The managed-care industry lost a key appeal intended to derail a sweeping class-action lawsuit claiming that the nation's largest health insurers systemically shortchanged some 900,000 doctors. The 11th U.S. Circuit Court of Appeals in Atlanta upheld a prior ruling by U.S. District Judge Federico Moreno rejecting the insurers' argument that the plaintiffs should be forced to settle their grievances individually through arbitration, as required under their contracts. The appellate court said in its 25-page opinion that "broad arbitration clauses cannot be extended to compel parties to arbitrate disputes they have not agreed to arbitrate." The insurers have not decided whether to ask the U.S. Supreme Court to review the latest decision on arbitration. They already have asked the high court to review an earlier 11th Circuit ruling allowing the doctors to sue as a class; the court has not said whether it will take up the matter. The overall class-action suit is set to go to trial beginning March 6 before Moreno in Miami.
Separately, the Supreme Court said it will not consider whether a health insurer violated antitrust laws by teaming up with doctors to adopt reimbursement policies that siphoned business away from chiropractors. At issue was whether Trigon Healthcare, Virginia's largest insurer, now owned by Anthem, illegally conspired to develop clinical guidelines that unfairly promoted doctors over chiropractors. In a lawsuit filed against Trigon by two chiropractor groups, the 4th U.S. Circuit Court of Appeals, Richmond, Va., ruled that there was insufficient evidence to show an illegal conspiracy. The chiropractor groups said the insurer's policies have unfairly cost its members $100.9 million in lost fees from 1996 to 2001. -- by Laura B. Benko