Judge Rules in Favor of Remaining Insurers in Class-Action Lawsuit

Another chapter in the class-action lawsuit filed in 1999 on behalf of more than 700,000 physicians came to a close recently when a federal judge dismissed all remaining claims against UnitedHealth Group and Coventry Health Care Inc.

The two companies were included in a group of health insurers accused of conspiring to improperly deny, delay or reduce payments to physicians between Aug. 4, 1990, and May 10, 2005.

In the class action, In re: Managed Care Litigation, physicians and physician groups across the country alleged that the insurers engaged in practices such as downcoding, bundling of codes, rejecting CPT modifiers and rejecting claims for medically necessary services.

Nearly all other insurers involved in the lawsuit -- including Anthem Blue Cross and Blue Shield, WellPoint Inc., Health Net, Prudential Insurance Company of America, Aetna, Humana Inc., and CIGNA -- had previously settled claims levied against them for hundreds of millions of dollars. The court had earlier granted summary judgment in favor of another company named in the suit, PacifiCare Health Systems.

In his June 19 order, (PDF file: 33 pages / 1.4 MB. More about PDFs.) U.S. District Judge Federico Moreno of the Southern District of Florida ruled that there was insufficient evidence to show the two insurers conspired to defraud the physicians.

According to a story in the June 20 Wall Street Journal, lawyers representing physicians and medical groups may consider appealing the decision, but they concede the bid would probably be unsuccessful.

In the same story, Archie Lamb, lead counsel for the physicians, made it clear that although the insurance companies that settled are no longer exposed to litigation, physicians are still free to file complaints against UnitedHealth over other reimbursement practices. "They may think they've won the war, but it is only a battle," he said.