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The slippery slope of utilization management

The initial intent was to review the medical necessity of hospital stays, various procedures, and tests. Companies created "guidelines" to determine if medical decisions were made appropriately and if services were utilized correctly. If they were deemed "unnecessary," the people and places performing them would not be paid.
United States Centers For Medicare Medicaid Services Justice Department Antitrust Division Unitedhealth Group Medicaid Services Change Healthcare

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