Ama Policy

Managed Care Medical Director Liability H-285.939

Liability-insurer shifting to physician
AMA policy is that utilization review decisions to deny payment for medically necessary care constitute the practice of medicine. (1) Our AMA seeks to include in federal and state patient protection legislation a provision subjecting medical directors of managed care organizations to state medical licensing requirements, state medical board review, and disciplinary actions; (2) that medical directors of insurance entities be held accountable and liable for medical decisions regarding contractually covered medical services; and (3) that our AMA continue to undertake federal and state legislative and regulatory measures necessary to bring about this accountability.

Policy Timeline

Sub. Res. 202, A-98Appended: Res. 201, I-98Reaffirmation A-99Reaffirmed: BOT Rep. 18, I-00Reaffirmation A-07Reaffirmed in lieu of Res. 235, A-11: BOT action in response to referred for decision Res. 235, A-11Reaffirmed: BOT Rep. 7, A-21Reaffirmed: CMS Rep. 4, A-21