ABOUT HMO LITIGATION
In Managed Care Litigation, MDL Case
No. 1334, the named providers and medical associations allege that the defendant
HMOs have systematically breached the terms of their contracts with physicians
and have engaged in illegal policies and deceptive practices.
Some of the allegations are that HMOs improperly influence the medical decision making process and have enacted policies to allow them to over-ride their physician's decisions regarding medical necessity.
The named providers and medical associations allege that HMOs do this by relying on automatic claims processing systems, hiring personnel unfamiliar with the patient's healthcare needs and indirectly providing reimbursements that are inadequate to cover the cost of medically appropriate care. This pattern of behavior constitutes a violation of the federal RICO statute, the Racketeering Influenced and Corrupt Organization Act.
The lawsuit also charges that during the last ten years the HMOs have delayed, denied and downcoded payments to doctors. You can read the Amended Complaint here. The Court will conduct a hearing on May 7, 2001 in Miami, Florida to determine whether to certify the case as a class action.
Some of the allegations are that HMOs improperly influence the medical decision making process and have enacted policies to allow them to over-ride their physician's decisions regarding medical necessity.
The named providers and medical associations allege that HMOs do this by relying on automatic claims processing systems, hiring personnel unfamiliar with the patient's healthcare needs and indirectly providing reimbursements that are inadequate to cover the cost of medically appropriate care. This pattern of behavior constitutes a violation of the federal RICO statute, the Racketeering Influenced and Corrupt Organization Act.
The lawsuit also charges that during the last ten years the HMOs have delayed, denied and downcoded payments to doctors. You can read the Amended Complaint here. The Court will conduct a hearing on May 7, 2001 in Miami, Florida to determine whether to certify the case as a class action.
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