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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 …
How Mfn Clauses Used In The Health Care Industry Unreasonably Restrain Trade Under The Sherman Act, Beth Ann Wright
How Mfn Clauses Used In The Health Care Industry Unreasonably Restrain Trade Under The Sherman Act, Beth Ann Wright
Journal of Law and Health
When used in the health care industry, an MFN clause is a contractual agreement that guarantees a health insurer the same best price as their market competitors. MFN clauses have the effect of unnecessarily raising consumer costs, reducing choice among providers, constraining access to care and preventing the development of alternative health care delivery models. The purpose of this paper is four-fold. First, to design a four-quadrant matrix to evaluate the pro-competitive and anticompetitive purpose and effects of MFN clauses under Section 1 of the Sherman Act. Second, to defeat the jurisprudential presumption that MFN clauses are pro-competitive in the …