Likely areas the Accountable Care Organizations can be sued:
- Medical treatment – Either denying treatment or being sued for vicarious liability based on the patients assumption that the physician is employed by the Accountable Care Organization (whether or not that is true).
- Coordination of Care/Case Management– Claims by the patient that the treatment plan was inadequate or was to favor the finances of the Accountable Care Organization at the peril of the patient.
- Employment Practices Liability– Claims from employees or third parties (i.e. contracted MD’s) who make claims of discrimination or wrongful termination. Deselecting an MD from the panel has led to these types of claims.
- Billing Errors and Omissions – Underpaying providers, or others, and violating contracts due to systems errors or intentional acts.
- Provider Selection – Contracting, termination, and payment.
- Coverage determinations or other medical necessity claims – Patients claim that healthcare was rationed and Accountable Care Organization relies on its contracts with its payers.
- Federal Compliance – HIPAA, HITECH, PPA CA and other state and federal compliance issues.
These are the leading areas that ACOs can be exposed to a claim. Certainly this isn’t a complete list, because the ACO evolves, as its risks do.
At HCP National we have ACO managed-care Errors and Omissions and Directors and Officers insurance with Employment Practices Liability insurance. We also can include HIPAA and HITECH and other risks from data breach coverage within the E&O and D&O coverage. With proper coverage, these risks for the Accountable Care Organization can be managed.
The challenge though is choosing adequate limits. Often the exposure can be greater than the limits that a reasonable size ACO can obtain. Therefore it’s wise for all ACO’s to consult with their attorneys and risk managers to determine what the best approach is to minimize ACO risk.
We have been providing our expert services to ACO’s for almost two decades. If you have questions about your policy or coverage, please contact one of our specialists for assistance.