LAWSUIT: Ruling Denies Right of MDs to Collect From HMOs
A San Diego court has refused to hear a case that would allow doctors to seek reimbursement directly from HMOs when medical groups falter, the Sacramento Bee reports. The case arose from the 1998 bankruptcy of a physicians group which left thousands of doctors unpaid for the care they had provided. On their behalf, the California Medical Association sued eight major health plans, saying they were "ducking their fundamental responsibility" and should pay the doctors. But in a ruling issued January 6, San Diego Superior Court Judge Janis Sammartino threw the case out of court, citing an earlier ruling by the California Department of Corporations, which regulates HMOs. CMA spokeswoman Trish Bell asserted that this is not the end of the matter. "We're going to continue to fight for this," Bell said. Dr. Jack Lewin, CMA's executive vice president, said that eventually, "HMOs need to come to the table ... and figure out a way to get along with providers." HMO executives aren't denying the tough spot that providers are in. "One has to have sympathy for physicians who aren't being paid, but the solution is not to have health plans pay twice," Walter Zelman, president of the California Association of Health Plans, said. He added that providers should be more cautious when contracting with medical groups (Fisher, 1/12).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.