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This essential reference is written specifically for practitioners who handle managed care disputes to help them rapidly focus on key issues and expertly advise their clients. The treatise covers typical disputes, reimbursement issues, state regulations, health plan liability laws, external review laws and health insurance exchanges, and class action lawsuits and arbitration, settlement, and discovery issues.
Practice-oriented guidance for litigating within the managed care industry
Myriad potential litigation issues were introduced by the Affordable Care Act (ACA), as health plans and other managed care organizations will have to comply not only with state mandated benefits but with federally mandated benefits as well. After 2014, the size of the health coverage market, especially for the individual coverage, will increase as higher-risk individuals are able to obtain coverage regardless of health status and lower-risk individuals elect to pay premiums rather than penalties. The influx of insured patients into the managed care system will result in more litigation and an array of new issues.
Managed Care Litigation, Second Edition is a practical, authoritative reference written specifically for practitioners who handle managed care disputes to help them rapidly focus on key issues and expertly advise their clients. The treatise offers in-depth analysis of all the important issues in managed care litigation, providing both a basic overview and a comprehensive examination of legal issues. The book provides useful guidance on:
This timely reference is an excellent springboard to drafting pleadings or advisory memoranda and is organized so that both in-house and outside managed care counsel and executives can quickly access the information they need, review the legal theories and processes involved, and get up to speed on the case law.
The 2014 Supplement offers important updates, including discussion of a Nevada jury decision in 2013 imposing $24 million in compensatory damages and $500 million in punitive damages; new sections on ERISA statute of limitations and ERISA prompt payment laws, and new case law on equitable relief under ERISA; updated discussion of ACA and legal challenges; discussion of an HHS advisory letter to state insurance regulators on November 14, 2013, stating that as a one-year “transitional policy” HHS would not consider health plans that renewed coverage in the noncompliant products to be out of compliance with requirements of the ACA; analysis of questions still unanswered after the Supreme Court’s Actavis decision; and new discussions on the Filed Rate Doctrine and waivers under the ACA for accountable care organizations’ compensation arrangements.
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