Study: HMOs Not Reporting Doctors

Managed care organizations are failing to report their physicians' malpractice claims and disciplinary actions to a government database that aims to protect patients from
poorly performing doctors, a federal study has found.

Health maintenance organizations reported only 715 such actions from 1990 to 1999.

This is at a time when the insurance plans became the dominant form of health care in the United States, the May report by the inspector general of the Department of Health and Human Service said.

Nearly 100 million Americans are enrolled in such plans.

The study said the likely explanation for the low level of reporting is that HMOs have become "bill paying organizations" that are focusing less on clinical oversight and more on administration.

Carmella Bocchino, vice president of the American Association of Health Plans, told The New York Times in Tuesday's editions that many HMOs apparently did not realize they were required to tell the government when doctors were disciplined.

The IG report found "plausible" that some reporting lapses could be attributed to misunderstandings about reporting requirements called for an outreach program "to clear up any such misunderstandings."

The data bank was created by a 1986 federal law that requires insurance companies, hospitals and state and federal regulators to report malpractice payments and disciplinary actions against all health care providers.

The information isn't available to the public, but health care organizations and licensing boards use the information in their reviews of doctors. Some lawmakers have been making a push to open the database to patients.

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