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Full-Text Articles in Law
To Preempt Or Not To Preempt: Hmo Liability Pre And Post Pegram V. Herdrich , Adam D. Glassman
To Preempt Or Not To Preempt: Hmo Liability Pre And Post Pegram V. Herdrich , Adam D. Glassman
Journal of Law and Health
Should consumers have the right to sue their HMOs (health maintenance organizations) for the way they deliver medical care? In recent years, the federal courts have focused their attention upon, inter alia, the issue of whether HMOs have a duty to reveal financial incentive provisions contained in contracts between the HMO plan physicians to plan members and beneficiaries under a health plan. In fact, on June 12, 2000, the United States Supreme Court, in Pegram v. Herdrich, pondered whether HMO physicians and administrators are fiduciaries under the Employee Retirement Income Security Act (ERISA), and if so, must they exercise their …
Cobra Continuation Coverage And The Plain Reading Of The Statute: Geissal V. Moore Medical Corporation , Judith C. Brostron
Cobra Continuation Coverage And The Plain Reading Of The Statute: Geissal V. Moore Medical Corporation , Judith C. Brostron
Journal of Law and Health
This Paper will discuss the relevant statutes, case law and the Supreme Court's opinion in Geissal v. Moore Medical Corp. It concludes that the Supreme Court correctly reversed the Eighth Circuit's opinion in Geissal by applying the plain meaning of the statute and rejecting the "significant gap" theory. James Geissal was entitled to COBRA continuation coverage even though his wife had preexisting group health insurance coverage. The Fifth, Eleventh and Eigth Circuits' significant gap theory is not supported by the plain meaning of the statute or Congress' intent. The employee should have the choice to elect COBRA or decide whether …
Erisa Preemption: Will The Elimination Of The Erisa Preemption Clause Help Or Harm America's Ability To Deal With Its Pending Health Care Crisis, Damon Henderson Taylor
Erisa Preemption: Will The Elimination Of The Erisa Preemption Clause Help Or Harm America's Ability To Deal With Its Pending Health Care Crisis, Damon Henderson Taylor
Journal of Law and Health
This article explores the arguments surrounding the fate of the preemption clause and argues that Congress must work to preserve self-insured employers' accountability to its employees while concurrently retaining the services of self-insured employers in the health care business. Part II analyzes the federal government's relationship with the health care industry, concentrating selectively on four episodes of federal regulation which helped create the health care crisis that we encounter today - the Hill-Burton Act, the Congressional amendments to the Health Professions Educational Assistance Act, the advent of Medicare, and ERISA. Armed with this understanding, Congress's evaluation of health care issues, …
Legal Issues In Creating Ppo's, Douglas L. Elden, Richard A. Hinden
Legal Issues In Creating Ppo's, Douglas L. Elden, Richard A. Hinden
Journal of Law and Health
The development of alternate health care delivery and reimbursement mechanisms, particularly those known as "Preferred Provider Organizations" (PPOs), raise a multitude of legal issues. Each PPO will exist in different market conditions and under different state laws. Therefore, while this Article seeks to identify and discuss the legal issues, it cannot provide definitive answers. This Article can, however, serve as a guideline or checklist for PPO analysis and provide recommendations and alternatives for dealing with the legal roadblocks that occur in the formation and operation of PPOs. This discussion will be general in nature and cannot substitute for legal advice …