Managed
Care Discussion Group
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| Managed
Care Compliance Alert (22
Biweekly Issues)
Your
Blueprint For Fighting Off Trial Lawyers
Top federal prosecutors say that
managed care cost control tactics may amount to fraud, and they are marshalling
their resources to police agreements between MCOs and providers. The Managed
Care Compliance Alert stands alone as the source for the latest word on what
regulators and private plaintiffs are targetting, and tips to help you avert liability.
Executives and compliance officials with health plans and health care providers
alike need the know-how delivered in every biweekly issue of the Managed Care
Compliance Alert. Drawing upon our unmatched contacts in the governmental,
legal, and business realms, our expert staff tells you where the compliance risks
lie in managed care and how you can avoid the pitfalls.
From incentives
to reduce care to limitations on drug formularies, states, the feds, and individual
patients all are placing managed care plans and providers under the microscope.
Managed Care Compliance Alert is a vital defense against the fines, settlements,
and even jail time that can result: •
Feds hit provider network for denying necessary care. How to make sure it doesn’t
happen to you.
• How to tell if a drug co’s “educational grant”
is an illegal kickback.
•
Florida HMO fined for denying emergency room care. How to make sure you’re
not hit as well.
• Using patient data to cut costs could expose you
to fraud charges, unless you know the ropes.
• 7 UR decisions guaranteed
to land you in hot water with the feds. One surefire way to avoid them.
•
Juries are handing down multi-million dollar awards against managed care plans
and their contractors for failure to provide adequate care. Quick test to see
if it could happen to you.
• What the wave of new state laws on managed
care could mean for you.
• 3 NCQA requirements most plans and providers
miss.
•
7 patient privacy traps to avoid with Internet-based disease management.
•
Do you have the right license to take on capitated risk? The answer may surprise
you.
• 9 fraud land mines in CMS’s physician incentive regs and
how to avoid them.
• Why your “most favorable rate” deal may
violate antitrust laws — and what to do about it.
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