OHIO: Medical Board Tries to Assert Liability Control

      "In a move that could be called both sneaky and inventive," the Ohio State Medical Board is attempting to circumvent the General Assembly's authority on health plan liability by asserting its own jurisdiction over medical directors. In February, the board asked state Attorney General Betty Montgomery (R) to affirm its assertion that medical directors "are making medical judgments every time they are asked to consider an insurance claim," and it "should be free to nail" them for bad decisions just as it would the other 30,000 doctors it oversees. Tom Dilling, the board's government affairs officer, said, "A physician working for a health-insuring corporation should be held to the same standards in regard to their decision-making as any other physician." But Jady Johnson, president of the Ohio Association of Health Care Plans, said, "We think the law is very clear that utilization review is not the practice of medicine." The General Assembly, in debating a managed care reform bill, has removed both a health plan liability provision as well as a section that "would have required health insurers to name doctors licensed in Ohio as their medical directors." State Rep. Dale Van Vyven (R) said, "[I]t is common practice to have doctors outside of Ohio acting as medical directors. So we stripped the whole thing out of there." Montgomery's decision on the issue is expected by late summer (Somerson, Columbus Dispatch, 6/13).