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Judge OKs class action against health plans

600,000 physicians are included in the massive lawsuit, but patients' suits must go forward individually.

By Tanya Albert, amednews staff. Oct. 14, 2002.

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If you're one of the estimated 600,000 physicians who has treated patients insured by some of the biggest health plans over the past decade, you stand to reap the benefits of a lawsuit working its way through the federal court system.

The payoff could be financial. It could also mean a change in the way health plans reimburse physicians.

U.S. District Judge Federico A. Moreno in September granted class-action status to lawsuits filed against Aetna Inc., CIGNA Corp., Humana Inc., Foundation Health Systems Inc., PacifiCare Health Systems, Prudential Insurance Co., UnitedHealthcare and Wellpoint Health Networks Inc.

"Doctors have been looking forward to seeing movement, and that is what they are seeing right now," said California Medical Assn. President-elect Ronald Bangasser, MD. "This is really viewed as an important step."

Lawsuits filed by medical associations and individual physicians from around the country -- combined and assigned to Moreno, of the U.S. District Court, Southern District of Florida Miami Division -- accuse the companies of breaching contracts and defrauding physicians, in violation of the federal Racketeer Influenced and Corrupt Organizations Act. Bundling, downcoding and arbitrarily denying claims are a few of the methods physicians say health plans used to reduce payments.

"Our allegations are that it is a systematic scheme and we've proven that enough to go forward as a class action," said Archie Lamb, co-lead counsel representing individual doctors and medical associations in California, Florida, Georgia, Louisiana and Texas. "The battle in this litigation is far from over, but today is a great day for physicians and their patients." [...]