High court OKs doctors' suits over insurance pay

Justices also declined to hear a lawsuit challenging the HIPAA privacy rules.

By Amy Lynn Sorrel, AMNews staff. Nov. 13, 2006.

The beginning of the U.S. Supreme Court term brought a victory to thousands of Kentucky and Ohio physicians when the high court turned down United Healthcare of Ohio's request to block the doctors' lawsuits alleging health plan price-fixing.

The Supreme Court's Oct. 2 decision clears the way for the Academy of Medicine of Cincinnati to go to trial over claims that United conspired with other health plans to hold down physician reimbursement rates in the area.

The doctors also filed antitrust lawsuits against Aetna, Humana and Anthem Blue Cross and Blue Shield. Those plans settled, although they admitted no wrongdoing.

United held out, arguing that an arbitration clause in the doctors' contracts required them to resolve their differences out of court. The insurer asked the high court to review the case after the Ohio Supreme Court in March rejected its claims and said the doctors' lawsuit could proceed.

Now that the decision stands, doctors have some ability in certain situations to be able to go to court to decide their claims, instead of being forced to negotiate on the insurer's terms, said the Academy of Medicine's attorney, Richard S. Wayne.

United spokeswoman Debora Spano did not respond to the allegations in the lawsuit, but said: "We will continue to vigorously defend the case as it goes forward."

In their lawsuit, the doctors accused United and the other plans of conspiring to fix payment rates, which they claim were 30% below what doctors received in other Kentucky and Ohio areas. The low fees, physicians said, reduced access to care in the region by discouraging them from practicing there, according to court documents.