Doctors can sue HMOs for RICO violations.

Doctors suing HMOs over unfair business practices can seek damages under the federal Racketeer Influenced and Corrupt Organizations Act (RICO), a federal judge in Florida recently ruled. The defendants--several large managed care companies, including Anthem Blue Cross and Blue Shield, Coventry Health Care, and Humana--sough t to dismiss the class action, claiming the plaintiffs could not prove that the companies conspired to compromise managed care contracts. Judge Frederico Moreno of the Southern District of Florida in Miami disagreed and upheld the claims. (In re Managed Care Litig., No. MDL 1334-MD-MORENO, 2003 WL 23000215 (S.D. Fla. Dec. 8, 2003).)

The doctors' suit claims the HMOs systematically underpaid providers by using software programs to change billing codes for regular procedures. The doctors' class was certified last year, although a similar class of patients was dismissed.

Two insurers, Aetna and CIGNA, have settled the claims. (Physician Suits Against HMOs Target Unfair Business Practices, TRIAL, Sept. 2002, at 16; Aetna Settles Suit Oven Unfair Business Practices, TRIAl, Aug. 2003, at 74; CIGNA Settles Doctors' Suit Over Unfair Business Practices, TRIAL, Nov 2003, at 88.)