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PROFESSIONAL ISSUESSupreme Court sends suits against 2 health plans to arbitrationA majority of managed care cases still await a decision from 11th Circuit Court of Appeals on class-action status.By Tanya Albert, AMNews staff. April 28, 2003. Arbitration is the appropriate place for discussions to begin between two health care plans and physicians who have gripes about how the companies reimbursed them, the U.S. Supreme Court said in April. Physicians accusing PacifiCare Health Systems Inc. and UnitedHealth Group Inc. of violating the Racketeer Influenced and Corrupt Organizations Act argued that they should be able to go straight to court because an arbitrator wouldn't have authority to award the treble damages RICO allows. Two lower courts agreed with the physicians. But the high court disagreed, saying it is unclear whether the arbitration agreements actually prevent an arbitrator from awarding treble damages under RICO. The agreements prohibit punitive damages. But the court said that while courts have considered treble damages purely punitive in some cases, courts also have considered treble damages purely compensatory. The arbitration clause then wouldn't automatically prevent treble damages from being awarded, the court said. "Since we do not know how the arbitrator will construe the remedial limitations, the questions whether they render the parties' agreements unenforceable and whether it is for courts or arbitrators to decide enforceability in the first instance are unusually abstract," the court said in an 8-0 opinion. "It would be premature for the court to address them. The proper course is to compel arbitration." PacifiCare spokesman Tyler Mason said the company was pleased with the decision. "We believe strongly that arbitration is the quickest and easiest way to resolve issues," he said. [...]Full text of AMNews content is available to AMA members and paid subscribers.
Copyright 2003 American Medical Association. All rights reserved.
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