HMO LAWSUIT: Class-Action Suit Filed Against Aetna
San Francisco attorney Fred Furth filed the first-of-its-kind class-action lawsuit against Aetna U.S. Healthcare Thursday, claiming "the company misleads customers by failing to reveal that doctors could have a financial incentive to withhold care." Filed in Contra Costa County Superior Court, the suit refers to Aetna's policy of paying doctors "a fixed monthly fee" of about $40 per patient which must cover all accrued fees for tests, doctor's visits and other provided care. "The doctors get the same sum no matter what services are given. [Physicians] keep money left over after all patients have been treated -- and they have to pay for services that exceed $40" (Associated Press, 10/29). The suit further asserts that the "financial incentive to reduce patient care ... is exacerbated by Aetna's policy of paying financial bonuses to (primary care physicians), based on their ability to keep costs down ... penalizing those doctors who provide a full range of care." Moreover, the suit contends that Aetna's financial policy pushes primary care physicians into "inherent conflicts of interest" that prevent them from "making medical decisions unsullied by financial concerns." The suit seeks an order enjoining Aetna and its officials from further "engaging in these kinds of illegal acts" and requires that the company surrenders "all of their ill- gotten gains and monies wrongfully acquired by means of any acts of unfair competition ... and/or any acts of unlawful advertising." Aetna, one of the nation's largest HMOs, issued a response statement assuring that its companies' "general practice is to provide full disclosure to potential members on how our health plans operate including how physicians are paid and we encourage participating physicians to discuss their financial arrangements with their patients." Yesterday's action is expected to be the first of a "wave of major suits" filed against California HMOs (Weinstein/Rubin, Los Angeles Times, 10/29).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.