Physician Groups with Individually Negotiated Health Net Contracts Have Until November 25 to Request Contracts Be Amended to Include RICO Settlement Reforms
[Posted 10/27/05]

As you know, CMA and more than a dozen other state medical associations agreed in May to a settlement with Health Net, one of the health plan defendants in the RICO class-action lawsuit pending before U.S. District Judge Federico Moreno in Miami.

Physician groups with more than five physicians who have “individually negotiated” Health Net contracts will not automatically benefit from key aspects of the settlement’s prospective relief unless they notify Health Net by November 25 that they want to amend their contracts to include these reforms.

Physician groups with more than five participating physicians must notify Health Net in writing if they want to take advantage of key settlement terms, including but not limited to the right to receive capitation payments retroactively from a patient’s date of enrollment. Groups may not pick and chose among these group-specific settlement terms; they must agree to all of the terms in order to benefit from any of them. Since these terms all benefit physician groups, most if not all groups will benefit by making this election and sending a timely letter.

Physicians with standard form contracts and individual physicians and physicians groups with five or fewer physicians with nonstandard contracts will in most cases automatically benefit from all of the settlement relief.

Contact: CMA's legal information line, 916/444-5532 or legalinfo@cmanet.org.