Doctors' case against HMOs remains intact

Physicians and health insurance companies both find something to be pleased about in a federal ruling on a series of wide-ranging lawsuits.

By Tanya Albert, AMNews staff. March 19, 2001.

Doctors are a step closer to having their day in court against some of the nation's biggest managed care companies.

While a federal judge in Miami earlier this month dismissed some charges that doctors had brought against eight health insurance companies, he held that charges that the HMOs breached their contracts with physicians had enough merit to go forward.

Physicians and the managed care companies both are finding reasons to claim victory in the judge's opinion.

"Doctors will finally get a level playing field with the insurance companies," said Birmingham, Ala., lawyer Archie C. Lamb Jr., who is heading up the California Medical Assn.'s lawsuit against three of that state's largest health plans. "That's something they haven't had before."

Over the past 18 months, physicians and patients across the country have filed lawsuits against managed care companies accusing the companies of things such as violating the Racketeering Influenced and Corrupt Organizations Act, and failing to pay claims promptly. Because the lawsuits were similar, dozens of them were sent to the U.S. District Court's South District of Florida's Miami Division for pretrial hearings. The cases involved eight HMOs, including Aetna Inc., Prudential, Cigna Corp., and Humana Inc.

This month the District Court ruled on the HMOs' motions to dismiss the lawsuits.

Specifically, the court:

• Held that breach-of-contract claims could go forward.
• Dismissed both state prompt-payment statutory claims and RICO claims, without prejudice, giving physicians until March 26 to rewrite their cases to more clearly substantiate the claims.