Cigna Proposes $19M Settlement in Lawsuit by Specialty Providers
Cigna officials on Monday announced a proposed $19 million settlement to end a class-action lawsuit filed in Miami U.S. District Court by medical specialists, the Hartford Courant reports. The lawsuit also names Aetna, Health Net, Anthem, UnitedHealth Group and WellPoint Health Networks, none of which has announced settlements. The lawsuit's allegations are similar to those made in a class-action suit against the insurers filed by about 600,000 physicians (Levick, Hartford Courant, 12/14). The physician lawsuit alleges that Cigna, Aetna, Humana Health Plan, PacifiCare HealthSystems, Prudential Insurance, UnitedHealthCare, WellPoint and Health Net delayed or denied reimbursements for health services and illegally rejected claims for necessary medical treatments as part of a racketeering conspiracy. Cigna and Aetna in February settled with the physicians for a total of $1.01 billion (Kaiser Daily Health Policy Report, 9/2).
Settlement Details
Under the proposed settlement, Cigna would:
- Establish an $11.55 million fund to compensate providers based on the volume of claims they submitted over 15 years;
- Pay up to $7.5 million for plaintiff attorneys' fees;
- Expand Internet referral, certification and claims management capabilities for specialty providers;
- Post on the company Web site details about claim coding policies, fee schedules and guidelines on payment to specialty providers;
- Limit most fee reductions in the schedules to less than once a year;
- Create an independent external review process for billing disputes; and
- Convene an advisory committee of specialty providers to address concerns.
Cigna does not admit guilt in the settlement, the Courant reports. It is not known how many providers will take part in the settlement; however, at least 210,000 are expected to participate, including optometrists, acupuncturists, physical and occupational therapists, nurse midwives, nurse practitioners, nurse anesthetists, nutritionists, audiologists, speech and hearing therapists, and orthotics and prostheses professionals. The specialists have the option of donating their settlements to a medical association, such as the American Psychological Association or American Chiropractic Association.
Response
Attorneys for the specialists maintain that the plaintiffs' claims are justified, but they said they agreed to settle because of concerns about time and finances. They also said that Cigna was seeking to enforce clauses limiting the number of providers who could participate in the suit. In a written statement, attorneys said the agreement "confers substantial benefits" on providers. Cigna Chief Clinical Officer W. Allen Schaffer said in a statement that the agreement "makes it easier for us to work closely with specialty providers to ... ensure patient safety and deliver the high-quality care patients need and expect." Officials for Cigna also said the settlement would not impact the company's finances, as the settlements already were included among previous earnings charges. The settlement is subject to approval by Judge Federico Moreno of the Federal District Court in Miami. A hearing date has not yet been scheduled (Hartford Courant, 12/14).
