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Astrid Fiano, DOTmed News Writer | December 07, 2009
Preliminary settlement
in insurance case
U.S. District Judge Lawrence McKenna of the Southern District of New York has given preliminary approval to a settlement of litigation between the American Medical Association (AMA) and several other plaintiffs and United Healthcare Corporation, et al.
Judge McKenna's Memorandum and Order resolved issues on the "delta" of the settlement (the range of the best possible recovery in damages) and also whether some releases to be obtained in the settlement were too broad. The judge held that the proposed releases are not too broad and that the delta did not have to be increased because of any unpaid but released claims. The class members will be notified of a hearing date for approval of the proposed settlement and information on filing claims for reimbursement from the $350 million settlement fund.
AMA Immediate Past President Nancy H. Nielsen, M.D., commented on the preliminary approval, "The court's approval is an important step in finalizing a settlement that recognizes UnitedHealth's flawed payment scheme resulted in significant damages to physicians who provided out-of-network care to patients enrolled with United Health. Years of litigation and tireless advocacy from the AMA and organized medicine have exposed the industry-wide insurer scheme and paved the way for a more equitable way to set payments for out-of-network care."
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The AMA case is related to New York State Attorney General Andrew Cuomo's efforts in investigating Ingenix, in which Cuomo's office found the database to be "defective and conflict-ridden," and had skewed "usual and customary" out-of-network health care rates downward through faulty data collection, poor pooling procedures, and lack of audits. Cuomo's investigation has led to the formation of a new not-for-profit company, FAIR Health, Inc., to reform the determination of out-of-network health care charges. (DOTmed has previously reported on the Ingenix case in DM 10611, 9448, 8578, 8297, and 7958).
Read AMA comments:
http://www.ama-assn.org/ama/pub/news/news/unitedhealth-class-action.shtml
