Managed Care Errors and Omissions Liability

You and your organization can be sued for the actions you take or fail to take that are considered to affect someone or the organization negatively. Healthcare Professional Liability (also known as Healthcare Errors & Omissions) policies provide coverage for actions brought against the Organization, its officers, directors, medical directors, employees and staff for errors or omissions committed in the daily activities of the organization.

McPhee & Associates has access to every E&O carrier that works in the managed care industry.

Summary of Product:

Insurable Costs:

  • Legal Fees
  • Damages (may includepunitive damages)
  • Settlements

Activities and Exposure to Loss:

  • Vicarious Liability – including bodily injury (typically excluded in E&O policies) ostensible agency or apparent agency (*)
  • Credentialing (including forms of provider selection)
  • Peer Review
  • Utilization Review
  • Claims Processing
  • Marketing/Advertising
  • Management/Administration of services
  • HIPAA Privacy Issues – provided by some carriers

*Organization is named in a suit because of an affiliation with the person or organization sued.

Insurable Events:

  • Wrongful denial of benefits
  • Failure to properly credential providers
  • Unlawful restraint of trade
  • Exclusive dealing (brought by a provider denied access to a panel)
  • Improper Utilization Review (rationing care)
  • Failure to process or negligent processing of claim bills or claim information
  • Misleading advertising or marketing
  • Improper conduct of Peer Review Panel
  • Discrimination against an enrollee or a panel provider
  • Improper staffing

To learn more about Managed Care Errors & Omissions services at McPhee & Associates—contact us via email or call (818) 541-7900.

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