Pennsylvania’s Medical Care Availability and Reduction of Error Act

What Is the Pennsylvania MCARE Act?

The Medical Care Availability and Reduction of Error (MCARE) Act is a crucial piece of legislation that governs medical malpractice insurance and patient compensation in Pennsylvania. Enacted in 2002, the MCARE Act was designed to ensure that healthcare providers have adequate malpractice coverage while also protecting patients who suffer from medical negligence.

Why Was the MCARE Act Introduced?

The MCARE Act was introduced in response to the rising medical malpractice insurance crisis in Pennsylvania. At the time, increasing malpractice claims made it difficult for physicians and hospitals to obtain affordable liability coverage. The Act aimed to stabilize the system by creating a state-managed MCARE Fund that provides excess malpractice coverage when private insurance limits are exceeded.

What Does the MCARE Act Do?

The MCARE Act serves two key purposes:

1. Regulating malpractice insurance by requiring physicians, hospitals, and healthcare providers to contribute to the MCARE Fund for excess coverage.
2. Ensuring fair patient compensation for individuals harmed by medical negligence, especially in cases where damages exceed a provider’s primary insurance limits.

For healthcare providers, understanding MCARE is essential for maintaining compliance and avoiding penalties. For patients, knowing how MCARE functions helps in navigating malpractice claims and seeking appropriate compensation.

 

How the MCARE Fund Works

The MCARE Fund is a state-managed reserve that provides excess liability coverage for medical malpractice claims exceeding a healthcare provider’s private insurance policy limits. The fund was established to ensure that patients receive full compensation, even when damages surpass the financial limits of private malpractice insurance policies.

Who Pays into the MCARE Fund?

All licensed physicians, hospitals, and healthcare providers in Pennsylvania are required to contribute to the MCARE Fund. This includes general practitioners, specialists, hospitals, and medical groups. The surcharge is determined annually by the Pennsylvania Insurance Department and varies based on the type of provider, medical specialty, and malpractice risk.

How Are MCARE Surcharges Calculated?

The MCARE surcharge amount is based on:

• The type of provider (e.g., general practitioner, surgeon, hospital).
• The malpractice risk associated with the provider’s medical specialty.
• The insurance premium costs for the provider’s primary malpractice policy.

For example, high-risk specialties such as surgery, obstetrics, and anesthesiology typically have higher malpractice risks and are therefore required to pay higher MCARE surcharges.

How the MCARE Fund Covers Claims

If a malpractice claim exceeds a provider’s private insurance coverage, the MCARE Fund pays the remaining balance. For example, if a patient wins a $1.5 million malpractice lawsuit, and the provider’s private insurer covers $500,000, the MCARE Fund will pay the remaining $1 million.

 

Medical Malpractice Insurance Requirements Under MCARE

Minimum Coverage Requirements

Under the MCARE Act, all physicians and healthcare facilities in Pennsylvania must carry medical malpractice insurance that meets the following minimum coverage limits:

• $500,000 in primary malpractice insurance through a private insurer.
• Excess coverage provided by the MCARE Fund for claims exceeding $500,000.

This two-tiered system ensures that patients receive full compensation while providers remain financially protected from catastrophic claims.

Who Must Comply with MCARE Insurance Mandates?

MCARE insurance requirements apply to:

1. All licensed physicians practicing in Pennsylvania.
2. Hospitals and healthcare facilities that provide medical services.
3. Medical groups and specialty practices, including surgeons, OB-GYNs, and anesthesiologists.
4. Nurses and therapists in certain high-risk medical settings.

What Happens If Providers Fail to Comply?

Failure to carry the required malpractice insurance can result in:

1. Financial penalties and fines from regulatory agencies.
2. Potential loss of medical licensure for non-compliance.
3. Personal liability for malpractice claims, which could lead to financial ruin.

Healthcare providers must ensure that their malpractice insurance policies are up to date and that they fulfill their MCARE Fund contribution obligations.

 

Filing a Medical Malpractice Claim Under MCARE

Step 1: Proving Medical Negligence

To file a malpractice claim under MCARE, a patient must prove that medical negligence occurred. This means demonstrating that:

• The healthcare provider had a duty of care toward the patient.
• The provider failed to meet the standard of care expected in the medical field.
• The patient suffered harm as a direct result of this failure.

This often requires expert medical testimony from professionals who can assess whether the provider’s actions deviated from standard medical practices.

Step 2: The MCARE Fund’s Role in Malpractice Claims

If a malpractice claim results in damages exceeding the provider’s insurance coverage, the MCARE Fund steps in to cover the remaining amount. This ensures that patients receive full compensation, even when claims surpass private insurance limits.

Step 3: Compensation and Payouts

The MCARE Fund provides compensation for:

• Medical expenses resulting from malpractice-related injuries.
• Lost wages due to the inability to work.
• Future earning potential lost due to permanent injuries.
• Pain and suffering damages awarded by courts.

 

MCARE Compliance Requirements for Healthcare Providers

What Are the Legal Obligations?

Pennsylvania healthcare providers must:

1. Maintain malpractice insurance that meets state requirements.
2. Pay annual MCARE Fund assessments as determined by the Pennsylvania Insurance Department.
3. Report medical errors in compliance with Pennsylvania law.
4. Ensure adherence to all MCARE regulations to avoid legal penalties.

Consequences of Non-Compliance

Failure to comply with MCARE regulations can result in:

1. Hefty fines and legal penalties for healthcare providers.
2. Increased malpractice insurance rates due to non-compliance.
3. Potential suspension or loss of medical licensure.

Physicians and healthcare institutions must stay informed about their MCARE obligations and ensure they are meeting all legal requirements.

 

Frequently Asked Questions About the Pennsylvania MCARE Act

What is the Pennsylvania MCARE Act?

The Pennsylvania MCARE Act, or the Medical Care Availability and Reduction of Error Act, is a law that governs medical malpractice insurance and patient compensation in Pennsylvania. It was enacted to ensure that healthcare providers maintain adequate liability coverage and that patients receive fair compensation when harmed by medical negligence.

Who is required to participate in the MCARE Fund?

All licensed physicians, hospitals, and certain healthcare providers practicing in Pennsylvania must contribute to the MCARE Fund. Participation is mandatory for those covered under the law, and failure to comply can result in penalties, fines, or loss of licensure.

How does the MCARE Fund work?

The MCARE Fund serves as an excess coverage fund that pays for malpractice claims exceeding a healthcare provider’s private malpractice insurance limits. Physicians and hospitals are required to carry primary coverage of at least $500,000, and the MCARE Fund covers any amounts above this threshold, ensuring that patients receive full compensation.

What does the MCARE Fund cover?

The MCARE Fund covers financial damages awarded in medical malpractice cases that exceed the provider’s private insurance policy. This can include medical expenses, lost wages, pain and suffering, and other economic and non-economic damages awarded in a malpractice lawsuit.

How is the MCARE surcharge calculated?

The amount a healthcare provider must pay into the MCARE Fund is based on the type of provider, their specialty, and their malpractice risk. The Pennsylvania Insurance Department determines the surcharge annually, with higher-risk specialties such as surgery, obstetrics, and anesthesiology typically paying higher amounts.

 

Contact Matzus Law, LLC Today

If you need legal assistance regarding an MCARE claim, insurance compliance, or malpractice lawsuit, it is highly advisable to consult a qualified medical malpractice attorney. Legal professionals can help you understand your rights, responsibilities, and options under the MCARE system.

If you are facing an MCARE-related legal issue, contact Matzus Law, LLC today for expert guidance.