Mixed decision for managed care industry. (News at Deadline).
A federal judge in Miami gave the go-ahead for a half dozen class-action suits Noun 1. class-action suit - a lawsuit brought by a representative member of a large group of people on behalf of all members of the group
class action on behalf o the nation's physicians against the managed care industry In a related move, U.S. District Judge Federic A. Moreno Moreno, city (1991 pop. 287,188), Buenos Aires prov., E Argentina. It is a residential and district administrative center in the Greater Buenos Aires area. The district was the scene of several major battles during the Argentine War of Independence and the , denied class-action status to several suits being brought on behalf of patients.
The plaintiffs in these cases accused the defendants--including Aetna, Cigna, Humana, Health Net, and United Health Group--of violating the federal Racketeer Influenced and Corrupt Organizations Act, better know as RICO RICO n. . , along with ERISA See Employee Retirement Income Security Act.
See Employee Retirement Income Security Act (ERISA). and a variety of state laws.
In turning down the request for class certification for members of health plans, the judge ruled that the plaintiffs failed to prove that they were a uniform class that had been abused by the deceptive de·cep·tive
Deceptive or tending to deceive.
de·ceptive·ness n. marketing of the various health insurers. The judge noted health plans are negotiated around the country and often vary from one contract to the next, so the plaintiffs were not similar enough to be lumped together into a single group.
Lawyers for the health plan members contended that there was an industry-wide scheme to limit patients' access to care by hitting physicians in the pocketbook for providing such access.
In contrast, in the physicians' suits, Moreno determined that the coding and payment methodologies used by the HMOs were similar enough to grant the doctors class-action status. Lawyers for the doctors are hoping to use the discovery process to uncover documents and obtain testimony backing their contention that the insurers set up systems to deny legitimate claims. Moreno instructed the attorneys in the doctors' case to agree on a mediator mediator n. a person who conducts mediation. A mediator is usually a lawyer, or retired judge, but can be a non-attorney specialist in the subject matter (like child custody) who tries to bring people and their disputes to early resolution through a conference. by October 30 and then report on whether any progress has been made in reaching a settlement by March 20 of next year. It is likely that both rulings by Moreno will be appealed.
James A. Hawkins is a health care writer based in Aiken, S.C. He can be reached by phone at 803/414-2062 or by e-mail at firstname.lastname@example.org.