The doctor insisted the man, at age 40, was too young to have heart problems. A few months later, the man died of heart failure. His HMO s contracts with physicians created a system of rewards for those who minimized referrals. Fees were docked for those who made too many referrals. The man s widow filed a wrongful death suit claiming that if her husband knew his doctor could earn a bonus for giving him a minimum level of treatment, he would have sought consultation with a cardiologist at his own expense.
Some health plans fine physicians who write more prescriptions than their contract allows.
Others offer bonuses to doctors who fall within a predetermined budget for hospitalizations and specialist referrals. Some refuse to refer patients to doctors who discuss expensive treatment options with their patients. Embarrassed by bad publicity, some HMOs have rewritten their contracts to eliminate some of the language restricting what doctors can say to patients. President Clinton and Vice President Gore support legislation that would ensure that cost-conscious HMOs and other managed care plans tell patients about all medical options, even the most expensive ones they don t cover. In February 1997, the U.S. Department of Health and Human Services, under orders from the President, banned gag clauses in Medicare and Medicaid.