Tenth Circuit Upholds BC/BS's Anti-Assignment Provisions

1996 ◽  
Vol 24 (1) ◽  
pp. 72-73
Author(s):  
M.K.
Keyword(s):  
Health Care ◽  
Medical Center ◽  
The United States ◽  
Health Plans ◽  
Court Of Appeals ◽  
Freedom Of Contract ◽  
Regional Medical ◽  
Regional Medical Center ◽  
Health Care Benefits ◽  
Blue Shield

In St. Francis Regional Medical Center v. Blue Cross & Blue Shield of Kansas (49 F.3d 1460 (1995)), the United States Court of Appeals for the Tenth Circuit upheld Blue Cross/Blue Shield of Kansas's anti-assignment requirement, on the grounds that the Employee Retirement Income Security Act (ERISA) preempted a hospital's claim against Blue Cross. The court also held that public policy supported anti-assignment requirements in health plans not covered under ERISA.When drafting ERISA, Congress did not explicitly address assignability of health care benefits. According to the court of appeals, congressional silence constituted an intent to allow the parties to negotiate freely the assignment of health care benefits. Examining non-ERISA health plans, the court adopted a balancing test to determine the validity of anti-assignment clauses; it found that anti-assignment requirements promote freedom of contract and may include medical costs.

scholarly journals SARS-CoV-2 Seroprevalence among Health Care Workers—A Voluntary Screening Study in a Regional Medical Center in Southern Germany

2021 ◽  
Vol 18 (8) ◽  
pp. 3910
Author(s):  
Katharina Müller ◽  
Philipp Girl ◽  
Michaela Ruhnke ◽  
Mareike Spranger ◽  
Klaus Kaier ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Workers ◽  
Close Contact ◽  
Medical Center ◽  
Limited Information ◽  
Specific Antibodies ◽  
Care Workers ◽  
Significant Difference ◽  
Regional Medical ◽  
Regional Medical Center

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is associated with a potentially severe clinical manifestation, coronavirus disease 2019 (COVID-19), and currently poses a worldwide challenge. Health care workers (HCWs) are at the forefront of any health care system and thus especially at risk for SARS-CoV-2 infection due to their potentially frequent and close contact with patients suffering from COVID-19. Serum samples from 198 HCWs with direct patient contact of a regional medical center and several outpatient facilities were collected during the early phase of the pandemic (April 2020) and tested for SARS-CoV-2-specific antibodies. Commercially available IgA- and IgG-specific ELISAs were used as screening technique, followed by an in-house neutralization assay for confirmation. Neutralizing SARS-CoV-2-specific antibodies were detected in seven of 198 (3.5%) tested HCWs. There was no significant difference in seroprevalence between the regional medical center (3.4%) and the outpatient institution (5%). The overall seroprevalence of neutralizing SARS-CoV-2-specific antibodies in HCWs in both a large regional medical center and a small outpatient institution was low (3.5%) at the beginning of April 2020. The findings may indicate that the timely implemented preventive measures (strict hygiene protocols, personal protective equipment) were effective to protect from transmission of an airborne virus when only limited information on the pathogen was available.

scholarly journals A Legacy of Lessons Learned: Landstuhl Regional Medical Center During Wartime, 2001–2014

2018 ◽  
Vol 46 (1) ◽  
pp. 20
Author(s):  
Amanda Homce
Keyword(s):  
Medical Center ◽  
The United States ◽  
September 11 ◽  
Lessons Learned ◽  
Care Hospital ◽  
East Europe ◽  
Us Military ◽  
Regional Medical ◽  
Regional Medical Center ◽  
Injured Patients

A Legacy of Lessons Learned by Karen Hennessy is a mix of history and organizational practice focused on the Landstuhl Regional Medical Center (LRMC), the largest US military medical facility in Europe. Before September 11, 2001, LRMC was a general care hospital for US military personnel and their families stationed in Europe. As troops were distributed to parts of the Middle East, Europe, and Africa in conflicts following September 11, 2001, LRMC developed into a premier trauma center caring for service members wounded in US military conflicts and then evacuated to LRMC. LRMC became a transition point for wounded and critically ill soldiers evacuated from their deployment, with approximately 20 percent of patients being returned to duty while many injured patients were transported on to facilities in the United States within 96 hours of arrival at LRMC.

Examining Exclusionary Conduct of HMOs and PPOs: A Case Comment on Northwest Medical Laboratories v. Blue Cross and Blue Shield of Oregon

1991 ◽  
Vol 17 (3) ◽  
pp. 271-288
Author(s):  
Debra M. Levitt
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Industry ◽  
Medical Laboratory ◽  
Care Providers ◽  
Court Of Appeals ◽  
Medical Laboratories ◽  
Care Industry ◽  
Antitrust Analysis ◽  
Blue Shield

As the climate of the health care industry has changed to one of cost-containment and competition through the growth of HMOs and PPOs, health care providers have become the subjects of antitrust litigation. One such case, Northwest Medical Laboratories v. Blue Cross and Blue Shield of Oregon, involved a medical laboratory and a radiology center who claimed that they were victims of an illegal group boycott after defendant's pre-paid health plan denied them preferred provider status. The Oregon Court of Appeals, using the traditional antitrust analysis applied to other industries for decades, failed to consider the intricacies that exist within the health care industry. This result led to an inaccurate market share computation and an inadequate rule of reason analysis. This Comment examines the shortcomings of the Northwest Medical opinion and argues that, in applying the antitrust laws to the health care industry, courts in future cases must recognize and respect the unique features of the business of providing health care.

Rewards and Challenges of Nursing Wounded Warriors at Landstuhl Regional Medical Center, Germany

2010 ◽  
Vol 45 (2) ◽  
pp. 205-218 ◽  
Author(s):  
Nancy M. Steele ◽  
Ann Kobiela Ketz ◽  
Kathleen D. Martin ◽  
Dawn M. Garcia ◽  
Shannon Womble ◽  
...  
Keyword(s):  
Medical Center ◽  
Regional Medical ◽  
Regional Medical Center ◽  
Wounded Warriors

Impact of Health Plan Deductibles and Health Insurance Marketplace Enrollment on Health Care Experiences

2018 ◽  
Vol 77 (5) ◽  
pp. 483-497
Author(s):  
Weiwei Chen ◽  
Timothy F. Page
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
The United States ◽  
Health Plans ◽  
Medical Needs ◽  
Care Access ◽  
Health Care Experiences ◽  
Monitoring Survey ◽  
Using Data ◽  
The Impact

High-deductible health plans (HDHPs) have become increasingly prevalent among employer-sponsored health plans and plans offered through the Health Insurance Marketplace in the United States. This study examined the impact of deductible levels on health care experiences in terms of care access, affordability, routine checkup, out-of-pocket cost, and satisfaction using data from the Health Reform Monitoring Survey. The study also tested whether the experiences of Marketplace enrollees differed from off-Marketplace individuals, controlling for deductible levels. Results from multivariable and propensity score weighted regression models showed that many of the outcomes were adversely affected by deductible levels and Marketplace enrollment. These results highlight the importance of efforts to help individuals choose the plan that fits both their medical needs and their budgets. The study also calls for more attention to improving provider acceptance of HDHPs and Marketplace plans as these plans become increasingly common over time.

Fraud and Abuse: United States ex rel Merena v. SmithKline Beecham Corp.; United States ex rel Spear v. SmithKline Beecham Clinical Lab.; United States ex rel Grossenbacher v. SmithKline Beecham Clinical Lab.

2000 ◽  
Vol 28 (2) ◽  
pp. 191-193 ◽  
Author(s):  
Allyson Behm
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care Providers ◽  
Laboratory Tests ◽  
The United States ◽  
Care Providers ◽  
Individual Analysis ◽  
Court Of Appeals ◽  
The Third ◽  
The Government

The United States Court of Appeals for the Third Circuit held that when quitam relators file a multi-claim complaint under the Fraudulent Claims Act (FCA), their share of the proceeds must be based on an individual analysis of each claim. More importantly, the court held that relators are not entitled to any portion of the settlement of a specific claim if that claim was subject to dismissal under section 3730(e)(4) Relator Merena filed a quitam suit against his employer, SmithKline Beecham (SKB), claiming, among other things, that SKB defrauded the government by billing for laboratory tests that were not performed, paying illegal kickbacks to health care providers, and participating in an “automated chemistry” scheme. Soon thereafter, additional relators filed suit.

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