Sacrificing patients for profits: physician incentives to limit care and ERISA fiduciary duty.

Dividing loyalties: caring for individuals and populations.

Are health maintenance organization (HMO) physicians obligated to act exclusively in the interest of the individual patient? Does the mere existence of financial incentives to limit patient care violate this obligation? To what extent are doctors responsible for the population of patients served by a health plan, or for promoting a fair distribution of health care among society as a whole? Thes...

Structural Impediments to Breach of Fiduciary Duty Claims

Stephen D. Rosenberg, Esq. is a partner in the McCormack Firm, a Boston litigation firm, where he heads the firm’s ERISA Practice Group. He has extensive experience in ERISA litigation, including breach of fiduciary duty cases and class actions, as well as in commercial litigation and arbitration, insurance coverage and bad faith, and intellectual property disputes. He publishes a blog at www.b...

Pegram's significance for managed health care.

On June 12, 2000, in a unanimous opinion written by Justice Souter, the U.S. Supreme Court, reversing a decision of the U.S. Court of Appeals for the Seventh Circuit, held in Pegram v. Herdrich that “mixed eligibility” decisions made by HMO physicians are not fiduciary decisions under ERISA. In so ruling, the Court upheld the concept that the reasonable sharing of financial risk with HMO networ...

Employer sponsored health benefit plans under ERISA after Pegram v. Herdrich: the fiduciary duty argument and mixed eligibility versus treatment decisions.

HEALTH LAW AND ETHICS ERISA Litigation and Physician Autonomy

THE FEDERAL EMPLOYEE RETIREMENT INCOME SECUrity Act (ERISA) looms like a colossus over the managed care environment. Originally enacted to regulate employer-sponsored pension plans, the statute also covers health care benefits established by self-insured employers (with few exceptions, such as for governmental employees). According to recent Department of Labor estimates, ERISA applies to appro...