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Write a two to three page paper on the legal basis for the immunization of HMOs from being sued for malpractice. Consid...

Write a two to three page paper on the legal basis for the immunization of HMOs from being sued for malpractice.
Consider such things as:
• the relationship of the HMO with its member physicians,
• the HMO organizational structure (IPA versus PPO versus staff model and so forth),
• the principle of direct liability, enterprise liability, indemnification, ERISA preemption, ostensible agency, and anything else that you believe would fall under an HMO's vulnerability to being sued.

An historical perspective would enhance the strength of your paper. Remember to cite sources.
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Legal basis for the immunization of HMOs from being sued for malpractice. A Health Maintenance Organization (HMO) could be a cluster of medical insurance suppliers that limit coverage to treatment provided from doctors that are beneath the contract ofhealth insurance 1) Physicians are paid supported their relationship to the health set up. Some plans pay their doctors as employees therefore these doctors treat solely patients of the HMO that employs them. Other physicians are paid a capitated fee by the HMO supported what number services every member (i.e., patient) is probably going to use every month. Typically doctors are paid cash, if they assist save the arrange money by orderng fewer tests or not referring patients to specialists. You will wish to predict out how the doctors on every position are paid to examine if theyre given any money incentives to over-treat or under-treat you. As HMO began to grow in quality extremely published cases began to rise of HMOs refusing to acquire the tests that the patients felt necessary or for procedures their doctor urged. HMO additionally were recorded as failing to reimburse patients for treatment that ought to be lined and all out deny coverage to an eligible policy holder ostensibly on a pretext, like minor, secret however impertinent pre existent condition like a yeast infection. Some physicians began to make Independent practice Associations (IPA) networks of Independent physicians, World Health Organization comply with participate in an association to contract with health maintenance organizations (Armon and Miller 2001). In distinction to HMO primarily based physicians IPA physicians dont mix their individual practices. Instead the IPA physicians retain their practices and compute of their own offices. The initial premise underlying the formation of IPAs within the late 1980s was for physicians to retain management over medical higher cognitive process and to exchange higher ordinary and contract terms from the HMOs. However these money advantages werent essentially passed onto the investor 2) In the early Nineteen Seventies, HMOs were classified into 3 types: staff, Group, and IPA. The staff Model is characterized by HMO possession of the delivery system facilities and therefore the employment of physicians on wage to serve completely the HMO membership. The group Model is characterized by associate HMO catching with a medical group to serve the HMOs membership. Most frequently the medical group was serving the HMO membership completely and was paid on a tax basis for providing its services. The IPA Model is characterized by associate HMO contracting with individual fee-for service physicians to supply services to HMO members within the physicians non public offices. Ihese physicians were typically paid on a reduced fee-for-service basis and are at monev risk to the extent of a Withhold from their fee-for-service payments T wo altemative variations of the normal HMO model sorts (mixed and open-ended) have evolved over the past decade. Mixed Model HMOs have developed in response to the wishes of staff and group Model HMOs to expand their market areas while not exploitation substantial capital investment to create or purchase new facilities.

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  • Write a two to three page paper on the legal basis for the immunization of HMOs...

    Write a two to three page paper on the legal basis for the immunization of HMOs from being sued for malpractice. Consider such things as: • the relationship of the HMO with its member physicians, • the HMO organizational structure (IPA versus PPO versus staff model and so forth), • the principle of direct liability, enterprise liability, indemnification, ERISA preemption, ostensible agency, and anything else that you believe would fall under an HMO's vulnerability to being sued. An historical perspective...

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