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Full-Text Articles in Law
The Medicare Appeals Crisis: Why Mediation Is The Medicine, Michelle Ellis
The Medicare Appeals Crisis: Why Mediation Is The Medicine, Michelle Ellis
Pepperdine Dispute Resolution Law Journal
This article will explore how unmeritorious RAC-reversals recently polluted the Medicare appeals process, and how this has led to a crisis for both providers and the United States Department of Health & Human Services (HHS). Furthermore, this article will consider the lack of available remedies and narrow measures taken by HHS, and will instead advocate for mediation as the best means of easing the backlog. While the delays also directly affect Medicare beneficiaries, this article will limit its discussion to the backlog in relation to providers and suppliers.
Healthism, Intersectionality, And Health Insurance: The Compounded Problems Of Healthist Discrimination
Marquette Benefits and Social Welfare Law Review
Healthism can identify situations where a person is subject to a particular form of bigotry based on their individual health status. In health insurance, some forms of healthism are unavoidable due to the very nature of health insurance structures. However, when analyzing health insurance programs, particularly those that are funded through government, it is possible to utilize a healthism framework to, first, recognize and minimize and potentially ameliorate the worst effects of healthism combined with intersectionality. This Essay analyzes these issues as they relate to health insurance, Medicare, and the potential role of the Independent Payment Advisory Board.
When Is Competition Not Competition: The Curious Case Of Medicare Advantage, Robert A. Berenson
When Is Competition Not Competition: The Curious Case Of Medicare Advantage, Robert A. Berenson
Saint Louis University Journal of Health Law & Policy
Policymakers routinely assume that Medicare Advantage plans and the traditional Medicare program compete for beneficiaries. Yet the District of Columbia federal district court blocked the proposed Aetna and Humana merger, finding that for purposes of antitrust analysis Medicare Advantage plans and traditional Medicare are effectively in different product markets. That is, they do not compete. This article reviews the basis for the court decision, which relied to a large extent on information that Medicare beneficiaries select their insurance coverage based on durable preferences either for the Medicare Advantage or the traditional Medicare option.
The article explores whether the apparently durable …