Medicine's legal offensive against managed care

New litigation aimed at managed care might garner physicians some respect from health plans.

Editorial. April 23/30, 2001.

Bad news for some of the nation's major health plans: Physicians are getting over their collective case of liticaphobia (that's fear of lawsuits). Late last month, the state medical associations of Georgia, California and Texas joined with 20 individual physicians in a class action lawsuit against some of the biggest health plans in the country.

The 109-page racketeering complaint reads like an encyclopedia of managed care dirty tricks, including systematic downcoding, wrongful denial of payments, coercion of physicians into unsound contracts and questionable capitation tactics.

Litigation and legislation are just about the only options left against such powerful and entrenched interests. This case joins the ranks of similar legal action in Connecticut, as well as perhaps dozens of other physician or patient lawsuits around the country. Meanwhile, the AMA is taking the national legislative lead in pushing for patients' rights legislation on Capitol Hill.

This litigation may take years to resolve, but even during that time it will help keep the heat on health plans and can result in other bonuses. Consider that the tobacco industry litigation uncovered 33 million pages of industry documents. What profits-before-patients smoking guns might health plan file cabinets yield? [...]