Physicians Get $2 Billion+ From RICO Suits

Physicians have earned more than $2 billion from settlements of federal class-action anti-racketeering lawsuits against the nation's largest for-profit HMOs by TMA and 18 other state and county medical societies and physician representatives, according to the Physicians Advocacy Institute(PAI). The lawsuits involved Aetna, CIGNA, Health Net, Humana, Anthem/WellPoint, and many Blue Cross and Blue Shield plans.

The greatest benefit for most physicians came from insurers changing their business practices, which the settlements required. Changes included paying claims promptly, separately recognizing and paying for modifiers 25 and 59, and notifying physicians 90 days in advance of any material adverse changes in their contracts.

In addition, funds from the settlements created the Physicians Foundation. Its grant-making programs advance the work of practicing physicians and improve the quality of health care for all Americans. TMA Executive Vice President/Chief Executive Officer Louis J. Goodman, PhD, is the foundation president.

PAI enforces compliance with the terms of the settlements. Dr. Goodman is the institute's treasurer, and TMA General Counsel Donald P. "Rocky" Wilcox, JD, serves on its board of directors. 

Action, May 15, 2012