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. Moreno made the decision to delay the trial after the insurers appealed his earlier rulings, actions which postponed the taking of depositions, providing witness lists and deciding on how to handle procedural motions (Kaiser Daily Health Policy Report, 1/3). According to the lawsuit, the insurers violated the Racketeer Influenced and Corrupt Organizations Act, which allows the collection of triple damages in fraud cases. Goldman Sachs analysts on Tuesday wrote in a research note that the court's action could prompt remaining defendants to settle. However, a member of the insurers' defense team said that the physicians' claims "will be revealed to be baseless no matter what forum the doctors choose." Washington, D.C., attorney Brian Boyle said that whether the case is before an arbitrator or a court, the insurers "are entitled to insist on a careful analysis of each of the doctors' claims for additional reimbursement. And we believe that those claims will not survive individual scrutiny" (Louisville Courier-Journal, 6/1). Aetna and Cigna, which also were named as defendants in the lawsuit, have settled with the physicians for a total of $1.01 billion (Kaiser Daily Health Policy Report, 1/3).