Managed care liability for medical malpractice and utilization review.

Area of Science:

• Healthcare Law
• Medical Malpractice
• Managed Care Liability

Background:

• Managed care subscribers increasingly face harm from physician negligence.
• Legal recourse often extends beyond physicians to managed care plans.
• Understanding liability is crucial for both patients and healthcare organizations.

Purpose of the Study:

• To review legal theories used by managed care subscribers alleging harm.
• To examine defenses employed by managed care organizations against such claims.
• To provide insights into the legal landscape of managed care liability.

Main Methods:

• Literature review of legal theories and case law.
• Analysis of common law and statutory claims against managed care plans.
• Examination of defense strategies utilized by managed care organizations.

Main Results:

• Five primary theories of liability are frequently asserted against managed care plans.
• Managed care organizations utilize various defenses to mitigate liability.
• The legal framework for managed care liability is complex and evolving.

Conclusions:

• Managed care plans face significant legal exposure for physician negligence.
• Awareness of liability theories and defenses is essential for managed care organizations.
• Further legal and policy developments are anticipated in this area.