• Summary Table of Contents
• Detailed Table of Contents
• Preface

In the constantly evolving managed care industry, it is difficult to keep pace with the legal issues facing market players, and health lawyers are busier than ever as clients contend with increasing, and often conflicting, regulations. Finally, there is a practical, authoritative reference written specifically for practitioners who handle managed care disputes to help them rapidly focus on key issues and expertly advise their clients—BNA Books’ Managed Care Litigation. This is the only treatise on the market that offers in-depth analysis of all the important issues in managed care litigation. Providing both a basic overview and a comprehensive examination of the legal issues facing managed care practitioners, this book gives you practical guidance on:

• Common managed-care disputes
• The main features of a typical ERISA lawsuit and ERISA preemption strategies
• Utilization review and coverage disputes
• Prompt pay statutes
• Health plan liability laws, post-Davila
• State insurance administrative processes
• Contractual disputes between payors and providers
• Managed behavioral health care litigation issues
• Litigating disputes arising under Medicare, Medicaid, and other federal health programs
• Antitrust laws and the defenses managed care entities and providers can use
• Class action lawsuits

This timely reference is organized so that both in-house and outside managed care counsel and executives can quickly access the information they need, review the legal theories and process involved, and get up to speed on the case law. It is an excellent springboard to drafting pleadings or advisory memoranda.

The 2010 Cumulative Supplement to Managed Care Litigation includes:

• Updated analysis of the development and scope of Medicare preemption of state common law causes of action
• New discussions of breach of nondelegable duties, bad faith claims, and vicarious liability theories
• Expanded coverage of balance billing and provider reimbursement issues
• A new section on accountable care organizations
• New examination of current litigation trends pertaining to silent PPOs, physician tiering, and provider inclusion and exclusion from networks
• Recent developments regarding post-claims rescission of policies
• New discussions on mental health parity laws and claims against managed behavioral health care organizations
• A revised comprehensive appendix listing recent managed care class actions
• Latest happenings in ADR and decisions regarding arbitration provisions and class actions
• Review of important recent ERISA decisions pertaining to de novo review, discretionary clauses, mandated benefits, and preemption