Managed Care Companies Request Reversal of Class-Action Status Decision in Physician Lawsuit
Managed care companies facing a class-action lawsuit filed by 700,000 physicians on Thursday asked the 11th U.S. Circuit Court of Appeals in Atlanta to reverse the case's class-action status, the AP/Fort Lauderdale Sun Sentinel reports (Wyatt, AP/Fort Lauderdale Sun Sentinel, 9/12). The doctors allege that HMOs including UnitedHealthcare, Coventry Health Care, WellPoint, Humana Health Plan, PacifiCare Health Systems and Anthem BlueCross Blue Shield have engaged in a racketeering conspiracy by delaying or denying reimbursement for health services and by illegally rejecting claims for necessary medical treatments. Last September, U.S. District Judge Federico Moreno approved class-action status for the physicians' lawsuit against the HMOs, ruling that the HMOs "systematically obstruct, reduce, delay and deny payments and reimbursements to health care providers" (California Healthline, 11/11/02). Aetna and Cigna, which were originally named as defendants in the lawsuit, have since settled with the physicians for a total of $1.01 billion. Attorneys for the managed care companies say that class-action status should be revoked because each physician's case against the insurers is different and because the lawsuit involves physicians in multiple states, which have different laws. The cases allege that HMOs use computer programs to bundle services to get rates lower than the agreed-upon fee by a few dollars for each service. Jim Tilghman, an attorney for the physicians, said, "There's no way to challenge it on an individual basis without challenging the whole computer system." The three-judge circuit court panel did not indicate when it would rule. A trial has been tentatively set for June (AP/Fort Lauderdale Sun Sentinel, 9/12).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.