Managed Care

 

In Separate Cases, Aetna, HIP Partner Face Tough Battles

MANAGED CARE February 1999. © MediMedia USA
News and Commentary

In Separate Cases, Aetna, HIP Partner Face Tough Battles

MANAGED CARE February 1999. ©1999 Stezzi Communications

Aetna U.S. Healthcare promises a vigorous appeal of a California jury's record $120 million award to the widow of a man who sought coverage of experimental treatment for a rare stomach cancer. While calling David Goodrich's death a tragedy, Aetna denied the implication that its actions shortened his life; Aetna says the progression of his disease made Goodrich an inappropriate candidate for high-dose chemotherapy. Aetna could ultimately be held responsible because Goodrich was a government employee — thus bypassing liability exclusions granted by the federal Employee Retirement Income and Security Act.

Across the continent, the company that until recently provided care for HIP Health Plan of New Jersey members is itself tangled in a stew of litigation. PHP Healthcare faces several provider lawsuits over unpaid bills, and now the U.S. attorney has been asked to review perks PHP executives received while the company was skidding toward bankruptcy.

According to court documents, PHP managers indulged in the kind of corporate greed that has given managed care a poor public image: luxury cars, private planes, double-digit raises. PHP claims HIP's mismanagement, not its own spending, brought on its woes.

Meetings

Private Health Insurance Exchanges Conference Washington, D.C. October 7–8, 2014
National Healthcare Facility Management Summit Palm Beach, FL October 16–17, 2014
National Healthcare CFO Summit Las Vegas, NV October 19–21, 2014
National Healthcare CXO Summit Las Vegas, NV October 19–21, 2014
Innovative Member Engagement Operations For Health Plans Las Vegas, NV October 20–21, 2014
4th Partnering With ACOs Summit Los Angeles, CA October 27–28, 2014
2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014