| HMO Liability for Failure to Authorize Treatment |
|
| Patients can sue their HMOs for the wrongful refusal to authorize treatment in order to obtain reimbursement of money paid for medical services that should have been authorized. Thus, patients can sue their HMOs for the failure to pay for the treatment. However, patients (or, if the patient has died, his or her family members) cannot recover for any damages that resulted from not authorizing the treatment or from a delayed treatment.
More... |
|
|
| Surgeon Liability for Negligence of Operating Room Personnel |
|
| Historically, hospitals were not sued for medical malpractice as most were immune from lawsuits on account of their status as charitable institutions. Instead, only physicians were sued. In cases where the malpractice took place in the hospital, such as in the operating room, the surgeon was held responsible for any actions that took place in the operating room as the "captain of the ship." More... |
|
|
| COVERED ENTITY'S DUTY TO SAFEGUARD PROTECTED HEALTH INFORMATION |
|
| A covered entity is required to have appropriate administrative, technical, and physical safeguards in place to protect the individual's privacy in protected health information. Under the Health Insurance Portability and Accountability Act of 1996 and the Privacy Rule promulgated by the Department of Health and Human Services (HHS), protected health information is generally defined as medical information that readily and easily identifies the individual.
More... |
|
|
| The Medicare Managed Health Care Plan |
|
| A managed health care plan is an arrangement under which a member agrees to receive care from certain healthcare providers and, in exchange, receives healthcare at a reduced cost. Some disabled persons and individuals over 65 years of age may choose to participate in Medicare managed health care plans, which provide basic Medicare coverage and also cover gaps in that coverage. More... |
|
|
| Certificates of Need |
|
| Certificate of need programs are regulatory processes that assign the responsibility of addressing access, quality, and cost issues related to healthcare delivery to state reviewers. In states that have certificate of need programs, hospitals and health care providers cannot open, expand or add services without complying with the state's certificate of need program requirements. More... |
|
|