California Medical Association Receives Encouraging Ruling in Rico Case Against HMOs

Mar 02, 2001, 00:00 ET from California Medical Association

    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