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Managed Care Law and Liability
by Sander Marc Rabin
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Results Managed Care Law and Liability
Managed Care Organizations and Liability BrainMass 1 Liability of MCOs managed care organizations such as HMOs health maintenance organizations and PPOs preferred provider organizations Where does the liability lie for the managed care organization when the MCO personnel Third Party Liability and Recovery Guidance NOTE Third party liability TPL requirements for managed care programs such as STAR Health MMP CHIP and Dental may vary from the other STAR managed care programs please refer to TPL contract language specific to the other managed care programs not listed above BILLING REQUIREMENT EXAMPLES1 Managed Care Plan Liability An Analysis of Texas and Managed Care Plan Liability An Analysis Of Texas And Missouri Legislation Patricia A Butler JD DrPH November 1997 Background As increasing numbers of Americans receive health care Liability for managed care decisions the Employee However the federal Employee Retirement Income Security Act ERISA shields managed care organizations from liability when they are part of an employee group health plan governed by ERISA Unlike patients with other types of insurance patients in ERISA health plans do not have a malpractice remedy for a managed care organizations negligence Managed Care EO Liability Travelers Insurance Managed Care Errors and Omissions Liability Insurance for the Managed Care Industry Travelers’ Managed Care Errors and Omissions Liability coverage is managed in conjunction with Chatham Insurance Services to ensure coverages are tailored to address unique managed care exposures Physician Liability and Managed Care A Philosophical GEORGIA STATE UNIVERSITY LAW REVIEW VOLUME 19 NUMBER 3 2003 PHYSICIAN LIABILITY AND MANAGED CARE A PHILOSOPHICAL PERSPECTIVE Dionne Koller Fine INTRODUCTION Rapid and farreaching changes in healthcare delivery have Managed Care EO OneBeacon Healthcare Group Managed Care EO and DO for organizations that seek coverage for today’s changing environment In today’s complex and challenging healthcare environment managed care organizations face unique risks and liability exposures around network design and other issues associated with the Affordable Care Act’s provisions and requirements Medical Liability and Managed Care Organizations The bill later died in committee It would have created a statutory medical malpractice cause of action against managed care organizations SB 512”An Act Concerning Liability of Providers and Managed Care organizations for Denials of Medically Necessary Care” received a public hearing by the Insurance and real Estate Committee Medicaid Third Party Liability Coordination of Benefits Third Party Liability TPL refers to the legal obligation of third parties to pay part or all of the expenditures for medical assistance furnished under a State plan Coordination of Benefits COB refers to the activities involved in determining Medicaid benefits when an enrollee has coverage through an individual entity insurance or program that is liable to pay for health care services Managed Care Managed Care is a health care delivery system organized to manage cost utilization and quality Medicaid managed care provides for the delivery of Medicaid health benefits and additional services through contracted arrangements between state Medicaid agencies and managed care organizations MCOs that accept a set per member per month capitation payment for these services
