California Medical Association Receives Encouraging Ruling in Rico Case Against HMOs
MIAMI, March 2 /PRNewswire/ -- U.S. District Judge Federico A. Moreno ruled today in his Miami court that the California Medical Association and individual physicians must amend their lawsuit if they are to prove that the health plans named as defendants constitute a "racketeering enterprise," but let stand other major allegations. The ruling rejected health plan motions to dismiss allegations that health insurers have engaged in unfair contracts, and wire and mail fraud "constituting a pattern of racketeering activity." "Doctors and patients should be encouraged that the lawsuit, which takes aim at insurance companies that have been for years delaying and denying care, can go forward," said Marie Kuffner, CMA president. "We are encouraged by the ruling and are hopeful that it is an important step forward. We are working diligently to amend the complaint," said Archie Lamb, the plaintiffs' attorney in the lawsuit. The ruling gives CMA and physicians until March 26 to file an amended complaint. "The ruling also rejected the classic insurance company claims of ERISA and the McCarran-Ferguson Act." The ruling comes in a case that consolidates two dozen individual lawsuits filed across the country by physicians as well as the California Medical Association. The consolidated suit named as defendants Humana, Aetna, Cigna, Connecticut General Corporation, Foundation and Pacificare Health Systems, Prudential Insurance Co., United Healthcare and Wellpoint Health Networks. CMA's original lawsuit, filed in San Francisco in May 2000, named as defendants Blue Cross of California, Pacificare Health Systems and Foundation Health Systems.
SOURCE California Medical Association
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