As reported two weeks ago in CMA Alert, checks were recently mailed to the nearly 12,000 California physicians and physician groups that filed claims under the Health Net settlement. CMA has learned that California physicians received a total of $13.5 million, which represents over one third of the $40 million settlement.

Physicians who filed claims under the Humana settlement have also begun receiving their checks. While Humana is not a major insurance industry player in California, more than 6,000 California physicians and physician groups who filed claims will receive more than $5 million collectively.

Of even greater significance is the RICO settlements’ prospective relief, which is valued at $1 billion. Humana, Health Net, and the other settling health plans have made binding commitments to change the way they do business with physicians and to put a stop to 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 a long legal battle fought by CMA on behalf of its member physicians and their patients. In a historic action six years ago, CMA filed a civil racketeering (RICO) lawsuit against for-profit HMOs in California, alleging that HMOs were using 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, forced into the open the unfair practices of an industry that had harmed physicians and negatively affected patient care 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 dismissals of the cases against United Healthcare and Coventry have been appealed.

Please help us ensure that these plans abide by the terms of their settlements. If you believe that a health plan is not living up to the terms of its settlement, contact CMA at 800/786-4CMA (4262).