Judge Throws Out Charges Against UnitedHealthcare, Coventry of Improper Practices in Paying Physicians

U.S. District Judge Federico Moreno on Monday dismissed all claims that remained against UnitedHealth Group and Coventry Health Care in a class-action lawsuit filed on behalf of more than 700,000 physicians nationwide, the Wall Street Journal reports (Fuhrmans, Wall Street Journal, 6/20). In the lawsuit, filed in the U.S. District Court for the Southern District of Florida in 1999, physicians alleged that Aetna, Anthem Blue Cross and Blue Shield, Cigna, Coventry Health Care, Health Net, Humana, PacifiCare Health Systems, Prudential Financial Securities, UnitedHealth and WellPoint Health Networks delayed or denied reimbursements for medical services and illegally rejected claims for necessary services as part of a racketeering conspiracy (Kaiser Daily Health Policy Report, 10/19/05). The other health insurers involved in the lawsuit had previously settled claims against them for a combined $646 million. In his decision, Moreno wrote, "After reviewing thousands of documents, there is simply insufficient evidence of the wrongdoing claimed." He added that, although he did not support the actions of UnitedHealth and Coventry, those actions were "beyond the power of this court." In addition, Moreno wrote, "Those desiring changes in the way health care is provided in America must either look for remedies before Congress or allow the free market to dictate the results."

Reaction
Harley Tropin, co-lead attorney for the physicians, said, "We are extremely disappointed and respectfully disagree with the court's order." He added that the plaintiffs might appeal the decision (Dorschner, Miami Herald, 6/20). Archie Lamb, co-lead attorney for the physicians, also said that UnitedHealth and Coventry could face additional lawsuits related to reimbursement practices because they did not settle the claims against them (Wall Street Journal, 6/20). In a statement, UnitedHealth CEO William McGuire said, "We are pleased with today's decision. Looking ahead, UnitedHealth Group will continue to focus on our overarching goal: working constructively with physicians and other partners to provide all Americans with greater access to affordable, quality health care" (Miami Herald, 6/20).