HMOs won another major court victory this week when a federal judge ruled that they do not have an affirmative duty under ERISA to disclose financial “incentives” they pay to primary care doctors to “ration” health care by limiting referrals to specialists.
In Horvath v. Keystone Health Plan East, U.S. District Judge Ronald L. Buckwalter found that while the 3rd U.S. Circuit Court of Appeals has never squarely addressed the question of physician incentives, it has outlined a standard that must be met by the plaintiff when alleging a breach of fiduciary duty.
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