Law Commons^™

Toward A Fair And Practical Definition Of "Willfully" In The Medicare/Medicaid Anti-Kickback Statute, Tamsen D. Love

Vanderbilt Law Review

Health care fraud takes on a variety of forms-from billing insurance companies for services not provided, to falsifying injuries for tort plaintiffs, to practicing medicine without a license.' All these types of fraud contribute to the astronomical cost of health care in the United States. As federal policymakers have focused on ways to contain these costs, health care fraud has become an increasing object of scrutiny. At the same time, the health care industry is experiencing significant institutional change, particularly with the emergence of health maintenance organizations ("HMOs") and other managed care systems. The Medicare/Medicaid anti-kickback statute, which prohibits payments …

Introduction: Current Issues In Mental Health Care - Special Edition, Tamsen D. Love

Vanderbilt Law Review

Today we think we know a lot more about mental health care than our country's founders did. Yet in many ways we are in no better position than our eighteenth-century predecessors. Certainly, the decisions we as a society face about mental illness are just as difficult. The vocabulary we employ is more complex--"behavioral health organization," "psychopharmacology," "cost containment"--but the issues are the same: Who should pay for mental health care? How much care is appropriate? And, more fundamentally, what exactly is mental health?

This year's Special Project addresses these issues. The Notes focus on particular legal issues in the mental …

Legislative "Subterfuge"?: Failing To Insure Persons With Mental Illness Under The Mental Health Parity Act And The Americans With Disabilities Act, Christopher A. Jones

Vanderbilt Law Review

The two primary problems with providing health care in the United States are cost and access., The cost of health care rose dramatically during the 1970s and 1980s and continues to increase, making coset containment crucial to the availability of care. In addition, many Americans are either entirely without health insurance or are underinsured for catastrophic illness. While individually these two issues are important, equally problematic is the tension that exists between them. Providing greater access to additional services results either in a cost increase or the loss of other services. Ultimately, however, a general plan to contain costs can …

The Early And Periodic Screening, Diagnostic, And Treatment Program And Managed Medicaid Mental Health Care: The Need To Reevaluate The Epsdt In The Managed Care Era, John A. Flippen

Vanderbilt Law Review

For a majority of Medicaid recipients, managed health care is fast becoming a reality. As state governments seek to control Medicaid costs in a world of limited resources, unlimited reimbursement for any treatment a doctor deems necessary is no longer feasible. One major tool for cost containment has been the privatization of the delivery of Medicaid coverage into managed care organizations. The shift to a managed plan means that services will be rationed. This rationing occurs because capitated rates, for example, require that private managed care organizations ("MCOs") bear the risk of providing services to the Medicaid population and attempt …