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AHIP Medical Management AHM-540 Question # 78 Topic 4 Discussion

AHIP Medical Management AHM-540 Question # 78 Topic 4 Discussion

AHM-540 Exam Topic 4 Question 78 Discussion:
Question #: 78
Topic #: 4

The Midwest Health Plan delegated utilization review (UR) activities to the Tri-City Utilization Review Organization. After Tri-City improperly recommended denial of payment for services to a Midwest plan member, the plan member filed suit. The court ruled that Midwest was responsible for Tri-City’s actions because of the relationship between Midwest and Tri-City. This situation is an illustration of a legal concept known as


A.

vicarious liability


B.

fraud


C.

a tying arrangement


D.

subdelegation


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