Consumers versus managed care: the new class actions.
The plaintiffs in pending consumer class-action lawsuits against health maintenance organizations (HMOs) should fail in their claims for damages for fraud under federal anti-racketeering legislation. Although HMOs have regularly failed to disclose their business methods and have not strictly honored their contractual coverage promises, the circumstances in which they introduced cost controls into a market sadly lacking them suggest motives not deserving punitive sanctions. Courts could easily find that HMOs violated the Employee Retirement Income Security Act (ERISA), however. Injunctive relief compelling more extensive disclosures and clearer contracts might well legitimize HMOs' methods and generally improve the performance of the health care marketplace.
Havighurst
C C
CC
D003254:Consumer Advocacy / Q000331:legislation & jurisprudence*; D019461:Employee Retirement Income Security Act; D005607:Fraud / Q000331:legislation & jurisprudence; D006279:Health Maintenance Organizations / Q000331:legislation & jurisprudence* / Q000592:standards; D016365:Liability, Legal; D011787:Quality of Health Care / Q000331:legislation & jurisprudence; D014481:United States