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Potential liability in utilization review: the risk grows.

The Medical Staff Counselor

|January 4, 1992

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Physicians and payors face potential liability when using cost containment measures in utilization review. A California case highlights these risks for both parties involved in healthcare cost management.

Area of Science:

Healthcare Law
Medical Economics
Health Policy

Background:

Cost containment measures in utilization review are a significant concern for healthcare providers and payers.
Physician and payer liability associated with these cost-saving strategies is a complex legal and ethical issue.

Purpose of the Study:

To analyze the potential legal liability of physicians and payers.
To examine a specific California case concerning cost containment in utilization review.

Main Methods:

Case study analysis of a recent California legal decision.
Discussion of legal principles related to physician and payer responsibilities.

Main Results:

The case provides insights into the legal ramifications of utilizing cost containment measures.

Related Experiment Videos

Potential liabilities for both physicians and payers are delineated.

Conclusions:

Physicians and payers must carefully consider legal implications when implementing cost containment strategies.
Understanding liability is crucial for navigating utilization review processes effectively.