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.