STORMY WEATHER. A Queens, N.Y.-based management services organization has filed suit in New York County Supreme Court against Norwalk, Conn.-based Oxford Health Plans, seeking $115 million in compensatory and $1 billion in punitive damages.
The suit charges Oxford with everything from breach of contract to conspiring to destroy the MSO by fraudulently and intentionally withholding money from it.
Comprehensive Health Care is the medical management company of Complete Medical Care and United Medical Care. The two groups, which represent about 350 Queens doctors and 30,000 patients, contract exclusively with Oxford, and CHC administers all interaction with the health plan.
CHC President Oscar Fukilman, M.D., says Oxford has defaulted on contract payments and bypassed the MSO altogether, making payments directly to participating providers. He contends the two groups, which contract exclusively with Oxford, will have lost $7.5 million to $8 million in cash revenues from August until Dec. 31.
Oxford, which has been the subject of previous physician complaints about denied and delayed claims (see September, page 56) issued a statement in which it disputed the amount of money withheld to date, saying it is less than $5 million. It said it began paying physicians directly because it had reports the groups were not properly paying their affiliated physicians.
UNDER NEW MANAGEMENT. Carondelet Medical Group, a division of three-hospital Carondelet Health System in Tucson, Ariz., says it has acquired the practices of four physicians from Talbert Medical Management, an affiliate of MedPartners.
The primary-care doctors are located in Green Valley, about 30 miles south of Tucson.
Dan Topp, administrator of Carondelet Medical Group, says his organization did not buy the doctors' practices. Instead, it is leasing equipment and other assets from MedPartners and employing the physicians. MedPartners had said it would exit Arizona before announcing Nov. 11 that it would get out of the physician practice management business.
Since August, Carondelet has grown to 75 doctors, including 15 who came from Thomas-Davis Medical Centers, which bankrupt FPA Medical Management closed in August.
NEW DOCTOR IN THE HOUSE. Family practitioner Ernest Fletcher, M.D., joined eight incumbent doctors in getting elected to the U.S. House of Representatives.
Fletcher, a Republican, won an open seat representing the Lexington, Ky., area. Fletcher was the only one of 18 physician nonincumbents to win.
The MDs re-elected were Tom Coburn, R-Okla.; John Cooksey, R-La.; Greg Ganske, R-Iowa; Donna Christian-Green, D-Virgin Islands; Jim McDermott, D-Wash.; Ron Paul, R-Texas; Vic Snyder, D-Ark.; and David Weldon, R-Fla.
Meanwhile, on the state level, Mark Osterloh, M.D., whom Modern Physicianprofiled in September, lost his second attempt at election to Arizona's House. But his Clean Elections campaign-reform initiative passed.
AMA MEMBERSHIP OPTIONS. In an effort to boost its declining membership, the American Medical Association will test a plan that offers physicians different annual dues options that correspond with varying levels of service.
The AMA last month announced that in 1999 it will conduct a trial in seven states in which physicians could opt for a lower-cost, lower-service tier of membership for $220, instead of the current $420.
E. Ratcliffe "Andy" Anderson Jr., the association's executive vice president, also says the AMA plans to devote more attention to representing physicians in such conflicts as dealing with insurance contracts and improving communications with members. "We're committing to changes to make ourselves relevant," Anderson says.