Fiduciary duty-HMOs-Disclosure-Physician compensation and financial incentives

Article Abstract:

In this court case, fiduciary obligations under Section 404 of ERISA do not incorporate a broad requirement to reveal the details of its physician compensation and reimbursement schemes to all plan members. Such a requirement might be implied if a participating specifically requests information regarding such arrangements,among other things.

Regulation, Licensing, and Inspection of Miscellaneous Commercial Sectors, Insurance Regulation, Laws, regulations and rules, Health insurance, Insurance law, Ehlmann, Marry Ellen

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HMOs--independent medical review--preemption

Article Abstract:

In the case Rush Prudential HMO Inc. versus Debra Moran, it was determined that a state statute can mandate a health maintenan ce organization to allow for an independent medical review of a denial of a request for a particular treatment as not medically necessary and to supply the treatment if it is determined by the reviewing physician that the covered service is reasonably necessary.

Health insurance industry, Moran, Debra, Rush Prudential HMO Inc.

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HMOs - financial incentives - disclosure

Article Abstract:

The decision given by the Third Circuit Court of Appeals in Horvath v. Keystone Health Plan East, Inc., 2003 U.S. App. LEXIS 12700 (3d Cir. 2003) is discussed. The case clarifies on the extent of applicability of fiduciary duties. Donna Horvath filed the case. The relevant provisions of ERISA are also discussed.

Hospital and medical service plans, Fiduciary duties, United States. Court of Appeals for the 3d Circuit, Horvath, Donna, Keystone Health Plan East Inc.

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