Provider terminations: strategies for risk management.
Managed care organizations should protect themselves from possible legal action by providers whom they have terminated, whether because of professional incompetence or for reasons related to the organization's business goals. Risk management begins by being aware of state and Federal laws regarding contracts, peer review, restraint of trade, discrimination, and retaliation against a provider. Managed care organizations should adopt a set of criteria for providers' professional competence as well as a list of business objectives that might necessitate the deselection of a provider. Because some courts have upheld a provider's right to a "fair procedure," managed care organizations also should consider offering providers an opportunity to respond to the termination decision.
Huntington
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Health Care Division, Chubb Executive Risk, Simsbury, Connecticut, USA.
D004282:Documentation; D006801:Humans; D016365:Liability, Legal; D008329:Managed Care Programs / Q000331:legislation & jurisprudence* / Q000458:organization & administration; D010559:Personnel Management / Q000331:legislation & jurisprudence*; D012308:Risk Management / Q000379:methods*; D014481:United States