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Related sites American Association of Health Plan
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HMOs hit with class-action lawsuits
Posted
10-18-99 Washington. Three separate class-action lawsuits were filed against two different health maintenance organizations this month. Lawyers for five patients in Texas and Florida filed suit in federal district court in Miami against Humana Inc., alleging the HMO offered financial rewards to its physicians who "limit medical coverage." The suit claims the company violated U.S. racketeering laws under the Racketeer Influenced and Corrupt Organizations Act (RICO) and is seeking class-action status, which could triple the amount of a potential award. In a statement, Humana said that while it had not been served with a copy of the lawsuit and could not respond to specific allegations, it would "vigorously defend [itself] on behalf of our 6.1 million plan members and the thousands of doctors who care for our members." The first of the other two suits filed against Aetna Inc.'s U.S. Healthcare division makes claims similar to the suit against Humana. Filed in Philadelphia in the name of Delaware resident Anthony Conte and all other members of Aetna U.S. Healthcare covered under employee health plans, the suit alleges that Aetna failed to disclose payments and other benefits provided to its physicians for keeping costs down. "Our case relates solely to disclosure," said Jerome Marcus, a lawyer with the Philadelphia firm handling the case. "Our claim is that subscribers don't have the information they need to make an informed decision … if you don't understand the incentives your doctor has to deny care." Marcus said his suit was "not an attack on managed care." But the other suit against Aetna U.S. Healthcare may be. Filed in federal court in Hattiesburg, Miss., by the same lawyers who helped bring about the billion-dollar settlement against the tobacco industry, the broader of the two suits claims that Aetna U.S. Healthcare systematically provided inadequate health care to its 18 million members. "We think the accusations put forward in the lawsuits are equally outrageous to those that were recently dismissed by two different judges in two different lawsuits," said Aetna spokesperson Fred Laberge. Marcus and the other lawyers involved in the cases have publicly denied any political gamesmanship in the timing of their suits, but all the suits have been filed amid a backdrop of congressional debate over a patients' bill of rights, that would give patients the right to sue their HMOs. "It's not a surprise to us that the trial bar is attacking the healthcare industry," said Susan Pisano, vice president of the American Association of Health Plans. "We are diverting healthcare dollars to the courtroom, and I think it should give members of Congress pause. They should worry what the consequences are if we turn the system over to the trial lawyers."
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