New York Physicians Group Sues Six HMOs for Care Denials, Contract Breaches
The New York Medical Society, which represents 27,000 physicians, filed suit against six HMOs Aug. 15 in the state Supreme Court, alleging that the companies engaged in "faulty business practices," the AP/Albany Times-Union reports. In addition to the suit filed by the society, individual society members filed class action suits. The suits allege that the HMOs -- Aetna, Cigna, Empire Blue Cross Blue Shield, Excellus, Oxford and United Healthcare -- have "harmed" beneficiaries and care providers by denying "medically necessary" care, reducing reimbursements, using computer programs that "deny claims based on arbitrary guidelines" and "breaching" contracts with doctors. The society also charges that staffing at the companies is "inadequate to ensure that all claims are processed properly." Medical Society President Dr. Robert Bonvino said that HMOs "have displayed an 'utter disregard' for patients and doctors in New York," adding, "It is a sad comment on the way these insurance carriers conduct business that we have to go to the court system to force them to live up to their obligations" (Stashenko, AP/Albany Times-Union, 8/16). The suits filed by individual doctors ask the court to "bar the HMOs' practices" and the class action suits ask for unspecified monetary damages (Rabin, Newsday/Hartford Courant, 8/16). Similar suits have been filed by physicians in New Jersey and Connecticut courts.
Lining Their Pockets?
Paul Macielak, head of the New York Health Plan Association, which represents health plans including Aetna, Cigna, Oxford and United Healthcare, said, "This lawsuit is not about patients. It is clearly a copycat action aimed at enriching doctors' pocketbooks." He added that "if doctors were truly concerned about patient care, they would use their considerable resources on efforts to improve overall quality of care and reduce medical errors" (AP/Albany Times-Union, 8/16).
