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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