They err, you pay

Article Abstract:

Health insurance companies servicing Medicare accounts sometimes overpay physicians, and the error may go undiscovered for a number of years. Then the companies and the Health Care Financing Administration demand return of the overpayments, which may amount to millions of dollars. Description is included of two such cases in which the AMA and state medical assns helped physicians appeal. In one case Cigna Corp. overpaid 248 North Carolina urologists for drug treatments for prostate cancer.

Administration of Public Health Programs, Health Care Services, Editorial, Services, Medical care, American Medical Association, CIGNA Corp., CI, Payment, United States. Centers for Medicare and Medicaid Services

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Doctor payment at issue in suit against Georgia Blues

Article Abstract:

Blue Cross Blue Shield of Georgia changed its physicians' payments to factor in the Medicare and Medicaid system, as well as fees paid by other insurance companies. The Medical Assn of Georgia is suing the health insurer for breach of contract, although the contract allows for changes. Georgia Blues claims it cannot compete for market share unless it modifies its payment system.

Medical Association of Georgia, Blue Cross Blue Shield of Georgia

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Follow the rules and fly right

Article Abstract:

A number of cases have arisen from physicians using the Messenger Model to negotiate contracts with health plans. Agents have to negotiate separate contracts for each physician.

United States, Legal issues & crime, Legal/Government Regulation, Company legal issue, Agency (Law)

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