Leonard J. Klay, MD v Humana, Inc.
Cigna Settles Specialty Health Care Provider Class Action
The agreement follows CIGNA HealthCare's settlement in September 2003 of similar class action suits filed on behalf of some 700,000 physicians across the country.
The settlement encompasses and brings to final resolution all specialty health care provider claims asserted in various cases that were transferred to U.S. District Court in Miami. The health care providers covered by the settlement include chiropractors, psychologists, counselors, podiatrists, acupuncturists, optometrists, physical and occupational therapists, nurse midwives, nurse practitioners, nurse anesthetists, nutritionists, orthotists, prosthetists, audiologists, speech and hearing therapists and others. While the exact size of the class is undetermined, a notice regarding the settlement will be mailed to at least 210,000 specialty health care providers.
Under the settlement agreement, CIGNA HealthCare will, among other things:
• Establish a fund of $11.55 million from which class members can obtain compensation in an amount based on the volume of claims they submitted to CIGNA HealthCare over a period of nearly 15 years;
• Further enhance its specialty health care provider claims processing and adjudication systems and processes;
• Continue to expand and improve its on-line referral, certification and claims management capabilities for specialty health care providers;
• Provide via the Internet detailed information about CIGNA HealthCare's specialty health care provider claim coding policies, fee schedules and related payment guidelines;
• Refrain from reducing its fee specialty health care provider schedules for participating providers more than once in a calendar year, in most circumstances;
• Implement an independent, external review process to resolve billing disputes fairly and expeditiously; and
• Establish a specialty health care provider advisory committee to maintain open and frequent communication between CIGNA HealthCare and the providers and to address relevant issues and concerns.
The litigation was originally brought by representative plaintiffs on behalf of a class of physicians against a number of managed care companies. The class action lawsuits are part of a federal multi-district litigation that is pending in the U.S. District Court for the Southern District of Florida (the "Court") called In re Managed Care Litigation, MDL Docket No. 1334.
Several other cases were transferred to the Court to become part of the multi-district litigation. The complaints in the litigation allege that at various times from 1990 to the present, several insurance companies engaged in a conspiracy to improperly deny, delay and/or reduce payments to physicians.
