Pennsylvania-based Capital BlueCross and its subsidiaries, Capital Advantage Insurance Companies and Keystone Health Plan, have agreed to a tentative settlement in the federal class action antiracketeering lawsuit by organized medicine. The lawsuit charges that Capital BlueCross engaged in a conspiracy to improperly deny, delay, and/or reduce payments to physicians from May 22, 1999, through March 12, 2008.
If the judge in the case approves the settlement, Capital will establish a $3.5 million fund for settlement payments to physicians. Texas physicians are eligible to receive compensation from the fund because they are members of the class on whose behalf the lawsuit was filed.
Click on the settlement link above for more information on the case, including how to file a claim.
Medicine's legal case against some of the nation's largest for-profit HMOs began in 1999, when a physician sued Humana, CIGNA, and several other HMOs, alleging they used fraudulent marketing tactics and financial incentives to restrict patient care, thus breaching their obligations under federal law to provide necessary medical care. In 2001, TMA entered the suit against CIGNA and Humana. Many of the lawsuits were consolidated, and eventually Aetna, Blue Cross and Blue Shield, Anthem/WellPoint, Prudential, Highmark, and Health Net settled some of the largest class action health care lawsuits ever settled in the United States. In settling their individual suits, the insurance companies agreed to make pivotal changes in their business practices and restructure the way they administer and pay for medical care.
Action , May 6, 2008