Chair's Column
by Gregory L. Pemberton, Ice Miller, Indianapolis, IN

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Managing Risks of Fraud, Waste and Abuse: Part D Challenges for Drug Plans
by José A. Tabuena, Deloitte Financial Advisory Services LLP

Where money flows, fraud is likely to follow. And where there is federal money, there is federal oversight3. Certainly these adages apply to the new Medicare prescription drug benefit, referred to as "Part D," that went into effect on January 1, 2006. Regulators and enforcement authorities have been on the speaking circuit warning about the risk of fraud, waste and abuse arising from the estimated $60 billion a year expected infusion of new federal funds.

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Ohio Supreme Court Precludes Arbitration of Provider Antitrust Lawsuit
by Fred Smith & David Goldhaber, Sedgwick, Detert, Moran & Arnold LLP, Chicago, IL

The Ohio Supreme Court has effectively authorized a group of physician providers to pursue their antitrust lawsuit against United HealthCare of Ohio in state court rather than in a private arbitration. The majority and dissenting opinions in this case reflect the debate that litigants -- and courts -- often engage in when deciding whether to arbitrate claims arising out of disputes in the managed care industry. While a motion for reconsideration is pending, the majority opinion appears to be yet another example of courts finding ways to narrow the scope of arbitration clauses in the managed care arena and allow claims to proceed in court rather than in a private arbitration setting.

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Interest Group Spotlight

Managed Care & Insurance

The Managed Care & Insurance Interest Group focuses on such issues as federal and state regulation of HMOs and other managed care organizations.

The IG is led by Chair David M. Humiston, Sedgwick, Detert, Moran & Arnold LLP, Los Angeles, CA and Vice Chairs R. Jeffrey Layne, Fulbright & Jaworski LLP, Austin, TX and Cindy Stamer, Glast, Phillips & Murray, PC, Dallas, TX.

If you would like to join the Interest Group, continue by clicking the following link: Health Law Section IG Sign-up Form.

Do you want to communicate your ideas to thousands of other members through the wonders of cyberspace? To contribute a newsletter article on a health law topic, send us your ideas to Adam.Bielawski@americanbar.org