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HMO and Managed Care Law / ERISA

(also see: Fiduciary Duty)

A key issue in ERISA law is the extent that federal law can preempt state tort laws. This issue also comes up in other liability contexts, as discussed here.

Articles

Thomas R. McLean and Edward P. Richards, "Health Care's 'Thirty Years War': The Origins and Dissolution of Managed Care," 60 NYU Annual Survey of American Law 283 (2004) (backup link)

Thomas R. McLean, MD, MS, JD, FACS and Edward P. Richards, JD, MPH , "Managed Care Liability for Breach of Fiduciary Duty after Pegram v. Herdrich: The End of ERISA Preemption for State Law Liability for Medical Care Decision Making," 53 University of Florida Law Review 1 (2001)

Edward P. Richards, "The Police Power and the Regulation of Medical Practice: A Historical Review and Guide for Medical Licensing Board Regulation of Physicians in ERISA-Qualified Managed Care Organizations", 8 Annals of Health Law 201 (1999)

Edward P. Richards, Past as Prolog: Can Managed Care Overcome the Conflicts Inherited from Fee-For-Service Medicine? 66 UMKC L. Rev. 735 (1998).

Cases

Court holds Maryland WalMart health insurance law violates ERISA - Retail Industry Leaders Association v. Fielder, No. 06-1840 (4th Cir. 2007)

ERISA health plans can claim reimbursement from tort damages for medical bills - Sereboff v. Mid Atlantic Medical Services, Inc., 126 S.Ct. 1869 (2006)

Court upholds RICO class action by physicians against HMOs - Klay v. Humana, Inc., 382 F.3d 1241 (11th Cir.(Fla.) 2004)

Supreme Court gives ERISA preemption to plans making mixed decisions - Aetna Health Inc. v. Davila, 542 U.S. 200, 124 S.Ct. 2488, 159 L.Ed.2d 312 (2004)

Supreme Court Upholds Any Willing Provider Law for Insured ERISA Plan - Kentucky Association of Health Plans, Inc. v. Miller, 123 S.Ct. 1471, 155 L.Ed.2d 468 (2003)

2nd Cir Upholds Pegram, Questions State Authority to Regulate MCO Claims Practices - Cicio v. Does, 321 F.3d 83 (2nd Cir.(N.Y.) 2003)

Brief - States Can Regulate ERISA HMOs Under Insurance Codes - Rush Prudential HMO, Inc. v. Moran, 122 S.Ct. 2151 (2002)

ERISA health plan cannot recover medical costs from general tort recovery - Great-West Life & Annuity Insurance Co. v. Knudson, 122 S.Ct. 708, 534 U.S. 204, 151 L.Ed.2d 635 (2002)

Brief - Are Claims against Medicare HMOs Subject to Medicare Administrative Review Limitations? - McCall v. PacifiCare of California, Inc., 25 Cal.4th 412, 21 P.3d 1189, 106 Cal.Rptr.2d 271 (Cal. 2001)

Supreme Court Rules on Suing MCOs Under ERISA - Pegram v. Herdrich, 530 U.S. 211, 218, 120 S.Ct. 2143, 147 L.Ed.2d 164 (2000)

Illinois Applies Liability for Corporate Negligence to HMOs - Jones v. Chicago HMO Ltd. of Illinois, 191 Ill.2d 278, 730 N.E.2d 1119 (Ill. 2000)

Brief - MCO plan members cannot force MCOs to disclose physician incentive schemes - Ehlmann v. Kaiser Foundation Health Plan of Texas, 198 F.3d 552 (5th Cir. 2000)

Supreme Courts holds that McCarran-Ferguson Act does not bar RICO Claims against HMOs - Humana v. Forsyth, 525 U.S. 299 (U.S. 1999)

Brief - IPA model HMO can be vicariously liable for a physician's medical malpractice - Hinterlong v. Baldwin, 720 N.E.2d 315 (Ill.App. 2 Dist. 1999)

Brief - Are Health Plan Disputes Arbitrable? - Broughton v. Cigna Healthplans of California, 21 Cal.4th 1066, 988 P.2d 67 (Cal. 1999)

The Shea Cases - Court rejects financial conflicts evidence in Shea med mal case - Shea v. Esensten, 622 N.W.2d 130 (Minn.App. 2001) - Suing physicians for negligent misrepresentation of MCO conflicts of interest - Shea v. Esensten, No. 99-1388 (8th Cir. 03-31-2000) - Managed Care Contract Violates Fiduciary Duty - Shea v. Esensten, 107 F.3d 625 (8th Cir.1997)

No ERISA Preemption of BOME Regulation of Medical Decisionmaking - Murphy v. Board of Medical Examiners, 949 P.2d 530, 190 Ariz. 441, 247 Ariz. Adv. Rep. 35 (Ariz.App.Div.1 07/15/1997)

Supreme Court Distinguishes Insured from Self-Insured ERISA Plans - Metropolitan Life Ins. Co. v. Massachusetts, 471 U. S. 724 (1985)

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