HMO LAWSUIT: Court Dismisses Suit Claiming Aetna ‘Fraud’

      Philadelphia's 3rd U.S. Circuit Court of Appeals Friday upheld a lower court decision that Aetna U.S. Healthcare does not violate racketeering laws in its advertising and membership materials, and ruled that the plaintiffs did not prove that they received inadequate care or were denied care because of the structure of the health insurance giant's HMO plan, the AP/Las Vegas Sun reports. Plaintiffs filed the class-action lawsuit in April 1999 on behalf of nearly six million Aetna customers, arguing that "Aetna promised quality medical care but encouraged widespread cost-cutting and penalized doctors who didn't increase their patient load." They maintained that customers paid too much for their health care, adding that such "abuses ... constituted a pattern of fraud." Aetna officials conceded that the insurer's advertising claims that the firm was committed to "maintaining and improving quality health care" were "mere puffery," but contended such claims were not fraudulent. Aetna spokesperson David Carter said that the ruling was significant because it showed that the plaintiffs' allegations of inadequate care "would have to be alleged and proven on an individual basis," rather than as a class-action suit (8/11).