Managed Care: Litigation


Summary

This practice note provides an overview of litigation issues that may arise from managed care operations. It addresses contract disputes involving members (subscribers) of managed care organizations and participants in health plans that deliver healthcare services in a managed care format. It also addresses negligence claims against managed care organizations, ancillary organizations involved in the pre-authorization process, and healthcare service providers. Finally, it addresses disputes between healthcare providers and managed care operations about payment for member care. The criminal elements of any of these issues, such as those that can arise from claims for reimbursement from government payer, are beyond the scope of this practice note.