Public Health Law Map - Beta 5 - Medical and Public Health Law Site

do cost-cutting that the physicians believe would injure patients, or when the plan
just cuts the most expensive physicians, with no efforts to determine if their
expenditures were valid.
To date, there has only been one successful case, Harper v. Healthsource. [Harper v.
Healthsource N.H., Inc., 674 A.2d 962 (N.H. 1996).] Dr. Harper alleged that he was
terminated because the plan resisted his efforts to provide proper patient care. The
court found that New Hampshire did not allow terminations that violated public
policy, and that various state regulations established that there was a policy
protecting the health of MCO patients. The court held the following:
Harper is entitled to proceed upon the merits of his claim that Healthsource’s
decision to terminate its relationship with him was made in bad faith or
violated public policy. In his petition, he asserted that his efforts to correct
errors made in patient records played a role in Healthsource’s decision, and
he argues on appeal that public policy should condemn “an insurance
company which, upon receipt of a letter from a medical provider asking for
assistance in correcting ... records of patient treatments, terminates the
doctor’s services.” [Id. at 967.]
Subsequent courts have not adopted Harper, limiting it to the special circumstances
of New Hampshire law. 14 In the absence of specific state laws or regulations, there
are few limits on the rights of MCOs to terminate physicians’ contracts without
judicial review. At this time, a physician’s only protection will have to be in the terms
of the contract with the MCO and any due process that is provided as part of that
contract. There are many legal challenges to the unfettered power of MCOs in
progress, however it is likely that public concern with the quality of MCO care will
force changes in this area.
G. References - Peer Review
Ankney RN, Coil JA. Residents’ knowledge of the National Practitioner Data Bank.
Acad Med. 1994;69:243.
Ankney RN, Coil JA, Kolff J, Esper E. NPDB: what physicians don’t know can hurt
them. Pa Med. 1994;97:10–14.
Ankney RN, Coil JA, Kolff J, Esper E. Physician understanding of the National
Practitioner Data Bank. South Med J. 1995;88:200–203.
Bok S. Impaired physicians: what should patients know? Camb Q Healthc Ethics.
1993;2:331–340.
Brouillette JN. Bilateral deselection. J Fla Med Assoc. 1995;82:423.
Cohen RJ. Managed care and the physician–patient relationship: implications for peer
review. Md Med J. 1997;46:91– 93.
Corsino BV, Morrow DH, Wallace CJ. Quality improvement and substance abuse:
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