Sunday, February 2, 2003

Judge allows lawsuit by doctors

Physicians allege insurer conspiracy to cut reimbursements

By John Nolan
The Associated Press

CINCINNATI - A judge ruled doctors may go forward with a lawsuit accusing health care insurers of illegally conspiring to reduce reimbursements for medical services.

Common Pleas Judge David Davis rejected insurers' claims that the lawsuit doesn't fall under the state's antitrust law. Insurers had argued that their contracts with doctors stipulated that reimbursement issues be arbitrated and not decided by a court.

But the doctors accused insurers of illegal price fixing, which isn't covered by their contracts and would not be arbitrated, Davis ruled.

Under Ohio's antitrust law, the doctors could collect triple the amount of money damages they prove against the insurance companies.

Davis also said Cincinnati Academy of Medicine and the suburban Butler County Medical Society can represent the doctors suing the insurance companies.

The ruling, unless overturned on appeal, would allow the doctors to obtain financial documents that they hope will support their claims. The lawsuit could go to trial later this year.

"Obviously, there's still a lot that must be proved," Russell Dean, executive director of the Cincinnati Academy of Medicine, said Friday. "The judge must have felt there was enough of an issue here that it warrants the light of day in a court of law."

Davis issued his ruling last week, but it wasn't signed and formally filed in Hamilton County Common Pleas Court until Friday.

The defendants are Aetna Health Inc., Humana Health Plan of Ohio Inc., United Healthcare of Ohio Inc. and Anthem Blue Cross and Blue Shield. Humana and Anthem said Friday they will appeal the ruling.

The insurers deny that they conspired to reduce reimbursement rates, saying they offer doctors fair and competitive reimbursements.

The doctors said they want reimbursement rates similar to those in comparable regional markets such as Dayton, Louisville, Columbus and Indianapolis. An Indianapolis physician is reimbursed at 70 percent of every dollar billed, while a Cincinnati doctor receives 35 to 50 percent, the doctors said.

Doctors said insurers began the illegal price fixing in response to a request years ago by major Cincinnati employers to hold the line on health care expenses.

The lawsuit - and a companion lawsuit in state court in nearby northern Kentucky - accuses the insurers of undermining health care. Physicians say it has become difficult to recruit young doctors who can make more money in similar-sized cities elsewhere, older specialists are retiring sooner and patients wind up waiting weeks or months to get appointments with specialists.

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