What you don't know can hurt you: why managed care organizations have a legal duty to disclose the use of financial incentives to limit medical care.
This article, winner of the 2000-2001 American Health Lawyers' Student Writing Competition, examines the conflicting policy goals at the heart of managed care--particularly in the use of financial incentives for physicians who limit their use of referrals and expensive diagnostic tests. While conceding the legality of such incentives, the author contends that Managed Care Organizations (MCOs) have a legal duty to disclose their existence to beneficiaries. After analyzing the basis for imposing a duty to disclose, the author proceeds to examine such issues as the proper timing, level, and extent of disclosure.
Rost
Kerry Toth
KT
krost@kentlaw.edu
D003363:Cost Control; D003954:Diagnostic Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008329:Managed Care Programs / Q000331:legislation & jurisprudence*; D010816:Physician Incentive Plans / Q000191:economics* / Q000331:legislation & jurisprudence; D012017:Referral and Consultation / Q000191:economics / Q000706:statistics & numerical data; D012052:Reimbursement, Incentive; D012941:Social Responsibility; D014342:Truth Disclosure; D014481:United States