Is CMS having second thoughts about preferred pharmacy networks? *

USA - April 19 2013
In January of 2005, the Centers for Medicare and Medicaid Services ("CMS") finalized its regulation permitting Medicare Part D plans to establish…

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One health system’s state tax-exempt status today; your federal tax exempt status tomorrow? *

USA - March 25 2013
On Wednesday, March 20, 2013, armed with a publicly circulated legal opinion and a complaint filed in the Court of Common Pleas of Allegheny County…

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A tale of two (or more) types of physician terminations: Ohio muddles the responsibility for notifying patients when their doctor departs *

USA - March 12 2013
On March 22, 2013, a new Ohio law will go into effect that seeks to clarify who must notify a patient that his or her physician's employment has been…

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Rivell v. PHCS: network provider contracts' unintentional limits on network rentals and provider marketing *

USA - August 20 2012
On August 13, 2012, in Rivell v. Private Health Care Systems Inc., the U.S. District Court for the Southern District of Georgia dismissed the plaintiffs’ claims arising from the rental of a health care provider network by a preferred provider organization (“PPO”) to a discount medical plan (“DMP”) as time barred for two plaintiffs and for lack of standing for a third plaintiff.

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David Moore v. John Deere Health Care Plan Inc: the mostly right way for managed care organizations to terminate an incompetent network provider *

USA - July 27 2012
When facing an incompetent network health care provider and angry members, a managed care organization (MCO), such as a health maintenance organization (HMO), a preferred provider organization (PPO) or a physician-hospital organization (PHO), must take action to protect its members. 

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