Health Insurance Companies May Find Themselves Policing Doctors and Hospitals
Cleveland, OH (Law Firm Newswire) June 13, 2013 – Nevada’s courts ruled health insurance companies must monitor the practices of health care professional members.
“Nevada just handed down a ruling with the potential for an octopus-like reach —- a $24 million jury verdict in a hepatitis C outbreak case that indicated health insurance companies are required to watch over the practices of their members,” stated Christopher Mellino, a Cleveland medical malpractice lawyer. “It’s well worth reading: Helen Meyer v. Health Plan of Nevada Inc, Eighth Judicial District Court (Clark County), No. 09A583799; and Bonnie Brunson v. Health Plan of Nevada Inc, Eighth Judicial District Court (Clark County), No. A-10-608344-C.”
Evidently the court found medical professionals related to UnitedHealth Group Inc., accountable for infecting two individuals with liver destroying Hepatitis C. The plaintiffs alleged they were infected due to their doctor using unsafe injection practices during an endoscopy. There were three plaintiffs in the suit, with one being the wife of one of the affected plaintiffs.
“What is unusual about this case is that in medical negligence cases, plaintiffs may only obtain damages from a hospital, doctor or both. In this lawsuit, the argument was made that the UnitedHealth Group should be held accountable, because the doctor was a member of their network and they should have known about his questionable and unsafe practices,” Mellino explained.
If this presumption of liability is upheld on appeal, and brought into play across the nation, it would be a major change for insurance companies. They would find themselves having to police their network physicians, which would likely translate into further restricting what doctor members of the network may do, or raise their malpractice premiums further.
“Even though this particular case was decided based on Nevada’s tort law, other states may take Nevada’s lead and force insurance companies to become Big Brother overseeing member doctors. This would actually bode well for potential victims of medical malpractice, as it would offer them protection in the form of a third party making sure the doctor is doing their job the right way. Given that most medical malpractice victims routinely get the short end of the stick with capped damages, this may be a welcome addition to their arsenal of protection,” suggested Mellino.
Based on evidence that may have been withheld at trial, it appears the doctor may have been a one-off exception in that he hid his actions from everyone, including other health agencies and the federal government. Whether that is the case and that information does come out on appeal, the can of worms that represents medical malpractice accountability and justice for innocent victims has been opened.
Plaintiffs in this case are seeking punitive damages for over $1 million. Since any award would be capped, it may ultimately come out at $240 million. The clock is ticking. If the case is upheld, patient care may take on a new dimension, with insurance companies watching over the physician’s shoulder.
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