- Center for Ethical Practice - https://centerforethicalpractice.org -

Managing Your Managed Care Contracts

Ethical & Practical Implications of Provider Contracts

Each provider contract you sign will have slightly different terms; each managed care company will have different policies and impose different limitations. We will review some implications of various written and unwritten understandings, consider their ethical implications, and use case examples to discuss how we can avoid some of the potential  ethical pitfalls.


I. Ethics Codes & Professional Standards

Fees & Reimbursement

Continuity of Care

Confidentiality & Disclosure

Informed Consent

II. Contracted Understandings

Actual Words vs Hidden Meanings & Unwritten Rules

III. Practical Issues

Fee Setting; Private Fee Agreements

Appealing Adverse Decisions

Standards of Care

One-Sided Indemnification

Reimbursement Limitations

Gag Clauses

Restrictive Covenants

Term-Of-Contract Considerations

Causes for Termination of Contract

Performance Evaluations

IV. Ethical Implications & Pitfalls

Informed Consent Complications

Confidentiality Limitations

Capitations & Other Financial Incentives

Ethical Responses to Potential Liability Issues

Potential Abandonment Issues