HMO lawsuit claiming fraud goes to court - 07/04/05

Article from the San Antonio Express-News Online

When Joan Smelik died June 1, 2001, in a North Side hospital, her husband of 47 years knew something wasn't right.

To begin with, when she was admitted to the North Central Baptist Hospital 19 days earlier, the emergency room doctor wanted to know the name of her kidney doctor.

"She didn't have one," said John Smelik, a retired business executive, recalling his wife's last trip to the hospital.

After his wife's funeral, Smelik said he took the advice of an attorney and began collecting copies of all her medical records. The couple's two grown children, Janice Ann and John Andrew, began to write down all that they remembered about the doctor visits and hospital stays they endured with their mother. Full Story...

Humana, HMO case to proceed ; High court won't halt class action - 07/04/05

Article from the Kentucky Courier-Journal Online

For the second time, the U.S. Supreme Court has declined to block proceedings in a lawsuit accusing Humana and six other managed-care companies of conspiring to underpay doctors.

 The class-action suit, on behalf of 600,000 or more physicians, claims HMOs programmed their computers to systematically lower doctors' reimbursements.

 The companies had sought to put off a trial until portions of the suit are heard in arbitration. But the Supreme Court declined to review a federal appeals court ruling that the trial can go forward this fall in Miami. Full Story...

Supreme Court Declines To Block Physicians' Lawsuit Against Health Insurers - 07/04/05

Article from the kaisernetwork.org

The U.S. Supreme Court has declined to delay proceedings in a lawsuit filed on behalf of about 600,000 physicians accusing Humana Health Plan and six other health insurers of conspiring to systematically lower doctors' payments (Howington, Louisville Courier-Journal, 6/1). In the class-action suit, physicians allege that Humana, PacifiCare Health Systems, United Healthcare, WellPoint Health Networks, Anthem Blue Cross and Blue Shield and Health Net delayed or denied reimbursements for health services and illegally rejected claims for necessary medical treatments as part of a racketeering conspiracy. U.S. District Judge Federico Moreno in Miami had postponed the trial in the racketeering lawsuit until Sept. 6, instead of the first week in March. Full Story...

Some Insurers Measuring Physicians' Fees, Quality To Determine Costs, Health Plan Members' Share of Payment - 07/04/05