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Discount Me Once, Shame on You, Discount Me Twice, Shame on Me
The Fifth Circuit Court of Appeals held that a hospital did not have standing under RICO to sue an insurance company, but reinstated its claims under ERISA. The hospital was an out-of-network provider but gave the insurance company’s enrollees a “prompt pay” discount that negated the out-of-pocket exposure the enrollees who selected the hospital would have paid. The insurance company countered by paying the hospital a percentage of the discounted rate.
N. Cypress Med. Ctr. Operating Co. v. Cigna Healthcare

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Question of the Week


Can advanced practice clinicians and other non-physicians be appointed to the medical staff?

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