Health Plan & Provider Report Index Summary

RACKETEER INFLUENCED AND CORRUPT ORGANIZATIONS (RICO) ACT

– HMO underpayment for services alleged in class action, sanction order vacated (3d Cir.), 1061
– No-fault insurance laws abuse alleged by auto insurer, motion to dismiss denied (E.D.N.Y.), 1127
– Off-label drug promotions, no cause of action against drug maker (C.D. Cal.), 38
– Provider suit over alleged insurer mailing of false explanations of benefits properly dismissed (8th Cir.), 290; (U.S., rev sought), 922; (rev den), 1189
– Tests and screening, certification denied in class action alleging fraudulent Quest Diagnostics billing (D.N.J.), 186

RATES

See PREMIUMS AND RATES; PROVIDER REIMBURSEMENT

REBATES, MEDICAID

See DISCOUNTS

REIMBURSEMENT

– Hospitals

See HOSPITALS

– Pay-for-performance programs

See PAY-FOR-PERFORMANCE PROGRAMS

– Policies

See COVERAGE AND REIMBURSEMENT POLICIES

– Prompt payment

See PROMPT PAYMENT

– Providers

See PROVIDER REIMBURSEMENT

– State health plan right to recoup medical care costs in third-party recoveries, affirmed (Ariz. Ct. App.), 1072

REPORTING REQUIREMENTS

– Medicare Advantage

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

– Medicare Secondary Payer Act, plan implementation deadline extended, 614
– Part D, CMS posts, 209

RESEARCH

– Clinical studies

See CLINICAL TRIALS

– Comparative effectiveness

– – Budget resolution

See LEGISLATION, FEDERAL, SConRes 13

– – Compromise legislative language, no consensus for Senate panel, 741
– – Costs of health care may not be reduced, study says, 1077
– – Experts promote use in Medicare coverage, conference, 97
– – Health care reform efforts will include, seminar, 1036
– – HHS

– – – Data infrastructure, greatest need for $400 million in allocated funding, report, 796
– – – Federal Coordinating Council on Comparative Effectiveness Research, members named, 335

– – Prescription drug prices, consideration urged but not to limit or deny coverage, meeting, 409
– – Quality concerns described, federal panel public meeting, 458; policy makers should focus on innovation during implementation, white paper, 491

RETAIL-BASED CLINICS

See LIMITED SERVICE CLINICS (LSCs)

RETALIATION

– Informal complaints about health plan administration, fired worker has no claim under ERISA Section 510 (E.D. Pa.), 924

RETIREE BENEFITS

– Ed. Note: This heading covers health insurance unless otherwise indicated.
– Cafeteria plans, Tax Code Section 125 discussed, CRS report, 947
– COBRA, early retirees of hospital entitled to notice although afforded other health benefits in retirement packages (W.D. Va.), 11
– Company changed free lifetime coverage, health plan dismissed as unnecessary party (W.D. Mich.), 774
– Idaho, bill passed requiring former state workers over 65 to use Medicare or private plans, 463
– Medical and death benefits, injunction to bar changes denied (D. Neb.), 13
– Premiums and rates, former power company workers do not have vested right to pay the same as current employees (E.D. Wis.), 289
– Same-sex domestic partners

See LEGISLATION, FEDERAL, HR 2517, S 1102

– State and local governments cannot sustain, report, 869
– Stock incentives not deferred until retirement, plan not governed by ERISA (D. Idaho), 826
– Terminating health coverage, bill to bar

See LEGISLATION, FEDERAL, HR 1322

RICO

See RACKETEER INFLUENCED AND CORRUPT ORGANIZATIONS (RICO) ACT

RURAL HEALTH CARE

– Hospitals, information technology implementation obstacles described, webinar, 465