News in brief - June 20, 2005

Supreme Court declines managed care suit - Ohio association selects new leaders

Supreme Court declines managed care suit

The U.S. Supreme Court May 31 said it would not take up a case in which several health maintenance organizations wanted justices to rule that physicians' lawsuits against the insurers must go to arbitration in lieu of a class-action lawsuit.

The ruling means that lawsuits against Humana, PacifiCare Health Systems, United Health Care, WellPoint Health Networks and Anthem Blue Cross and Blue Shield will go forward, with a trial scheduled for September in federal court in Miami. Anthem and WellPoint have merged since the lawsuits were initially filed.

Physicians and some medical societies sued the nation's largest health plans in federal courts, accusing the HMOs of systematically denying or downcoding claims.

The lawsuits were combined and sent to U.S. District Court Judge Federico Moreno in the Southern District of Florida. The Supreme Court's ruling upholds Moreno's and the 11th U.S. Circuit Court of Appeals' rulings that the lawsuits could proceed without arbitration.

Physicians were pleased with the latest ruling, Archie C. Lamb, co-lead counsel for the physicians and medical societies, said.

"America's physicians look forward to their day in court and the opportunity to shed more light on the unfair and abhorrent billing practices of these defendants," he said in a statement.

Earlier in May, Health Net and Prudential Insurance Co. of America announced a settlement with physicians. In 2003, Cigna Corp. and Aetna signed similar settlements with physicians, agreeing to pay millions to compensate doctors for past claims and promising to make changes to the way they pay physicians.

Ohio association selects new leaders

Molly A. Katz, MD, a Cincinnati-area obstetrician-gynecologist, recently was installed as president of the 15,000-member Ohio State Medical Assn. during the organization's annual meeting in Cleveland. Emergency medicine physician James M. Sudimack, MD, was named president-elect.

Dr. Katz, whose one-year term will end in May 2006, has been a member of the OSMA since 1982. She also is a past president of the Academy of Medicine of Cincinnati. As OSMA president, she said she would like to focus on physician issues, such as medical liability and reimbursements, and work to educate doctors about technology uses and pay-for-performance initiatives.

Dr. Sudimack has been an OSMA member since 1981 and serves on the association's Focused Task Force on State Legislation and Committee on Emergency and Disaster Care. He will serve a one-year term as president-elect, then be installed as president in May 2006.