Article Abstract:
Health Care Financing Administration (HCFA) head Bruce Vladeck has terminated the agency's contract with Washington State's King County Medical Blue Shield because the organization failed to meet goals that were part of a remedial plan. The organization had been the Medicare Part B claims carrier for the HCFA, and several other Medicare carriers on probation may face similar action. King County Blue Shield failed to follow up on fraud and abuse charges, was below acceptable standards in its processing of electronic claims and offered its services at high cost.
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Article Abstract:
A federal appeals court ruled Healthsource Inc's signing of physicians to exclusive-services contracts does not violate antitrust laws because the contracts allow the physicians to provide services at other HMOs.. US Healthcare Inc had brought the suit against Healthsource claiming its contracts with physicians were in violation of section one of the Sherman Act and that it impeded their ability to enter the New Hampshire market. Fewer than 25% of New Hampshire's primary care physicians belong to Healthsource.
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Article Abstract:
A growing number of health maintenance organizations are using drug utilization reviews, withholds and risk pools, and formularies to control the cost of drug prescriptions. According to a Marion Merrell Dow Inc survey, 48% of HMO's used drug utilization reviews in 1991, a 1% increase over 1990; 27% used withholds, a 2% increase; and 49% used formularies, up 5%. Other monitoring practices included quality assurance programs - 43% - and financial incentives - 15%.
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