HMO PAYMENTS: CMA Unveils Suit Against Eight Leading Plans
At least eight major HMOs face charges by the California Medical Association that the plans have failed to ensure payments to physicians for treatment, resulting in "patients' losing access to medical care." Reuters/Los Angeles Times reports that the CMA plans today to discuss the details of the lawsuit and reveal which HMOs have been targeted. The suit was filed July 15 in San Diego Superior Court, but has remained under wraps until now (9/8). The Orange County Register notes that last week, the CMA released a PricewaterhouseCoopers report pointing out that 30% of the state's medical groups have been forced out of business in recent years because of rising medical costs and declining payments from insurers. The report predicts that about 10% of the remaining groups are expected to go bankrupt this year (see yesterday's CHL). David Olson, spokesperson for Foundation Health Systems Inc., one of the largest managed care insurers in the country, believes the CMA is "engaging in extreme scare tactics"; it is not yet known if his HMO is named in the lawsuit (Reuters/Los Angeles Times, 9/8). Other plans deny they are "shirking their responsibility" and blame medical group mismanagement as the source of physicians' troubles. Cory Black, spokesperson for the California Association of Health Plans, said, "The question is, should an HMO be made to pay twice for the same care? We believe not" (Crabtree, Orange County Register, 9/8).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.