Credentialing is key to avoiding lawsuits

Article Abstract:

Health care providers can avoid much of the threat and damage of a lawsuit by ensuring that they can provide the appropriate credentials for al those involves in the health care process. Health maintenance organizations need to maintain an accurate and up-to-date file on their physicians, facilities, and other people or operations involved in health maintenance. HMOs will remain liable for damages if they delegate credentialing responsibility to a third party.

Insurance, Insurance Carriers and Related Activities, INSURANCE CARRIERS, Employer liability, Brief Article

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Crackdown set on health care fraud

Article Abstract:

The federal government, armed with the Kennedy-Kassebaum insurance reform law's anti-fraud provisions, plan to step up its efforts to battle Medicare and Medicaid fraud in 1997. The Health Care Financing Administration plans to institute an anti-fraud system designed to identify illegal claims before they are paid. The reform law dramatically increases the chance that perpetrators of healthcare fraud will be caught, according to an Ernst & Young report.

Police Protection, Administration of Public Health Programs, Fraud, Health Care Services, Planning, Prevention, Medicaid fraud, Medicare fraud, United States. Centers for Medicare and Medicaid Services

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Any willing provider laws threaten to sink managed care

Article Abstract:

Any willing provider laws can be differentiated into four main types of legislation. These laws govern nonphysician health care, pharmacies, physicians and general health care. Approximately 25 states considered some form of this legislation in 1995 but only four states adopted it. Arkansas and Wyoming passed laws governing general health care, Texas passed a law governing pharmacies and Washington state broadened its any willing provider law.

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