Patient Suit Against Humana to Go Forward, Suits Against Five Other MCOs Dismissed

A Miami federal judge on June 12 "partially dismissed" several lawsuits filed on behalf of health plan members alleging that six managed care organizations illegally denied medical care, the Wall Street Journal reports. U.S. District Court Judge Federico Moreno dismissed allegations that Aetna Inc., Health Net Inc., Cigna Corp., UnitedHealth Group and PacifiCare Health Systems Inc., violated both federal civil racketeering laws and the Employee Retirement Income Security Act by offering "undisclosed financial incentives forcing physicians to cut medical costs by denying care." Moreno, however, did allow racketeering charges against Humana to proceed, and said that plaintiffs' attorneys could refile their claims against all the defendants later this summer, indicating that more evidence was needed to proceed (Geyelin, Wall Street Journal, 6/13). In addition, Moreno scheduled a hearing for July 24 to determine whether all the health plan members' cases should be certified as a class-action suit, a status sought by the plaintiffs and opposed by the insurers (Freudenheim, New York Times, 6/13).

Parallel Universe
The Journal report's that yesterday's ruling "mirrored one he issued in March" against several doctors and state medical associations accusing managed care companies of "conspiring to reduce and delay payments to physicians" (Wall Street Journal, 6/13). Regarding that case, Moreno yesterday "postponed a decision on a plaintiffs' request for access to computerized data collected by the insurance companies," leading lawyers to "speculate that [he] intended to deal simultaneously with the requests for company documents in the plan members' and doctors' cases" (New York Times, 6/13). Last month, Moreno told the plaintiffs in the physician case -- which names Aetna, Cigna, Humana, Foundation Health Systems, PacifiCare Health Systems, Prudential Insurance Co. of America, UnitedHealth Group and Wellpoint Health Networks as defendants -- that they could proceed with the discovery phase of the trial (American Health Line, 5/10).