Brent Annear
(AUSTIN)-A federal judge today galvanized the patient protection efforts of every physician in the United States into one sharp scalpel now aimed squarely at the nation's profit-driven managed care industry.
In a historic ruling, U.S. District Court Judge Federico Moreno certified the doctors' class action status in a landmark lawsuit filed to combat widespread and chronic abuses by some of the nation's largest for-profit health maintenance organizations (HMOs). The suit identifies Aetna, United Healthcare, CIGNA, Coventry, Wellpoint, Humana Health Plan, Inc, Pacificare Health Systems, Inc, & Anthem Blue Cross Blue Shield as co-conspirators who have violated contracts and defrauded doctors in violation of the federal Racketeer Influenced and Corrupt Organization Act (RICO).
"America's physicians, now united and represented by some of the country's leading medical societies, are determined to restore sanity and fair play to what has become a very disturbing industry," said Archie Lamb, co-lead counsel representing the state medical associations of Texas, California, Florida, Georgia, and Louisiana, and individual physicians. "All of the defendants and many other critics said this day would never come. Our battle is far from over but this is a great day for America's physicians and their patients."
The California Medical Association and individual physicians originally filed the lawsuit in May 2000. With other states joining in as plaintiffs, the lawsuit has since been consolidated with other litigation in the US District Court in Miami against dozens more defendant health plans.
"This is a major victory for a team that faced some long legal odds," said Texas Medical Association President Fred Merian, MD. "But we kept plowing ahead, down after down. Now we've marched the ball nearly the length of the field against one of the best defensive teams in the nation.
"It's 'first and goal' for the medical profession and the patients we serve," he said.
"This ruling confirms what we've known all along -- that for-profit health plans across the nation are systematically denying and delaying our ability to treat patients," said Dr. Ronald Bangasser, president-elect of the California Medical Association. "And if we try to take care of our patients in the way we see fit, we are denied payment or paid at a rate that doesn't even cover the cost of care. We look forward to the opportunity to use the internal documents and testimony of the managed care industry's own executives to prove our case."
Dr. Merian pointed out that TMA and the other medical societies in the case are not seeking monetary damages. "Our goal is to stop this industry from putting profits ahead of patients," he said. "We want to make sure everyone plays by the rules."
"Our legal and public policy goals are inseparable from the patients'. Just like the patient protection laws we fought for, any victory for the physicians in this case is really a victory for our patients."
The case is being heard in the United States District Court, Southern District of Florida, Miami Division: MDL No. 1334; Master File No. 00-1334-MD-Moreno.
TMA is the largest state medical society in the nation, representing more than 37,000 physician and medical student members. It is located in Austin and has 119 component county medical societies around the state. TMA's key objective is to improve the health of all Texans.
- 30 -