Suit Continues Against Other
Major HMOs
Aetna and representatives of over
700,000 physicians, state and other medical societies received final judicial
approval of the landmark settlement agreement in the national class action
pending in the federal court for the Southern District of Florida. The
agreement, entered into on May 21, 2003, includes industry-leading improvements
to physician-related business practices that set new levels of transparency in
paying claims, including a National Advisory Committee of Practicing Physicians
to provide advice to Aetna on issues of importance to physicians.
Co-lead counsel for the
Plaintiff Physicians, Archie Lamb, noted after the hearing that “this settlement
agreement continues to be haled by all as a truly landmark accord that
recognizes the importance of the physicians’ input in all healthcare decisions.
Aetna’s agreement to be bound by the innovative industry guidelines embodied in
the settlement demonstrates that only by a commitment to partnership can the
true goal of quality healthcare be achieved.”
The settlement has led to
major improvements in health care including industry-leading improvements that
streamline communication between physicians and Aetna, reduce administrative
complexity in the claims payment system. Physicians will now have less
administrative burdens allowing them more time for direct patient
care.
U.S. District Court Judge
Federico Moreno granted preliminary approval of the settlement agreement in
Miami in June. The settlement agreement that received final judicial
approval today was in response to a lawsuit filed to combat widespread and
chronic abuses by some of the nation’s largest for-profit health maintenance
organizations (HMOs). The suit identified Aetna, as well as United Healthcare,
CIGNA, Coventry, Wellpoint, Humana Health Plan, Inc, Pacificare Health Systems,
Inc, & Anthem Blue Cross Blue Shield as co-conspirators who have violated
contracts and defrauded doctors in violation of the federal Racketeer Influenced
and Corrupt Organization Act (RICO).
A settlement agreement
with defendant CIGNA was reached in September with preliminary approval granted
by Judge Moreno. The lawsuit against all other defendants continues before
Judge Moreno.
The case is being heard
in the United States District Court, Southern District of Florida, Miami
Division: MDL No. 1334; Master File No. 00-1334-MD-Moreno. Additional background
information on the case can be found online at www.hmocrisis.com . This site
includes a complete copy of the settlement agreement as well as the joint press
release announcing the settlement on May 21, 2003.
