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Payers with Market Power

Learn about business practices of health insurers that may draw antitrust scrutiny when the insurer has market power.

Transcript

Health-insurance companies may face potential antitrust scrutiny in either of two healthcare markets. First, as the sellers of health insurance that compete against other sellers, insurance companies may take actions that harm competition in the health-insurance market. Second, although insurance companies are purchasers of healthcare services, insurance companies still sometimes have enough power to harm competition in the healthcare-services market.

Let’s explore some examples of business...

Lessons

1. Welcome
  • Welcome to Healthcare Law
2. Health Insurance
3. The Structure of Healthcare Entities
  • The Professional Workforce
  • Forming a Healthcare Entity
  • Fiduciary Duties at Healthcare Entities
  • Tax-Exempt Status
  • Joint Ventures and Tax-Exempt Status
4. Fraud and Abuse in Healthcare
5. Antitrust Issues in Healthcare
  • Overview of Antitrust Laws in Healthcare
  • Mergers and Acquisitions in Healthcare
  • Working with Competitors
  • Payers with Market Power
6. Tort Liability of Healthcare Entities
  • The Physician-Patient Relationship
  • Physician Duties Regarding Information
  • Physician Duties Regarding Clinical Care
  • Hospital and Health Plan Liability
7. Recurring Legal Issues in Patient Care
8. Public Health Law