A Florida physicians' group that tangled with the Federal Trade Commission in the early 1990s is drawing renewed attention by suing HMOs.
The Jacksonville-based Florida Physicians Association has slapped five HMOs with lawsuits in the past 13 months, charging the plans with wrongly denying physicians' claims. One of the cases was filed under the name of a new subsidiary of the association, the Florida Physicians Union.
In 1991, the FTC found that an independent practice association formed by the physicians' group illegally tried to fix prices charged to a health plan operated by one of the HMOs the association is now suing.
The filings against AvMed Health Plan, HIP Health Plan, Humana, Prudential HealthCare and United HealthCare haven't generated a penny in judgments for doctors, but they have resulted in the publication of at least two dozen articles in newspapers in the state and coverage in MODERN HEALTHCARE (Aug. 16, p. 31).
Donald Weidner, the association's general counsel and executive director, said the cases are "a frontal attack" on HMOs, which are "stringing the doctors along."
"Until we get a class-action ruling that mandates the companies (pay claims), they're not going to sit up and take notice," Weidner said.
The suits contend the health plans used strategies such as downcoding, or reimbursing at a lower level than the care provided should have generated; alleging nonreceipt of claims or coordination-of-benefits issues; or, in the case of Humana, using an outdated Medicare fee schedule.
None of the plans except AvMed would comment on the suits. AvMed acknowledged a temporary disruption in payments last year. Spokeswoman Valerie Rubin said the problem was corrected and "didn't significantly impact" providers.
Rubin said the association represents a "marketing activity" for Weidner's law practice, Weidner & Winicki.
"We're talking about a small group of physicians that's headed by an attorney that's going around stirring up the pot," said Richard Dorff, president of the Florida Association of HMOs.
The Florida Physicians Association said it represents about 4,000 physicians. Weidner said all the pending suits were filed at the direction of the boards of directors of the association and the union. All the board members are doctors, he said.
Provider and consumer complaints about denied claims escalated last year, according to state agencies, which launched a review of HMOs' records earlier this year. In recent weeks, the Florida Agency for Health Care Administration levied fines totaling $163,000 against five HMOs, including Humana, for wrongly denying emergency room claims. Humana said it will appeal.
Weidner said the state hasn't done enough to police the plans. So far, though, none of the association's lawsuits have been declared class actions by a court. Of the earliest cases filed, a decision denying class-action status in the AvMed case is on appeal, while the Prudential case stalled after it was transferred to federal court, Weidner said. Both were filed last year. The other suits are pending in state court.
The cases have generated publicity for the association and its Florida Physicians Union, which Weidner said has attracted 300 members since it incorporated in November 1998. The subsidiary was formed several months after the Florida Medical Association voted not to join an affiliate of the AFL-CIO.
Weidner said the subsidiary filed the lawsuit against United last month because it "wanted to be in a position of showing that it was going to fight the abuses that it saw taking place."
He said the subsidiary has its own board and was created "to become a physicians' union." However, the subsidiary is not a recognized labor organization under the National Labor Relations Act.
Antitrust laws prevent independent, competing physicians from negotiating collectively with health plans, but members of legitimate labor unions are exempt from those restrictions. Some physician groups are lobbying to change the law to allow physicians to collectively negotiate with payers outside of a union structure.
The Florida Physicians Association has a history of confronting health plans, including AvMed. In 1991, 23 OB/GYNs on the staff of Baptist Medical Center in Jacksonville agreed to dissolve their IPA, called Southbank IPA, to settle charges they conspired to fix prices against SunCare, an HMO owned by AvMed.
Under Weidner's leadership, the association helped form the Southbank IPA and coordinated its legal defense.