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Monday, May 7, 2012

RICO Suits Bring Physicians More Than $2 Billion

Physicians have received more than $2 billion in benefits from national settlement agreements reached with Aetna, Cigna, Health Net, Humana, Anthem/WellPoint, and many Blue Cross and Blue Shield plans in class action lawsuits that 19 state and county medical associations and physician representatives brought against these insurers. TMA was an active plaintiff in many of these suits. The greatest benefit for most physicians came from the business changes the settlements required these insurers to implement. These included paying claims promptly, recognizing and paying for modifiers 25 and 59, notifying physicians 90 days before any material adverse contract changes, and limiting the time in which insurers could recover alleged overpayments. TMA actively monitors the insurers’ compliance with these requirements.

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