The Legal Environment of Business: Text and Cases (MindTap Course List)
10th Edition
ISBN: 9781305967304
Author: Frank B. Cross, Roger LeRoy Miller
Publisher: Cengage Learning
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Chapter 24, Problem 1CT
Summary Introduction
Case s ummar y:A company POM is making and selling pomegranate-based products. The company in ads claimed that it will prevent or reduce heart disease and cancer on daily consumption. Federal Trade Commission(FTC) charged the company for misleading and misrepresentation ads. The company was barred for future ads and affirmed that other advertisements of the company are deceptive. The court affirmed that the benefits in its product required Randomized Controlled Trials result. The court ordered that benefits in Ads should be supported by the evidence to the consumer in a non-misleading way.
To find:The validity of arguments advanced by the company POM.
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Anthem, one of the largest healthcare insurers in the United States, implemented an“avoidable ER” policy to help manage the care of its enrollees. The policy stated thatAnthem would not pay for emergency room visits if the company determined that the visitwas not necessary. The policy, which was instituted in six states beginning in 2015, wasmeant to encourage patients to seek care in appropriate settings. However, providers feelthat this policy might cause patients to avoid emergency treatment, even when it isnecessary. In response to customer and provider complaints, Anthem created severalexceptions: Claims will be covered if a healthcare provider tells a patient to go to theemergency room, if the patient is under 15 years of age, if the patient is outside his or her state of residence, and if the patient had a CT scan or MRI or underwent surgery. Still,providers are unhappy with the policy (Livingston 2018).1-Why did Anthem implement this policy?
Anthem, one of the largest healthcare insurers in the United States, implemented an“avoidable ER” policy to help manage the care of its enrollees. The policy stated thatAnthem would not pay for emergency room visits if the company determined that the visitwas not necessary. The policy, which was instituted in six states beginning in 2015, wasmeant to encourage patients to seek care in appropriate settings. However, providers feelthat this policy might cause patients to avoid emergency treatment, even when it isnecessary. In response to customer and provider complaints, Anthem created severalexceptions: Claims will be covered if a healthcare provider tells a patient to go to theemergency room, if the patient is under 15 years of age, if the patient is outside his or her state of residence, and if the patient had a CT scan or MRI or underwent surgery. Still,providers are unhappy with the policy (Livingston 2018).How is this policy an example of managed care?
Chapter 24 Solutions
The Legal Environment of Business: Text and Cases (MindTap Course List)
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