Fighting Back: Holding Blue Cross and Other Health Plans Accountable; What the RICO Settlements Mean to You and Your Practice
[Posted 11/17/05]

CMA, AMA, and the Santa Clara County Medical Society (SSCMS) are hosting a one-day seminar to educate physicians about the RICO settlements and what the settlements mean to their practices. The seminar will be Tuesday, November 29, 8 a.m. to 1 pm at the SCCMS offices in San Jose. Physicians in surrounding counties are also encouraged to attend.

To date, six major health plans (Blue Cross/Anthem/Wellpoint, Aetna, Cigna, Health Net, Prudential, and Humana) have settled CMA’s RICO lawsuit, which alleges that the health plan defendants have engaged in fraud and extortion in wrongfully denying payment to physicians, in violation of federal racketeering law.

Although the settlements have provided nominal cash payments to physicians, their true value lies in the prospective relief that is estimated to be worth more than $1 billion to physicians over the next few years.

Seminar participants will learn how to maximize their relief under the settlement by identifying inappropriate health plan business practices—including improper health plan claim denials—and holding the health plans accountable for failures to comply with the settlement terms. Under the settlement, the compliance process will be overseen by a court-appointed mediator.

Registration is $49 for CMA members, $149 for nonmembers.

Click here to download a registration form.

Contact: Aileen Wetzel, 916/444-5532 or awetzel@cmanet.org.