Mich. doctors can sue over payment

NEWS IN BRIEF — Posted Dec. 18, 2006

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The U.S. Supreme Court handed a first-round victory to a group of Michigan gynecologists when the high court rejected the attempt of the state Blues plan to block the doctors' lawsuit that accuses the insurer of fraudulent payment practices.

The decision leaves in place a March ruling by the 6th U.S. Circuit Court of Appeals that said the doctors can sue Blue Cross Blue Shield of Michigan for allegedly downcoding or denying their payment claims, in violation of the federal Racketeer Influenced and Corrupt Organizations Act. The fact that doctors can pursue their case in federal court is significant because "there is very little remedy for nonpayment under Michigan's timely payment laws," said Daniel J. Schulte, legal counsel to the Michigan State Medical Society, which filed a friend-of-the-court brief supporting the physicians.

The Blues plan had argued in court papers that state insurance laws preclude the doctors from suing it under the federal RICO statute. The company denies any wrongdoing.

William H. Horton, the doctors' attorney, said the decision gives physicians some recourse to address health plans' unfair business practices.

He said the Blues plans' coding procedures for certain gynecological services affected thousands of other physicians in the state, and the lawsuit will seek class-action status.

Michigan Blues spokeswoman Helen Stojic said that the company denies the allegations in the lawsuit.

The case next returns to the U.S. District Court for the Eastern District of Michigan in Detroit. No trial date has been scheduled, Horton said.

Note: This item originally appeared at

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