Appeals Court Agrees To Decide Whether Doctors’ Class-Action Lawsuit Against HMOs Can Proceed
In an "important legal victory" for HMOs, a three-judge panel of the 11th U.S. Circuit Court of Appeals in Atlanta on Nov. 20 unanimously decided to review the class-action status of a lawsuit filed by 600,000 doctors nationwide against several of the nation's largest HMOs, the Atlanta Journal-Constitution reports. U.S. District Judge Federico Moreno in Miami certified the case as class-action in September (Rankin, Atlanta Journal-Constitution, 11/22). The lawsuit, filed against Aetna, United Healthcare, Cigna, Coventry Health Care, WellPoint Health Networks, Humana Health Plan, PacifiCare Health Systems and Anthem BlueCross BlueShield, alleges that the HMOs delayed or denied reimbursement for health services and rejected claims for "necessary medical treatments" as part of a racketeering conspiracy (Kaiser Daily Health Policy Report, 11/11). The court could take up to one year to decide on the class-action status of the lawsuit.
'Big Win' for HMOs
Legal experts said that a class-action lawsuit would place the HMOs "under pressure to pay out mountainous settlements because it would be too risky to go to trial," the Journal-Constitution reports. "This is a big win for the HMOs," Barbara Radnofsky, chair of the American Bar Association committee on managed care litigation, said, adding, "The implications of class-action certification on any defendant can be so devastating." Jeffrey Klein, an attorney for the HMOs, said that the HMO industry prefers to settle payment disputes between HMOs and physicians in individual negotiations, which he called "much less costly for all concerned" (Atlanta Journal-Constitution, 11/22).
