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HMO malpractice: have the floodgates opened?

E Hansen
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Abstract

The U.S. Supreme Court's holding in Pegram v. Herdrich--that decisions by an HMO's physician employees in which eligibility issues and reasonable medical treatment are inextricably mixed are not fiduciary acts under the Employee Retirement Income Security Act (ERISA)--was applauded by the managed care industry. By delineating issues on which it was not ruling, however, the Court's decision may have given a boost to additional lawsuits against managed care plans on both ERISA and malpractice grounds.

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Employee Retirement Income Security ActHealth Care RationingHealth Maintenance OrganizationsHumansMalpracticeReimbursement, IncentiveUnited StatesJournal ArticleLegal Case

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BibTeXRIS

E Hansen. 2000. HMO malpractice: have the floodgates opened?. https://pubmed.ncbi.nlm.nih.gov/11142969/

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Federal enforcement in group and individual health insurance markets. Final rule.

This rule makes final an interim final rule that details procedures we use for enforcing title XXVII of the Public Health Service Act as added by the Health Insurance Portability and Accountability Act of 1996, and as amended by the Mental Health Parity Act of 1996, the Newborns' and Mothers' Health Protection Act of 1996, and the Women's Health and Cancer Rights Act of 1998. Specifically, we are responsible for enforcing title XXVII requirements in States that do not enact the legislation necessary to enforce those requirements, or otherwise fail to substantially enforce the requirements. We are also responsible for taking enforcement actions against non-Federal governmental plans. The regulation describes the process we use in both enforcement contexts. This final rule deletes an appendix to the interim rule that listed examples of violations of title XXVII and corrects the description of a cross-reference, but makes no substantive changes to the interim final rule.

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