rico ruling

Federal Court Ruling a Huge Victory for HMO Patients and Doctors

In a historic ruling, U.S. District Judge Federico Moreno granted class action status in a landmark lawsuit filed to combat widespread and chronic abuses by some of the nation's largest for-profit HMOs. The suit identifies Aetna, United Healthcare, CIGNA, Coventry, Wellpoint, Humana Health Plan, Inc., Pacificare Health Systems, Inc, and Anthem Blue Cross and Blue Shield as co-conspirators who have violated contracts and defrauded doctors in violation of the federal Racketeer Influenced and Corrupt Organization Act (RICO).

"This ruling confirms what we've known all along—that for-profit health plans across the nation are systematically denying and delaying our ability to treat patients," says Dr. Ronald Bangasser, CMA president-elect. "And if we try to take care of our patients in the way we see fit, we are denied payment or paid at a rate that doesn't even cover the cost of care."

CMA and individual physicians in California originally filed the lawsuit in May 2000, naming as defendants Foundation Healthcare, Pacificare, and Wellpoint. The state medical associations of Florida, Georgia, Louisiana, and Texas, along with individual physicians from these states, have joined CMA as plaintiffs, which is being tried in U.S. District Court in Miami.

"America's physicians, now united and represented by some of the country's leading medical societies, are determined to restore sanity and fair play to what has become a very disturbing industry," says Archie Lamb, co-lead counsel for the plaintiffs. "All of the defendants and many other critics said this day would never come. Our battle is far from over but this is a great day for America's physicians and their patients."

Business Wire News Release:
US District Court Grants Class Action Status
for Suit Filed by 700,000 Doctors Against Leading HMOs

CMA News Release:
Ruling a Big Victory for HMO Patients and Doctors