Cigna Plans To Appeal Florida Judge’s Injunction on Illinois Settlement with Physicians

Health insurer Cigna yesterday announced that it will appeal a ruling by a federal judge in Miami last week that granted an injunction against the insurer's settlement of class-action litigation in Illinois with physicians over payment practices, the Hartford Courant reports. Cigna filed notice in the 11th U.S. Circuit Court of Appeals that it intends to appeal the injunction, issued on Dec. 12 by Judge Federico Moreno in U.S. District Court in Miami (Hartford Courant, 12/20). In issuing the injunction, Moreno, who is hearing a separate case against Cigna and several other insurers, accused Cigna of "underhanded maneuvers" and of "snookering" judges in both federal courts to achieve the settlement (Martinez, Wall Street Journal, 12/20). The plaintiffs' attorneys in the Miami lawsuit asked for the injunction because they claimed that the Illinois settlement was "woefully inadequate" for doctors and that Cigna had "inappropriately" reached a quick settlement with the Illinois court while the Miami case was ongoing. Cigna had said that the Illinois settlement also would resolve claims from the Miami suit. That lawsuit alleges that Cigna and seven other HMOs delayed or denied reimbursements for health services and rejected claims for necessary medical treatments as part of a racketeering conspiracy.

In the Illinois suit, physicians alleged that Cigna used a program called ClaimCheck to screen their claims for combinations of procedures and then eliminated or reduced payments for some of them, thus paying less than what the doctors billed. Under the settlement, Cigna agreed to pay back claims to 600,000 to 700,000 physicians and other health care providers. In addition, the insurer said it would post explanations of its payment policies and claim coding system on its Web site and appoint a third-party administrator to review claims that have been denied since Jan. 1, 1996 (California Healthline, 12/13). While the Illinois attorneys could file a federal appeal of the judge's decision or move forward and file the settlement in the Miami court, Moreno is not likely to approve the settlement without the support of the plaintiffs' attorneys in Miami, the Wall Street Journal reports (Wall Street Journal, 12/20).