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Negligent Provider Selection

Negligent Provider Selection

Definition

A key source of liability for a managed care organization (MCO), that arises from an MCO's negligence in selecting (or retaining) a healthcare provider who is deficient in delivering healthcare services, and such deficiency produces an injury. MCOs owe a duty to their subscribers to investigate the competence of their healthcare providers and to exclude those who pose a foreseeable risk of harm. Coverage for this exposure is afforded by a managed care liability insurance policy. Such claims have also been made against employers in which employees allege that the employer negligently selected an MCO or health insurer under an employee benefit plan.

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