a lawsuit filed on behalf of about 600,000 physicians nationwide against six of the largest U.S. health insurers, the New York Times reports.

The panel upheld a decision issued in 2002 by U.S. District Judge Federico Moreno of the Federal District Court in Miami. According to health insurance attorneys, the recent decision could prove "crucial to the case's outcome," the Times reports (Freudenheim, New York Times, 9/2).

In the lawsuit, the physicians allege that Humana Health Plan, PacifiCare Health Systems, Prudential Insurance, UnitedHealthCare, WellPoint Health Networks and Health Net delayed or denied reimbursements for health services and illegally rejected claims for necessary medical treatments as part of a racketeering conspiracy. Aetna and Cigna, which also were named as defendants in the lawsuit, have settled with the physicians for a total of $1.01 billion (Kaiser Daily Health Policy Report, 1/6).

Moreno in September 2002 approved class-action status for the lawsuit. The health insurers appealed the decision over concerns that the lawsuit could prove "financially disastrous," the Miami Herald reports.

Decision Details

However, the panel, which included judges Gerard Tjoflat, Stanley Birch and Alfred Goodwin, rejected the arguments of the health insurers. In his opinion, Tjoflat wrote, "It would be unjust to allow corporations to engage in rampant and systematic wrongdoing and then allow them to avoid a class action because the consequences of being held accountable for their misdeeds would be economically ruinous" (Dorschner, Miami Herald, 9/2).

He added, "It is ridiculous to expect 600,000 doctors across the nation to repeatedly prove these complicated and overwhelming facts" (New York Times, 9/2).

Reaction

Harley Tropin, co-lead attorney for the physicians, said, "This is huge. This will allow the 600,000 doctors and the medical associations to finally bring the case to a jury and Judge Moreno." Kent Jarrell, a spokesperson for the health insurers, said, "With respect to the federal claims, we continue to believe that these claims are not appropriately handled as a class action. Ultimately, with respect to these federal claims, we are confident that we will win at trial based on both the heightened standard of proof and the evidence" (Miami Herald, 9/2).

Archie Lamb, an attorney for the physicians, said that the lawsuit will proceed to trial on March 6 in Miami. He also said that the amount of the settlements paid by Aetna and Cigna could increase by $500 million to $1 billion based on follow-up claims by individual physicians (New York Times, 9/2).

More than a dozen medical associations, including the Texas Medical Association and the California Medical Association, also are plaintiffs in the lawsuit (Miami Herald, 9/2).