It was the case that was going to overhaul the way for-profit HMOs do business and enhance the rights of patients and physicians in dealing with the giant health insurers. It also was supposed to be the next big case since Big Tobacco, bringing a huge payday for plaintiff attorneys.
By the time the case concluded last week in the Miami courtroom of U.S. District Judge Federico A. Moreno, it did bring some big payoffs to lawyers. But it’s not clear how much good the massive federal class action case did for the nation’s medical consumers and providers.
The litigation against the nation’s biggest managed-care insurers began seven years ago and was consolidated before Moreno. At one time, the case included lawyers for some of the biggest law firms in the country and such star litigators as David Boies and Archie Lamb. The defendant insurers controlled about half the nation’s managed-care market.
Over the past several years, six large insurers — Aetna, Humana, Cigna, Prudential, HealthNet and WellPoint — settled for some $600 million. Then last week, Moreno granted summary judgment in favor of the two remaining HMOs that had refused to settle, Minnesota-based United Healthcare and Maryland-based Coventry Health.
The original suit alleged that the insurers conspired to deny, underpay and delay payment to physicians automatically by using special computer software. They sued under RICO — the Racketeer Influenced and Corrupt Organizations Act.