Fitzgerald T F, Montez A C, Edgar M A
Groom and Nordberg, Washington, DC, USA.
Empl Benefits J. 1998 Mar;23(1):23-8, 30-5.
This article addresses the key legal issues facing ERISA welfare plan fiduciaries in health care cost management and explores the current status of a number of fiduciary obligations particularly relevant to welfare plan trustees. The authors discuss the fiduciary issues raised by the selection of a health care delivery system, plan design decision making and provider discount arrangements with health plans, and provide suggestion for administering reimbursements for health care costs from third party recoveries and addressing provider fraud.
本文探讨了员工退休收入保障法(ERISA)福利计划受托人在医疗成本管理中面临的关键法律问题,并探究了一些与福利计划受托人特别相关的信托义务的现状。作者讨论了在选择医疗服务提供系统、计划设计决策以及与健康计划的提供商折扣安排中出现的信托问题,并就管理第三方追偿的医疗费用报销以及应对提供商欺诈提供了建议。