Managed
Care
Miles & Peters represents the state's only Medicaid-only HMO with respect
to its rates and reimbursement from government payors. The firm is also familiar
with HMO contracting issues in connection with its nursing home and DME provider
practices, where Miles & Peters has long been involved in counseling
its clients concerning the managed care contracts they enter into with health
maintenance organizations.
Click below for News and Information regarding:
ALJ UPHOLDS FTC'S COMPLAINT AGAINST
PHYSICIANS GROUP FOR PRICE FIXING
In an initial decision announced November 16, an Administrative Law Judge
(ALJ) upheld the Federal Trade Commission's (FTC's) complaint against a physicians
group alleging that the group conspired to fix prices in certain contacts
its doctors entered into to provide medical services to the patients of health
plans.
For more information go to www.ftc.gov/opa/2004/11/northtexas.htm
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FTC Settles
with Physicians Group on Price-Fixing Charges
The Federal Trade Commission (FTC) announced April 5 it has reached a settlement
with a Chicago-area physicians group. Evanston Northwestern Healthcare Corporation
(ENH) and ENH Medical Group, Inc. (ENH Medical Group), whereby the group
has agreed to put an end to collective bargaining on behalf of its members.
According to FTC,ENH Medical Group "violated Section 5 of the FTC Act by
facilitating and implementing agreements among rival physicians to fix prices
and other terms of dealing with health plans and other third-party payors,
and by refusing to deal with such payors except on jointly determined terms."
To read FTC's press release go to www.ftc.gov/opa/2005/04/050405evanston.htm.
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POTENTIAL
HEALTH PLAN LIABILITY FOR PARTICIPATION IN PRESCRIPTION DRUG IMPORTATION
PROGRAMS
According to a recent report issued by the U.S. Department of Health and
Human Services (HHS) Task Force on Prescription Drug Importation (HHS Task
Force Report), nearly 5 million shipments of unapproved prescription drugs
entered the U.S. in 2003 from Canada through Internet sales and from travel
to Canada by American consumers. The Task Force produced a report that contains
our findings based on all of the information presented to us and expert views
solicited from appropriate government agencies.
The report is available online at:
http://www.hhs.gov/importtaskforce
The Surgeon General's testimony is available online at:
http://www.hhs.gov/asl/testify/t050216b.html.
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DOJ
OFFERS GUIDANCE ON NONDISCRIMINATION AGAINST
LIMITED ENGLISH SPEAKERS
The Civil Rights Division of the U.S. Department of Justice issued guidance
October 26 on what recipients of federal assistance-including hospitals-must
do to ensure they are not discriminating against those with limited English
proficiency.
The guidance is online at www.usdoj.gov/crt/cor/lep/Oct26Memorandum.htm.
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CMS PUBLISHES NATIONAL PROVIDER
IDENTIFIER FINAL RULE
On January 23, 2004 CMS published the long awaited National Provider Identifier
(NPT) final rule. This NPT final rule requires all health care organizations
to use an assigned identifier for each health care provider when filing and
processing electronic claims and other standard transactions.
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