Managed Care Litigation, Second Edition, 2018 Cumulative Supplement - Softcover

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The 2018 Cumulative Supplement of Managed Care Litigation, Second Edition discusses: Disputes involving: medical necessity determinations; benefit exclusions on mental health disability, autism spectrum disorder treatment, and gender dysphoria; an anti-abortion group s challenge to the contraceptive mandate exemption; and bad faith and negligent credentialing cases Provider versus payor issues such as line item denials of charges, and patient actions brought for charging more than payor contract rates Updates on pay for performance programs (P4P), Hospital Value-Based Purchasing (VBP), the Merit-based Incentive Payment System (MIPS) and Advanced APM In antitrust litigation, whether a hospital system unreasonably restrained trade through steering provisions incentivizing consumers for using healthcare providers in certain tiers or plans The impact of regional variations in legal standards in class actions Federal health program topics such as beneficiary suits against MCOs for failure to cover benefits, or for failure to provide benefits ordered in a fair hearing, in addition to MCO contract bid protests based on the use of third-party materials in bids Application of the Second Circuit s Montefiore test regarding ERISA preemption of state regulatory power, and the Eleventh Circuit s rate of payment versus right of payment test

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