HMOs must discloser financial incentives

Article Abstract:

The US Eighth Circuit Court of Appeals found that the Medica health maintenance organization breached its fiduciary duty under the Employee Retirement Income Security Act of 1974 when it did not tell patient Patrick Shea of the financial rewards for physicians who did not offer an abundance of specialty referrals. Patrick Shea died of heart failure because his primary care physician did not deem a visit to the cardiologist necessary when Shea had chest pains and dizziness and a family history of heart disease. Shea's widow, Diane, sued.

Medica, Shea, Diane

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State laws on managed care spur new battles

Article Abstract:

Health maintenance organization (HMO) trade groups and the Health Insurance Association of America have introduced marketing campaigns to counter consumer efforts to regulate managed care plans. Federal and state lawmakers have introduced legislation in response to consumer complaints that price competition between HMOs has hurt the quality of managed care. Lobbying efforts by national managed care entities has intensified in California where over 80 related legislative bills have been introduced.

Political activity, Managed care plans (Medical care)

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Antitrust verdict hits HMO

Article Abstract:

U.S. Healthcare Inc. has been ordered to pay a $1.6 mil penalty to Brokerage Concepts Inc. for violating antitrust laws. A Philadelphia, PA, jury found the health maintenance organization (HMO) giant guilty of using its market clout to pressure a contracting pharmacy to utilize its services. The case is expected to set a precedent for antitrust action against HMOs.

Insurance Agencies and Brokerages, Insurance agents, brokers, & service, Insurance Agents & Brokers, Insurance industry, U.S. Healthcare Inc., USHC, Insurance brokers, Brokerage Concepts Inc.

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