Managed Care

 

Class-Action Suit By 600,000 Docs Heading To Court

MANAGED CARE February 2005. © MediMedia USA
News and Commentary

Class-Action Suit By 600,000 Docs Heading To Court

MANAGED CARE February 2005. ©MediMedia USA

Two roads diverged in a lawsuit and Aetna and Cigna took the one less traveled by.

Ok, Robert Frost probably would not find much to inspire him in a lawsuit that about 600,000 physicians have filed against some of the biggest health plans in the country, but maybe John Grisham would. And both sides are definitely seeking poetic justice, especially in light of the U.S. Supreme Court's refusal last month to hear an appeal by the health plans to stop the class-action suit.

The court's action, or inaction, means that the 11th Circuit U.S. Court of Appeals ruling last September will stand. And the lower court said that the class-action suit can proceed.

The health plans had argued that the individual contracts the physicians had signed were so varied that it made a class action not practicable.

The physicians say that from 1990 to 2002 insurers programmed their computers so that the machines automatically underpaid doctors for services.

Named in the suit are Humana, PacifiCare, UnitedHealthcare, WellPoint, Anthem, and Health Net.

Aetna and Cigna had also been named but decided to settle out of court in 2003 for about $1.1 billion.

Yes, that seems steep, even by the standards of American industry. But now some suggest that a court ruling against the remaining HMOs would be even more costly.

The Blue Cross and Blue Shield Association, which faces similar provider lawsuits, tells Bloomberg News that the top court's decision "places heavy pressure" on the six health plans to follow Aetna and Cigna's lead and settle out of court "rather than roll the dice and possibly incur potentially crippling — even bankrupting — damages awards."

Meanwhile, both sides have not been idle while waiting for the Supreme Court's decision. They have been preparing for trial, and now they have a tentative start date.

U.S. District Judge Federico Moreno in Miami says that he will hear the case on Sept. 6. He had originally planned to begin in March. Stay tuned.

Meetings

2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014
6th Semi-Annual Diagnostic Coverage and Reimbursement Conference Boston December 4–5, 2014
Customer Analytics & Engagement in Health Insurance Chicago December 4–5, 2014
Pharmaceutical and Biotech Clinical Quality Assurance Conference Alexandria, VA December 4–5, 2014
9th Semi-Annual Medical Device Coverage and Reimbursement Conference San Diego December 5, 2014
8th Annual Medical Device Clinical Trials Conference Chicago December 8–9, 2014
HealthIMPACT Southeast Tampa, FL January 23, 2015