News in brief - Nov. 27, 2006

N.J. doctors and Horizon reach settlement in reimbursement lawsuit - Canada sees increasing number of physicians return home - New members for Calif. medical board

N.J. doctors and Horizon reach settlement in reimbursement lawsuit

New Jersey physicians who sued the state's Blues plan won't receive any reimbursements under a proposed settlement agreement. However, Horizon Blue Cross Blue Shield of New Jersey has agreed to "continue significant business practice improvements ... to increase transparency in payment of claims," the HMO and the doctors said in a joint statement.

Changes Horizon agreed to include:

Making fee schedules available on a CD-ROM or electronically.
Giving participating physicians 90 days notice of material changes to its contracts, policies and procedures.
Reducing fees no more than once a year, if at all.
Recovering overpayments to physicians no more than 18 months after the original payment.
Revoking a determination of medical necessity only with evidence of fraud, error or material change in the patient's condition.

Horizon also agreed to pay the physicians $6.5 million in attorney's fees. If the court approves the Oct. 16 settlement, it would end a class-action lawsuit that accuses the HMO of routinely delaying and underpaying doctors' claims. Horizon did not admit any wrongdoing. About 40,000 doctors are part of the settlement. A final hearing in the Essex County Superior Court is scheduled for Dec. 20.

The settlement does not preclude doctors who are involved in a separate lawsuit against Horizon, brought by the Medical Society of New Jersey, from receiving damages.

Canada sees increasing number of physicians return home

A physician shortage in Canada has helped put the country in a position of gaining more physicians than it is losing to the United States for the second year straight. Work-force watchers said higher reimbursements and better facilities may be encouraging physicians to come back to Canada.

The Canadian Institute for Health Information reports that 122 Canadians moved to the United States to train in 2005, while 169 doctors who did training in America returned to their homeland for a net gain of 47 doctors. In 2004, 202 physicians left the United States for Canada, while 162 Canadian doctors moved south, primarily to do residencies.

New members for Calif. medical board

The Medical Board of California welcomed four new board members at its November meeting: Reginald Low, MD; Janet Salomonson, MD; John Chin, MD; and Frank Zerunyan. Gov. Arnold Schwarzenegger appointed them to the board.

Dr. Low is a professor and chief of cardiovascular medicine at the University of California, Davis, School of Medicine. Dr. Salomonson is a plastic surgeon and medical director of the Cleft Palate Center at Saint Johns Health Center. Dr. Chin is a cardiologist and partner at Cardiovascular Care Medical Group. Zerunyan is the new public member of the board.