Medical Director’s Liability
Physicians who also serve as medical directors in MCOs face special legal problems. Under ERISA, a medical director is a statutory fiduciary of the health plan because the ERISA defines a fiduciary as anyone who can allocate the plan’s assets. Under state law, a medical director also has common law fiduciary responsibilities if the medical director makes decisions about the care of individual patients. This happens whenever the medical director looks at a patient’s records or talks to a treating physician or an NPP about the patient and then makes any decision about that patient’s care, including the decision that the care is fine and no changes need to be made.