Dozens of Lawyers Involved in Lawsuit Against Big HMOs
August 3, 2001
One of the key players in the multi-billion dollar tobacco litigation has teamed with the Federal government's lead attorney in the Microsoft anti-trust suit to gang up on the Nation's largest HMOs for denying promised medical care and "unjust enrichment." U.S. District Judge Federico Moreno is presiding over the Miami courtroom filled with up to 50 lawyers arguing for and against class-action status for millions of HMO patients and subscribers.
The suit claims that HMO literature promised that all subscribers would receive "medically necessary care" as judged by their doctor. However, this same literature failed to disclose that doctors were given financial incentives to deny care and keep costs to a minimum. The lawyers allege that doctors' medical decisions were essentially cost-based instead of care-based, as the brochures promised.
Attorneys filed lawsuits against Cigna, United Healthcare, Prudential Health Plans, Aetna U.S. Healthcare, and Health Net (formerly Foundation Health Systems).
HMO attorneys deny the allegations and have filed motions to dismiss the cases. HMOs believe that any attempt to change the Nation's medical insurance system should be handled by Congress, not the court system.
Among evidence the plaintiffs offered were HMO guidelines for hospital admission used in place of doctors' decisions and judgments. The plaintiffs also allege that HMOs changed their prescription lists without telling subscribers, altered lists of specialists, and lied about the ease of seeing a specialist if needed. Essentially, the plaintiffs claim they did not receive the service they paid for.
Coincidentally, Judge Moreno is also presiding over a separate lawsuit filed by over 600,000 doctors and medical associations against several HMOs. The suit alleges that HMOs systematically underpaid doctors in a procedure known as "downcoding." Defendants include Cigna, Aetna, Prudential Health Care and others.
-- Article Courtesy of InjuryBoard.com
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