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Supreme Court declines managed care suit

NEWS IN BRIEF — Posted June 20, 2005

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The U.S. Supreme Court May 31 said it would not take up a case in which several health maintenance organizations wanted justices to rule that physicians' lawsuits against the insurers must go to arbitration in lieu of a class-action lawsuit.

The ruling means that lawsuits against Humana, PacifiCare Health Systems, United Health Care, WellPoint Health Networks and Anthem Blue Cross and Blue Shield will go forward, with a trial scheduled for September in federal court in Miami. Anthem and WellPoint have merged since the lawsuits were initially filed.

Physicians and some medical societies sued the nation's largest health plans in federal courts, accusing the HMOs of systematically denying or downcoding claims.

The lawsuits were combined and sent to U.S. District Court Judge Federico Moreno in the Southern District of Florida. The Supreme Court's ruling upholds Moreno's and the 11th U.S. Circuit Court of Appeals' rulings that the lawsuits could proceed without arbitration.

Physicians were pleased with the latest ruling, Archie C. Lamb, co-lead counsel for the physicians and medical societies, said.

"America's physicians look forward to their day in court and the opportunity to shed more light on the unfair and abhorrent billing practices of these defendants," he said in a statement.

Earlier in May, Health Net and Prudential Insurance Co. of America announced a settlement with physicians. In 2003, Cigna Corp. and Aetna signed similar settlements with physicians, agreeing to pay millions to compensate doctors for past claims and promising to make changes to the way they pay physicians.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2005/06/20/prbf0620.htm.

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