ABSTRACT
Utilization management (UM) systems can substantially impact the delivery of care. Therefore, UM decisions have the potential for harm to consumers and are subject to legal liabilities. The issues surrounding the exact nature and extent of such liabilities are complex, and are unfolding both through case law and the implementation of new legislation and regulation. It is beyond the scope of this discussion to detail and explore all the intricacies of this topic. Instead, this chapter will focus on major cases in recent years that have been construed as establishing the legal underpinnings of the UM process. 1
