1. Health Net RICO Settlement Checks Are in the Mail
Physicians who filed claims under the Health Net settlement will soon begin receiving their checks. California physicians and physician groups will receive a total of $13.2 million, which represents more than one-third of the $39 million settlement fund.
The pro rata share of the settlement is just under $60. Physicians will be paid based on the total 3 year volume of Health Net claims they submitted, as they indicated on the claim form they filed last fall. Physicians with less than $5,000 in Health Net claims receive one share; those with $5,000 to $49,999 receive five shares; and those with $50,000 or greater receive 10 shares.
Of even greater significance is the settlement’s prospective relief, which is valued at more than $80 million. Health Net has made a binding commitment to change the way it does business with physicians and to put a stop to the underhanded business practices that were used to deny or delay payment to physicians for legitimate claims. These changes are expected to result in increased predictability and speed of claims payment, creating significant value for physicians by reducing time-consuming and costly administrative burdens.
This settlement is the direct result of CMA advocacy and demonstrates the tremendous strength of CMA and its membership. In a historic action six years ago, CMA filed a class action lawsuit against for-profit HMOs in California. Eventually, more than 800,000 physicians and 19 state and county medical associations joined CMA as plaintiffs. The civil racketeering (RICO) lawsuit alleged that the HMOs used fraud and other illegal activities to interfere in the physician-patient relationship. The case, which became the largest class-action health care lawsuit in U.S. history, allowed physicians to air profound grievances against an industry that had arrogantly and unfairly exploited them and harmed their patients for more than a decade.
Of the 10 defendants named in the lawsuit, six have settled (including the merged Anthem/WellPoint/Blue Cross), and three had their cases dismissed by the court. The dismissal of the cases against United Healthcare and Coventry have been appealed.
It is essential that the plans abide by the terms of the settlements. CMA encourages physicians to help ensure these plans keep their promises. If you believe that a health plan is not living up to the terms of its settlement, please contact CMA’s legal department at 415/882-5144 or legalinfo@cmanet.org.
Click here for more information on the RICO lawsuits.
Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.
2. CMA Convenes 150th Anniversary House of Delegates
The 2006 House of Delegates convenes this weekend, October 28-30, at the Sacramento Convention Center. Physicians from across the state will debate and set policy on important health care issues including universal health care, physician-assisted suicide, making California tobacco-free, and improving Medicare and workers’ compensation programs. Other resolutions will address limiting physician participation in torture, mandating HPV testing in middle school, and taxing soft drinks.
During the three-day meeting, about 1,000 physicians—including 499 delegates and nearly 300 alternate delegates representing their geographic communities, ethnicities, and specialties from throughout the state, as well as specialty association representatives, medical students, and others—will address 145 resolutions on key issues that affect the practice of medicine.
On Saturday afternoon, CMA will celebrate the 150th anniversary of its founding in 1856 in Sacramento with a multimedia presentation of CMA’s leadership role in 150 years of medical and health care advances. There will also be a historic display in the meeting hall, and a reception for VIPs from around the country.
Anmol Singh Mahal, M.D., will be inaugurated as CMA’s 139th president. Dr. Mahal, a gastroenterologist from Fremont, is the first CMA president of Sikh origin.
Stay tuned to CMA Alert over the next few weeks for highlights from this year’s House of Delegates.
Click here for more information, including copies of this year’s reports and resolutions.
3. CMA Foundation’s Obesity Prevention Project Receives National Recognition
CMA Foundation’s Physicians for Healthy Communities Initiative was highlighted as a “promising practice” by the Institute of Medicine (IOM) in its recent report on childhood obesity.
The report, “Progress in Childhood Obesity: How Do We Measure Up?” examines the progress made by obesity prevention initiatives in the United States over the past two years. The Physicians for Healthy Communities Initiative was recognized as a community-based approach that “builds on the reality that communities have numerous resources and assets that, if mobilized strategically, can directly impact the health and well-being of children and adolescents.”
The foundation’s Physicians for Healthy Communities Initiative trains physicians to become “physician champions” who advocate for healthy eating and physical activity in their local schools and communities. Physician champions are given the tools, resources, and support needed to carry out successful obesity prevention campaigns in their communities.
The next training session is Saturday, November 18, in Redding. If you would like to schedule a Physician Champion training in your county, contact the foundation at the number below.
Click here for more information.
Contact: Liz Burdick, 916/551-2886 or lburdick@cmanet.org.
4. New at California Physician: CMA’s 2006 Legislative Wrap-Up
Click here to read CMA’s annual “Legislative Wrap-Up” by Dustin Corcoran, CMA's vice president of government relations.
If you would like a hard copy, please call CMA’s Center for Communication at 916/551-2072 and we will fax or mail you a copy.
Contact: Michelle Grant, 916/551-2072 or mgrant@cmanet.org.
5. We Don’t Mean to Nag, But Have Your Completed Your Pain CME Yet?
Early-Bird Registration for CMA’s Pain Conference Ends Next Week
California law (AB 487) requires physicians to complete 12 hours of continuing medical education (CME) in pain management and the care of terminally ill and dying patients. Physicians have until December 31 to satisfy this requirement.
One way to fulfill the requirement is by attending CMA’s pain management conference, “Pain, Palliation, & Politics: Pain Management and End-of-Life Care in California’s Regulatory Environment.” This practical two-day CME program will be offered December 1-2 at the Disneyland Hotel in Anaheim. CMA tailored this program to meet the needs of physicians who do not specialize in pain medicine.
Members pay $335 (nonmembers $600). Register by November 1 and get a $40 early-bird discount.
Click here for more information.
Contact: CMA's seminar line, 415/882-3330 or kdefabrique@cmanet.org.
6. 150th Anniversary Trivia: Did You Know?
Did you know that when the Medical Society of the State of California had its first meeting in March 1856, dues were set at $5 a year? The dues remained relatively consistent until 1900, when they were raised to $10. Two of those $10 went to pay county dues.
CMA is celebrating its 150th birthday! Visit http://www.cmanet.org/150 for other interesting information about CMA history.
7. CMA Member Benefit of the Week: Health Savings Account
Open a CMA Health Savings Account (HSA) today and we’ll deposit $20 in your account. And the set-up fee is waived for CMA members, their families, an their office staff. An HSA is a tax-exempt account used to pay for current health care expenses and save money for future expenses. To maximize your federal tax deductions for 2007, you must complete the enrollment process by December 15.
Visit http://www.cmanet.org/hsa or stop by the Internet café kiosk at the CMA House of Delegates for more information.
Contact: Marsh Affinity, 800/842-3761.
|
No. 2068
