Politics & policy

Insight into federal and state health care legislation & CMS regulation

Georgia Weighs HMO Malpractice Liability, Mandates

A bill before the Georgia legislature that would allow patients to sue HMOs for malpractice has created an unusual alliance between physicians and plaintiffs' lawyers, both of whom support the measure. Health plans and business groups oppose the bill, which the Georgia Chamber of Commerce calls a "huge threat" to employers.

The legislation would hold an insurer liable for harm resulting from refusal to pay for a treatment it covers but decides is not necessary in a particular case. Insurers would have to exercise "ordinary diligence," the bill says, and adhere to what it calls — but does not define — general practices and standards for health care professionals. An injury to an enrollee "resulting from a want of such ordinary diligence shall be a tort for which a recovery may be had."

Supporters of the bill argue that it would actually lead to fewer malpractice lawsuits because the threat of being sued will make managed care plans less likely to deny coverage. Opponents dismiss this argument and say that trial lawyers will be the main beneficiaries. The state HMO association says that if the bill becomes law, premiums will rise and many Georgians will lose their health coverage. Unlike a similar measure already on the books in Texas, the Georgia proposal would not require an independent review before someone could file a malpractice lawsuit.

Georgia legislators also are weighing at least 18 bills that would mandate coverage of specific conditions, including obesity, diabetes, ovarian cancer and venereal disease, as well as a proposal that would mandate minimum hospital stays of up to three days for various types of breast cancer surgery.

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