Medical expert witnesses are called to testify when patients file lawsuits against physicians or HMOs alleging that capitation played a causal factor in medical malpractice. In Physicians Win Lawsuits Over Inadequate PMPM Rates, Capitation Management Report describes two scenarios:
Non-referral to specialists:
Patients file lawsuits against physicians or HMOs because the primary care physician failed to refer, or to refer in a timely manner, the patient to a specialist. The reason for the non-referral generally cited in the lawsuit is that the doctor received a financial incentive to withhold care.