The likelihood of a three- to five-month wait for a decision on whether even the most basic portion of physicians' lawsuits against insurers can proceed hasn't dissuaded additional practitioner groups from piling more lawsuits on some of the nation's largest health plans.
And firing salvos against the managed care industry hasn't been limited to health plan targets. In California, the state governmental department that advocates for consumers has not only come under fire but also faces a legal challenge from physicians over its authority to publish the financial data of medical groups.
The new legal actions came within a few weeks of each other. They were the most recent in a spate of activity that renewed this spring when three medical societies came together to sue the nation's insurers.
In August, Florida's doctors joined the parade by filing suit against eight insurers. The suit names as defendants Aetna, Cigna, Coventry Health Care, Humana, UnitedHealth Group (the parent company of UnitedHealthcare), Aetna's Prudential Health Care, Health Net and WellPoint Health Networks.
Florida joined the California, Georgia and Texas medical societies, which had sued the plans earlier this year. The suits accuse health plans of a myraid of things, including violating laws by hiring each other's top executives and violating anti-racketeering statutes.
The April and August lawsuits were rolled out with gusto, complete with supporting statements--but thus far no supporting money--from the AMA.
But for now, no suits are going anywhere.
A ruling earlier this summer froze the most preliminary steps necessary for a civil action to continue when health plans successfully argued that discovery should be put on hold. An appellate court ruled that attorneys for physicians can't have access to health plan records until the 11th U.S. Circuit Court of Appeals decides whether discovery should proceed. The federal judge handling the case had ruled that health plans had to turn over internal documents as the medical socities demanded them.
The hearing at the 11th Circuit is scheduled for the week of Dec. 3. The panel likely won't issue its ruling until the first quarter of 2002.
In addition to anti-racketeering violations, the Florida suit accuses the plans of breach of contract, manipulation of CPT codes, systematic and intentional delay of denial of payments, downcoding and bundling, coercive use of power, conspiracy and fraudulent practice related to capitation agreements.
Several of the named plans declined comment. Previously, plan officials have called the suits "frivolous" and said they were without merit. American Association of Health Plans officials have said the cases will only serve to drive up the cost of healthcare and line the pockets of trial attorneys.
Those cases are being heard by U.S. District Court Judge Frederico Moreno. He has divided the cases into two tracks: provider and patient. He has dismissed and subsequently allowed the groups to refile various allegations in their suits. The provider-track suits are in arbitration to determine whether they qualify as class actions.
It isn't known when Moreno will make any more rulings on the cases in the patient track. Plaintiffs in those suits claim they were sold a faulty product and deceived through advertising. They also seek class-action status.
In mid-August, the Medical Society of the State of New York sued Aetna, Cigna, Empire Blue Cross/Blue Shield, Excellus, Oxford and UnitedHealthcare. The suit alleges essentially the same transgressions as previous suits: The health plans systematically downcode claims, put patients at risk by denying care, breach contracts with physicians and fail to have adequate staff to process claims in a timely manner.
New York society officials say they tried to get resolutions through legislation, but they have not seen any improvements in relationships with health plans. New York Health Plan Association President Paul Macielak calls the lawsuit a "copycat action that doctors have brought for their own financial enrichment."
While targeting health plans' pocketbooks and their general mode of business have been the usual tactics, they aren't the only legal avenues being pursued.
In California, the state medical association wants a judge to stop the California Department of Managed Health Care from publishing details about the financial health of medical groups.
A 1999 state law mandates that medical groups must report their financial data to the DMHC. Department officials would then make public that data. The argument in favor of publishing that data was that it would help avoid another debacle like that of KPC Medical Management. Last November, KPC filed for bankruptcy and left thousands of patients without access to medical records and tests.
Claiming the regulations would irreparably harm medical groups, California Medical Association officials last month asked a state judge to prevent financial solvency standards from going into effect. CMA officials say publicizing the data would only lead to health plans dropping financially weak medical groups from their networks.
CMA officials asked a Sacramento County Superior Court judge for a temporary restraining order preventing the state's managed care chief from implementing the regulations. Under those regulations, medical group financial data would have been made public Oct. 1. CMA officials contended the regulations would not only cause damage to medical groups and cause even more to close, they also would violate the spirit and letter of the law that created the financial solvency standards.
The regulations require medical groups to file quarterly financial information with the department. There are no legal penalties for not filing the information, since the DMHC regulates health plans and not medical groups.
DMHC Director Daniel Zingale says publishing financial information on medical groups levels the playing field for patients by giving them a heads-up when their medical groups are in financial straits. But CMA's CEO, Jack Lewin, M.D., says the regulations give health plans unfair advantage, allowing them to cherry-pick medical groups with which to contract.