It is estimated that as many as 700,000 doctors may be able to participate in the action. Originally, the action was brought on behalf of an estimated 145 million patients covered by HMOs, as well as physicians, but the court decided not to certify the patients as a class.

With respect to the RICO claims, the court ruled that six medical associations, which joined individual doctors in pressing those claims, had standing to sue because they demonstrated an injury in fact, caused by the managed care companies' actions, that was likely to be redressed by a favorable court ruling.
In addition, the court said, the doctors' RICO claims were properly supported by allegations that the racketeering action was engaged in by managed care entities and associations--that together constituted a managed care enterprise (MCE)--and that the MCE was a "vehicle for the commission of continuing predicate crimes with the Defendants squarely in the driver's seat."

The court found that the doctors also adequately alleged predicate acts underlying the RICO violations--including mail fraud and concerted fraudulent schemes to violate their provider contracts--and that the violations proximately caused the doctors' injuries "by manipulating the entire managed care industry."
The court found there were sufficient allegations in the doctors' complaint to support the RICO conspiracy charges. The court also said that RICO did not prohibit the grant of equitable or injunctive relief and that the claims were not preempted by state laws regulating the "business of insurance" under the McCarran-Ferguson Act.

The ruling is the most recent development in the long-running litigation over the managed care companies' payment practices under which doctors' payment claims were systematically reduced or denied. The lawsuit originally named Aetna, Anthem Blue Cross Blue Shield, CIGNA, Coventry, Humana Health Plan Inc., PacifiCare Health Systems Inc., United Healthcare, and WellPoint as defendants. Both Aetna and CIGNA settled the claims against them, agreeing to pay millions of dollars in damages and litigation costs and making a commitment to adopt significant changes in the way doctors' claims are handled and paid.