitals

– – Facilities to pay overtime back wages (D. Mass.), 926
– – Gifts, network implements rules restricting drug and device company ties, 439
– – Medical errors, rule adopted barring providers from billing for care, 592
– – Overtime, network pays millions to settle failure to pay claims (D. Mass.), 535

– Provider reimbursement

– – Cost of health care, officials probe link between increase and insurer payments to providers, 43
– – Panel recommends end to fee-for-service method, 594; payment system revision outlined, 865; global payment system transition, providers cite difficulties in meeting timetable, 2024

MATERNITY SERVICES

– Cal. passes health insurance coverage mandate bill, 1102

MCCARRAN-FERGUSON ACT

– Health and medical malpractice insurers antitrust exemption

See LEGISLATION, FEDERAL, HR 3596, S 1681

MEDICAID

See also specific states
– Coding

See generally CODING

– Coverage continuity gaps, nonprofits outline possible solutions, 823
– Drug rebates

See DISCOUNTS

– Dual eligibles

See DUAL ELIGIBLES

– Economic stimulus package

– – Baucus (D-Mont) plan includes funding increase, 94
– – House package includes funding boost, 61
– – Increased funding, House measures

See LEGISLATION, FEDERAL, HR 1, HR 598, S 1

– FY2010 budget, billions in cuts proposed over 10 years, 249; final proposal would cut program spending by $309 billion to fund health reform, 557; President defends program spending reductions in address to AMA, meeting, 692; Obama proposes $313 more program cuts, 694
– Information technology, “meaningful use” payment incentives

See INFORMATION NETWORKS AND TECHNOLOGY

– Pharmacy groups seek HHS intervention to stop reimbursement rate cuts, 1059
– Physicians revenue sources, survey findings, 1076

MEDICAID MANAGED CARE

– Capitated, not all states report encounter data to national database, IG report, 672
– Dental services access for low-income children needs to improve, GAO report, 1183
– Drug rebates

See DISCOUNTS

– Savings for states likely, report, 616

MEDICAL DEBT

See DEBT COLLECTION

MEDICAL DEVICES

– Hearing aids

See HEARING AIDS

– Hospital gainsharing, industry concerns expressed in letter to CMS, 212
– Industry gifts for health care providers

See generally GIFTS

MEDICAL ERRORS

– Hospitals

– – Colo. Medicaid, executive order signed to deny payments for avoidable mistakes, In Brief, 417
– – Mass., rule adopted barring providers from billing for care, 592

– Medicare, 3 CMS national coverage decisions deny payment for some surgical mistakes, 98
– Pa. senate to vote on bill to deny payment, 416

MEDICAL HOME

– Pilot program, CIGNA partners with Tex. clinic, 1075

MEDICAL NECESSITY

See MEDICALLY NECESSARY SERVICES

MEDICAL RECORDS

– HIPAA rules

See HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)

– Personal electronic

See ELECTRONIC HEALTH RECORDS

– Privacy

See generally PRIVACY AND CONFIDENTIALITY

MEDICAL TECHNOLOGY

– ICD-10 coding conversion

See generally CODING

MEDICAL TOURISM

– BNA audio conference, In Brief, 187
– Growth industry, possible risks and legal issues discussed, Special Report, 354

MEDICALLY NECESSARY SERVICES

– Anthem BCBS, class action alleges regular payment denial (Cal. Super. Ct.), 292; treatment approved in coverage reversal, 314
– Autism, Cal. group seeks changes to policy allowing plans to deny treatment, 265; state regulatory clarifies coverage requirements, 316; court order sought to require coverage (Cal. Sup. Ct.), 802
– Fraud, guilty plea entered by recruiter of healthy patients for unnecessary surgeries (Cal. Super. Ct.), 264
– Idaho, lawmakers pass bill creating external review system for denied claims, 384
– Neurofeedback therapy, plan administrator properly denied coverage (5th Cir.), 216
– Out-of-network care

– – Denial proper where Medicare beneficiary did not prove surgery was superior to procedure plan covered (9th Cir.), 261; subpoenas ruling by administrative law judge (U.S., rev sought), 1157; (rev den), 2020
– – Medicare coverage for liver resection surgery performed out of plan without prior authorization, denial affirmed (D. Haw.), 1099

MEDICARE

– Bariatric surgery, covered for some obese diabetics, 181
– Benefits of care coordination, study compares fee-for-service and Advantage plans, 1055
– Billing fraud, 8 Miami defendants charged (S.D. Fla.), 775
– Chronic illness disease management pilot, limited impact of interventions, report, 33; AMA study confirms, 178
– Claims processing for Part A and B payments, CMS contractor provider satisfaction survey for 2009, 1096
– Coding

See generally CODING

– Comparative effectiveness research, experts promote use, conference, 97
– Compliance, CMS recommends voluntary self-reporting of suspected issues, 581
– Delivery system reform

– – CMS requires increased resources and greater flexibility, hearing, 493
– – Payment structure lacks incentives, MedPAC report, 702; more work required, MedPAC official says, hearing, 771

– Drug coverage

See MEDICARE DRUG COVERAGE

– Dual eligibles

See DUAL ELIGIBLES

– Eligibility, most American support expansion, survey, 214
– Enrollment period for beneficiaries, conference told CMS supports extension, 1096
– Exhaustion of remedies, federal law preempts cancer patient's fraud and breach of contract claims against Humana (S.D. Fla.), 288
– FY2010 budget, billions in cuts proposed over 10 years, 249; final proposal would cut program spending by $309 billion to fund health reform, 557; President defends program spending reductions in address to AMA, meeting, 692; Obama proposes $313 more program cuts, 694
– Funding increase, Baucus (D-Mont) economic stimulus plan includes, 94
– Health care reform, program key to legislative efforts, Leavitt says, 66
– Hospital gainsharing, medical device makers express concerns in letter to CMS, 212
– HRAs, payment errors source, conference, 306
– Information technology, “meaningful use” payment incentives

See INFORMATION NETWORKS AND TECHNOLOGY

– MA

See MEDICARE ADVANTAGE (MA)

– Medical errors, 3 CMS national coverage decisions deny payment for some surgical mistakes, 98
– Medicare Act does not preempt claims by persons enrolled by private MA plan without their permission causing coverage loss (S.D. Miss.), 774
– Offshore captive insurer owned by hospital group, insurance premiums paid to insurer not reimbursable (D.D.C.), 1188
– Out-of-network care

– – Denial proper where beneficiary did not prove medical necessity or superiority of surgery plan covered (9th Cir.), 261; subpoenas ruling by administrative law judge (U.S., rev sought), 1157; (rev den), 2020
– – Liver resection surgery performed out of plan without prior authorization, coverage denial affirmed (D. Haw.), 1099

– Overpayments, imposition of over $904,000 in interest not unfair to Kaiser (N.D. Cal.), 826
– Part D drug program

See MEDICARE DRUG COVERAGE

– Payment inequities, House Democrats release plan, 886; reimbursement formulas recalibration, agreement near, 1155
– Physicians

See generally PHYSICIANS; SPECIALISTS

– Private-sector insurer payments, CMS and Treasury Dep't officials consider timing changes, GAO report, 282
– Provider incentives, Accountable Care Promotion Act bill introduced to create voluntary shared savings program, 740
– Quality of care

See QUALITY OF CARE

– Reform need, cost increases and reduced access to care underscore, report, 1026
– Secondary Payer Act

– – BCBS, statute not violated by reimbursement for non-network dialysis at lower rates (N.D. Ga.), 261
– – ESRD, plan violated law by terminating coverage upon learning of now deceased beneficiary's Medicare eligibility (E.D. Tenn.), 975
– – Hospital reimbursement, federal program had superior claim and first right before facility's claim to policy covering patient hit by uninsured motorist (N.D. Ind.), 100
– – Plan reporting requirements, implementation deadline extended, 614
– – Qui tam suits

– – – Hospital reimbursement, State Farm's motion to dismiss properly granted where insurer did not avoid legal obligation to repay after accident (D. Idaho), 1005
– – – Insurer acceptance of payment was allegedly improper, no claim for patient (2d Cir.), 925
– – – Sanctions imposed on individual who did not receive benefits and therefore lacked standing to sue (U.S., rev sought), 70

– SNFs, most Part A payments improper, IG report, 674
– Trends in increasing health care spending, MedPAC discusses at meeting, 1123
– Virtual colonoscopy, bipartisan House members urge coverage, 340
– Wrongful death, federal program has right to reimbursement from family's insurance settlement for medical costs of deceased beneficiary (8th Cir.), 156

MEDICARE ADVANTAGE (MA)

– Ed. Note: The name of this program was changed from Medicare+Choice to Medicare Advantage under the Medicare Prescription Drug, Improvement, and Modernization Act.
– Am. Health Ins. Plans releases report at conference describing successes, 1096
– Antitrust, more plans entering market increase product proliferation, study, 918
– Bidding

– – Budget, MedPAC debates pros and cons of competitive process included in proposal, 255
– – Enrollment, competitive bids might reduce, MedPAC report, 739
– – Former CMS chief predicts competitive program, meeting, 373
– – Payments based on average submitted, industry leaders object to White House proposal, 250; OMB director defends, forum and hearing, 306; MedPAC deems long-term impact of lower pay hard to predict, 309
– – Preparation, draft 2010 call letter for plans released, 31; withdrawn, 95; oversight focus in revision, 253
– – Spending, CBO estimates competitive process would reduce by $159 billion, 609

– CMS subregulatory guidance, compliance risks defined and discussed, BNA Analysis, 77
– Coding

See generally CODING

– Comparative cost adjustment, possible congressional focus issue, reports, 285
– Compliance, CMS recommends voluntary self-reporting of suspected issues, 581
– Consumer satisfaction, CMS seeks to raise quality ratings, forum, 151
– Coordinated care, key to program survival, summit, 849
– Coverage denial, Kaiser dismissed as improper defendant but leave to amend granted to sue HHS (S.D. Cal.), 676
– Dual eligibles

See DUAL ELIGIBLES

– Enforcement

– – CMS actions updated, In Brief, 674
– – Revised rules, CMS to propose, 584; changes to 2010 benefit plan outlines clarified, 945

– Exhaustion of remedies, federal law preempts cancer patient's fraud and breach of contract claims against Humana (S.D. Fla.), 288
– Federal funds use by companies to lobby enrollees re health care reform legislation prohibited, CMS memoranda, 2011
– Fraud and abuse

– – Bogus treatments, 2 charged in 5-state billing scheme (S.D. Fla.), 590
– – Improper billing, 8 Miami defendants charged (S.D. Fla.), 775
– – Medicare Act, no preemption of claims by persons enrolled by private plan without their permission causing Medicare coverage loss (S.D. Miss.), 774

– Funding cuts possible under health care reform legislation, CMS tells Humana to stop mailing letters to enrollees, 1095; HHS nominations, Senate Republican leaders warn of delays unless CMS rescinds order, 1124; Sebelius defends CMS action, 1181; mailings allowable only with enrollee opt-in prior authorization, CMS says, 2011
– Hospitalization, shorter less costly stays than Medicare patients, study, 67
– Independent insurance agents, eligibility groups enlarged to ensure higher compensation, 944
– International economic crisis, compliance programs critical, BNA Analysis, 470
– Marketing

See MARKETING

– Out-of-pocket expenses, less protection than Medigap, studies, 339
– Outlook 2009, among top health issues to be addressed, Special Report, 18
– Plan types, 3-limit requirement to avoid 2010 duplication, CMS call letter, 368; more definitive, Kaiser brief, 563; CMS telephone campaign to drop duplicative plans, 607; requiring minimum enrollment and reducing complexity desirable goals, report, 887
– Policy and technical changes to plan program, CMS issues proposed rule, 1176; proposed changes would boost oversight and accountability, Special Report, 2028
– Quality of care versus traditional Medicare, MedPAC meeting discusses comparable performance measures, 1123; data collection requirements expansion considered, 1177
– Rates

See PREMIUMS AND RATES

– Reimbursement

– – Alternative payment system, MedPAC says Congress should focus first on program goals, 431
– – CMS estimates 0.5 percent increase in 2010, 208; physician pay may be considered in rate calculations, BCBSA says, 337; 0.81 percent is actual rate, 403
– – Cuts will result in fewer plans and options, MedPAC says, 65
– – Fee-for-service providers

– – – MA plans to be paid $11.4 billion more in 2009, report, 528
– – – Payments may be less, Sebelius says, hearing, 429
– – – Private MA plans should receive same pay, briefing, 615
– – – Wellcare to withdraw from private market in 2010, 571

– – Funding cuts likely, summit, 211
– – Payment policy changes, House leaders and Baucus (D-Mont) support proposal, 282
– – Private-sector insurer payments, CMS and Treasury Dep't officials consider timing changes, GAO report, 282

– Reporting requirements

– – CMS posts, 209
– – Private plan monitoring will improve, forum, 117

– Special needs plans, survival problematic, teleconference, 179

MEDICARE+CHOICE

– Ed. Note: The name of this program was changed from Medicare+Choice to Medicare Advantage under the Medicare Prescription Drug, Improvement, and Modernization Act.

MEDICARE DRUG COVERAGE

– Ed. Note: Entries at this heading refer to Medicare Part D unless otherwise indicated.
– Access, no improvement for many beneficiaries, study, 284
– Appeals process, CMS draft guidance issued, 1025
– Bid preparation

– – Draft 2010 call letter for plans released, 31; withdrawn, 95; oversight focus in revision, 253
– – Errors, no refunds for overcharged enrollees, 487

– Brand and generic access increased, report, 45
– Choices, numerous options impede ability to select low-cost plan, study, 739
– Copayments from state board, no sanctions, IG advisory opinion, 999
– Cost increases, consumers union cites in support of reform, 797
– E-prescriptions

– – Community pharmacists want federal incentives, 489
– – Technical issues prevent plan sponsors from complete implementation of standards in 2008, survey finds, 2012

– Efficiency, concerns remain, report, 889
– Enforcement

– – CMS actions updated, In Brief, 674
– – New regulations proposed, 584; changes to 2010 benefit plan outlines clarified, 945

– Federal funds use by sponsors to lobby enrollees re health care reform legislation prohibited, CMS memoranda, 2011
– Formulary offerings will decrease in 2010, CMS official says, 2011
– Gap

– – Affected seniors cut prescriptions 14 percent, study, 152
– – Closing, AARP campaign fact sheet, 616
– – Concerns remain although program performance exceeds expectations, study, 1027
– – Cost cuts, drug industry pledges, 731; hospital spending reductions anticipated, 791
– – House Democrats' proposal, costly for chronically ill, news release, 798
– – Jurisdiction, challenge dismissed (3d Cir.), 924
– – 7 percent total of 2006 beneficiaries, report, 283

– Government-negotiated prices, former CMS chief says benefits are threatened, summit, 178
– Low-income persons

– – Auto-assignment to prescription drug plans, CMS official discusses at conference, 1096
– – Health reform would help most, briefing, 615

– Marketing

– – Guidance, CMS revises, 609; final guide released, 971
– – Plans, fair market value sales agent compensation rates set, 7; rule may discourage independent agent assistance, 64

– Outpatients, spending up in first program year, brief, 433
– Oversight challenges loom, IG report, 34
– Payment policy changes, House leaders and Baucus (D-Mont) support proposal, 282
– Policy and technical changes to plan program, CMS issues proposed rule, 1176; proposed changes would boost oversight and accountability, Special Report, 2028
– Premiums

See PREMIUMS AND RATES

– Private-sector insurer payments, CMS and Treasury Dep't officials consider timing changes, GAO report, 282
– Protected classes, comments sought on proposed CMS rule requiring coverage, 61; managers' group opposes expansion, 371
– Reconciliation payments for 2008 plan year, CMS expects to owe money, 1058
– Reporting requirements, CMS posts, 209
– Stand-alone plans, over 40 percent of beneficiaries purchased, study, 284
– 2007 coverage, Kaiser Found. analysis, In Brief, 974

MEDIGAP

– Ambiguous policy provision, plan must pay hospital's standard rate rather than lower Medicare charges reimbursement (Wis.), 590
– BCBS of Mich.

– – Deceptive practices, plan warned, 16
– – Interim rates, increase approved, 978

– Consumer satisfaction, 88 percent of policyholders pleased, study, 701
– ESRD, new Fla. coverage law, 711
– GINA, CMS to use Natl. Ass'n of Ins. Comm'n model for regulations, 486
– Hospitals, HHS IG approves proposal to create preferred provider networks, 944
– Out-of-pocket expenses, MA affords less protection, studies, 339
– Policy sales increasing, study, 750

MEETINGS

See CONFERENCES AND MEETINGS

MENTAL HEALTH

– Cal. passes health insurance coverage mandate bill, 1102
– Dependents

– – Disabled, medical and denial plan acted arbitrarily to deny 23-year-old son's enrollment (N.D. Ill.), 387
– – Eating disorders, Horizon BCBS of N.J. settlement of coverage claims approved (D.N.J.), 494
– – Out-of-network care, claim over denial of residential treatment for eating disorder barred (S.D.N.Y.), 347

– Employer health plan options and requirements explored, ABA meeting, 587
– Fraud and abuse, Horizon BCBS terminated benefits arbitrarily over claims for psychiatric services (D.N.J.), 950
– Parity law revision

See PAUL WELLSTONE AND PETE DOMENICI MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT (MHPAEA)

– Residential treatment, claims against BCBS over coverage denial proceed (N.D. Cal.), 1029

MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES

– Dependents, medical and dental plan acted arbitrarily to deny disabled 23-year-old son's enrollment (N.D. Ill.), 387

MERGERS AND ACQUISITIONS

– Antitrust

– – CVS/Caremark, FTC probe sought, 561
– – FTC to focus on hospital quality improvement potential, meeting, 177
– – Justice Dep't review, hospital association urges, letter and report, 585
– – Long-term care pharmacy's claims against merged insurance companies dismissed for insufficient evidence (N.D. Ill.), 89; Omnicare to appeal, 89

– BCBS

– – Highmark and Independence, Pa. plans halt effort, 103
– – Physicians Health Plan of Mid-Mich. acquisition, Mich. attorney general requests more information, 1104
– – Transferring funds to subsidiary, suit alleging state law violation dismissed (Mich. Cir. Ct.), 72

– MeritCare Health Sys. of N.D./Sanford Health of S.D., 871
– PBM, Express Scripts/WellPoint agreement, 441; community pharmacists file objections with FTC, 536
– Preferred Care Partners/Humana, claims over alleged breach of confidentiality agreement proceed (S.D. Fla.), 495
– Sales, binding arbitration hearing set in suit over sale of 3 hospitals (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

MHPAEA

See PAUL WELLSTONE AND PETE DOMENICI MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT (MHPAEA)

MICHIGAN

– BCBS

– – Individual health insurance market rates, lawmakers adjourn without action, 16; insurer to cut jobs and seek increases to offset losses, 106; commissioner sets hearing, 681; increase approved, 978; Dingell (D-Mich) and Levin (D-Mich) ask for details on rate increases, 997
– – Medigap policies, insurer warned about deceptive business practices, 16
– – Mergers and acquisitions, suit alleging state law violation for transferring funds to subsidiary dismissed (Mich. Cir. Ct.), 72
– – Omega Hosp., trial over plan reimbursement proceeds (E.D. La.), 376
– – Physicians Health Plan of Mid-Mich. acquisition, attorney general requests more information, 1104

– Emergency services, no ERISA fiduciary duty breach claim for GM participants over BCBS coverage denials (E.D. Mich.), 413
– Health insurance, ERISA does not preempt state rules barring discretionary clauses in policies (6th Cir.), 343
– No-fault automobile insurer bound by 2-year limitations period in ERISA plan contract (E.D. Mich.), 158

MINNESOTA

– Antitrust, legislative exemption of health care cooperatives activities will reduce competition and increase costs, FTC letter, 384
– Care delivery improvement, Medica and Fairview Health Sys. collaborative agreement, 898
– Electronic claims processing requirement, savings expected under new billing law, 866
– Hospitals

– – Allina pays $1.1 million to settle patients' usury claims (Minn. Dist. Ct.), 460
– – Net income, many lost money on operations, report, 596

– Long-term and home health care plans, attorney general alleges fraud and sues Home Health Am., 1193
– Low-cost plan, attorney general alleges fraud and sues Consumer Health Benefits Ass'n, 1193
– Medicaid program, Mayo Clinic of Rochester, Minn. to disenroll, 2024
– Medical debt, state attorney general sues Allina Health Sys. over interest rate charges that violated state usury laws (Minn. Dist. Ct.), 128
– Website allows residents to compare health care services by price and quality, 1072

MISREPRESENTATION

– Aetna underpricing to gain market share, class securities action dismissed (E.D. Pa.), 742
– Insurance eligibility, former plan participant's claims proceed (S.D.N.Y.), 376
– Out-of-network care, ERISA no bar to negligent misrepresentation claim over physician statement that knee treatment would be covered by plan (S.D. Ohio), 675
– Standing, spouse cannot sue insurer over terms of policy covering late wife (Cal. Ct. App.), 500

MISSOURI

– BCBS, ERISA preempts physician's state law prompt payment claims (S.D. Fla.), 158
– Chiropractic services, charges settled over violation of state insurance laws, 1031
– Data breach notice, health information protected under new law, 897
– HMOs, state regulation violated by charging copayment and percentage fee for same single service (W.D. Mo.), 706

MONTANA

– BCBS insurance forms exclude coverage of injuries covered by other policies, prohibition on use affirmed (Mont.), 1160