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May 8, 2001, Tuesday
H.M.O.'s Say Doctors' Suit Is No Class Action
In March, the managed care companies won a partial victory from United States
District Judge Federico A. Moreno. He rejected racketeering and other
accusations by the doctors, who contended that the insurers cheated on fees.
A lawyer for Aetna, Richard Doren, said the contentions by doctors and other
health care providers were too complex and varied to be lumped into a single
class action.
Aetna, he said, has 22,000 rates for medical services and Humana, another big
health insurer, has 24,000 rates. In addition, not all the disputed claims were
incorrectly handled by the insurers and were covered by different contractual
terms and as many as 50 state laws.
Most disputes between health care providers and the insurers are resolved
outside court, said John Harkins, a lawyer for Cigna. ''Over 90 percent of
claims are paid as submitted,'' Mr. Harkins said. ''Most of the time, the
problems get worked out.''
Plaintiffs' lawyers representing the doctors and medical groups said the
claims against the insurers would probably unravel without class-action status
because the amounts sought by any single health care provider were relatively
small. A class action allows a handful of people to sue on behalf of thousands
of others similarly harmed by the wrongful actions of a defendant.
''This case, if it's going to proceed, it has to be as a class,'' said Joe
Watley, a lawyer for the plaintiffs. ''While we are arguing procedure, we are
really deciding the whole ballgame.''
The lawsuits contend that the insurers are liable for violating contracts and
misrepresenting business practices to the doctors and organizations that provide
services to the insurers' clients.
The plaintiffs accuse the companies of lumping together itemized bills from
doctors and paying a single, substantially smaller fee.
Janet Humphreys, a member of a team of lawyers pressing the cases against the
managed care companies, said the insurers routinely and systematically underpaid
doctors.
It was not certain when Judge Moreno would rule on the class-action request.
Besides Aetna, Humana and Cigna, UnitedHealth Group and WellPoint Health
Networks are among the defendants.
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