Fraud changing with market; government expands probes, enforcement efforts

Article Abstract:

State and federal investigators including the Federal Bureau of Investigation and the Inspector General's Office report great increases in fraud cases in connection with medical programs. For example, managed-care facilities are suspected of false advertising, denial of services and dumping of patients. Criminals are attracted by increased spending on health care, which rose from $51 billion in 1967 to more than one trillion in 1995.

Health Care, Health Care and Social Assistance, Health Care Services, Investigations, Crime, Managed care plans (Medical care), Medicare fraud

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HMO coverage battle rages on; quality issues at core of high-profile case

Article Abstract:

A legal battle continues to move through the courts in a case involving HMO healthcare provider TakeCare Health Plan Inc and its owner FHP Health Care for allegedly denying out-of-plan care to patient Carley Christie. The healthcare providers were fined $500,000 by California's Dept of Corporations following an investigation by the state agency. TakeCare and FHP are pursuing relief through the courts.

Cases, FHP Inc., Christie, Carley, California. Department of Corporations, TakeCare Health Plan Inc., TKCR

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Medical market correction; employer pressure holds prices; access woes grow

Article Abstract:

Inflation of medical care costs fell in 1994 during the debate in Congress over health care reform. However, access to care has also decreased, and the number of uninsured persons in the US climbed to 39 million in 1993. Most health insurers and health maintenance organizations showed a profit in 1994, as employers encouraged price tightening by controlling physicians' salaries and other costs.

Accident & Health Insurance, Insurance Carriers, Medical Service and Health Insurance, Health Programs, Economic aspects, Finance, Supply and demand, Public health, Health care reform, Health insurance industry

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