N.J. doctor's suit becomes class action -
08/04/04
Article from
Modern Physician
Online
A New Jersey physician won a round in a state court against the state's
largest HMO when a judge certified three classes of plaintiffs in a lawsuit
against Horizon Blue Cross Blue Shield of New Jersey. The suit alleges breach
of contract and violations of prompt-payment laws.
John Sutter, M.D., a pediatrician from Clifton, N.J., filed suit in April 2002
covering a period of claims activity from 1996 up through the present date.
On Tuesday, New Jersey Superior Court Judge James Rothschild issued an opinion
certifying that Sutter and a class of about 40,000 New Jersey physicians could
go forward with a suit regarding prompt-payment issues.
Rothschild denied class certification for physicians of all specialties on an
element of Sutter's suit regarding downcoding, bundling of claims and refusal
to recognize modifiers. The judge allowed the suit to go forward on those
issues as a class limited to Sutter and other pediatricians, but added he
would allow nonpediatricians to apply for injunctive relief on downcoding,
bundling and refusal to recognize modifiers.
Physician feedback encouraged as health plan settlement shakes out - 08/04/04
Article from AMED
News
If you don't think CIGNA and Aetna are living up to their lawsuit settlement agreements, here's what you need to do to report problems.
Physicians, medical societies and lawyers who hammered out agreements with Aetna and CIGNA that will change the way the health plan giants handle physician claims have no reason to believe the changes won't go as promised.
But they aren't taking any chances.
The 40 medical societies that signed on to each agreement will help in making sure that the companies follow the settlement agreements and change their business practices.
"It's one of those trust-but-verify situations," said Connecticut State Medical Society Executive Director Timothy B. Norbeck. CSMS is one of the original medical societies to sue Aetna and CIGNA over the way they paid physicians. The Medical Assn. of Georgia, Texas Medical Assn., California Medical Assn. and more than a dozen other medical societies also were part of the original lawsuits.
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