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Question ID 17120

The following situations illustrate per se violations of federal antitrust laws:
Situation A - Two groups of providers agreed among themselves that each provider will do
business with health plans only on a fee-for-service basis.
Situation B - In order to avoid competing with each other, two independent, competing
physician-hospital organizations (PHOs) divide the geographic areas in which they will
market their services.
From the following answer choices, select the response that correctly identifies the types of
per se violations illustrated by these situations.

Option A

Situation A: price fixing; Situation B: horizontal division of markets

Option B

Situation A: price fixing; Situation B: tying arrangement

Option C

Situation A: horizontal group boycott; Situation B: horizontal division of markets

Option D

 Situation A: horizontal group boycott; Situation B: tying arrangement

Correct Answer A
Explanation


Question ID 17121

The National Association of Insurance Commissioners (NAIC) adopted the Health
Maintenance Organization Model Act (HMO Model Act) to regulate the development and
operations of HMOs. One true statement regarding the HMO Model Act is that the act

Option A

includes mental health services in its definition of basic healthcare services

Option B

authorizes only one state agency-the department of insurance-to regulate HMOs

Option C

requires HMOs to place a deposit in trust with the state insurance commissioner for the purpose of protecting the interests of enrollees should an HMO become financially impaired

Option D

requires HMOs that wish to offer a point-of-service (POS) product to contract with a licensed insurance company to provide POS options to plan members

Correct Answer C
Explanation

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