Judge Rules RICO Suit May Proceed to Trial, -AND- HMO profits climb 81% in 2002

CAL/AAEM News Service pottsbri@yahoo.com
Sun, 21 Dec 2003 10:45:51 -0800 (PST)


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-----Original Message-----

From: cma_alert@cmanews.org

Sent: 11/12/2003 13.52

1. Judge Rules RICO Suit May Proceed to Trial 

In a victory for the nation’s physicians and patients, U.S. District Judge Federico Moreno ruled on Tuesday that physicians have the right to sue HMOs for damages under the federal Racketeering Influenced and Corrupt Organizations (RICO) Act. The lawsuit, originally filed by CMA on behalf of the nation’s doctors in May 2000, alleges that the for-profit HMO defendants violated federal law by using coercive, unfair and fraudulent means to control physician-patient relationships. 

Although settlements have already been reached with Aetna and Cigna, two of the defendants, Judge Moreno’s ruling allows the case against the remaining six HMO’s to proceed to trial. The trial date has been set for June.

Lawyers for the HMOs have asked the U.S. Court of Appeals for the 11th Circuit to overturn an earlier ruling by Judge Moreno that granted class-action status in this case. 

For more information on CMA's RICO lawsuit, click here. 

Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.

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AHA NEWS NOW

The Daily Report for Health Care Executives

www.ahanews.com

===================================

Thursday, Dec. 11, 2003

5) HMO profits climb 81% in 2002 

The nation's HMOs reported an aggregate 81% increase in profits in 2002 to $5.5 billion, up from $3 billion in 2001, according to rating agency Weiss Ratings Inc. Profits from Medicare+Choice plans increased 117.7%, to $1 billion from $462.9 million in 2001, as insurers discontinued or reduced costly plans and realized higher reimbursements rates from the 1999 Balanced Budget Refinement Act, Weiss said. HMOs also capitalized on an increased need for Medicare supplement insurance (Medigap) as seniors left or were dropped by M+C plans and returned to traditional Medicare, Weiss said. 

One-quarter of the 544 HMOs studied by Weiss reported a loss in 2002, down from 36.6% in 2001. "Profitability continues to improve as insurers raise premiums and restructure policies to reduce costs," a Weiss official said. "While this bodes well for the industry's overall health, rising premiums have forced many consumers to select more restrictive health plans or opt not to purchase insurance entirely." For more information, see the news release at http://www.weissratings.com/News/Latest/. 

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Copyright 2003 by the American Hospital Association. All rights reserved. For republication rights, contact Craig Webb.

AHA News is a registered trademark of the American Hospital Association. The opinions expressed in AHA News Now are not necessarily those of the American Hospital Association.



Brian Potts 
Managing Editor, CAL/AAEM News Service 
MS-IV, UC-Irvine

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<DIV><FONT size=2><FONT size=2>
<P>-----Original Message-----</P>
<P>From: <A href="mailto:cma_alert@cmanews.org">cma_alert@cmanews.org</A></P>
<P>Sent: 11/12/2003 13.52</P>
<P>1. Judge Rules RICO Suit May Proceed to Trial </P>
<P>In a victory for the nation’s physicians and patients, U.S. District Judge Federico Moreno ruled on Tuesday that physicians have the right to sue HMOs for damages under the federal Racketeering Influenced and Corrupt Organizations (RICO) Act. The lawsuit, originally filed by CMA on behalf of the nation’s doctors in May 2000, alleges that the for-profit HMO defendants violated federal law by using coercive, unfair and fraudulent means to control physician-patient relationships. </P>
<P>Although settlements have already been reached with Aetna and Cigna, two of the defendants, Judge Moreno’s ruling allows the case against the remaining six HMO’s to proceed to trial. The trial date has been set for June.</P>
<P>Lawyers for the HMOs have asked the U.S. Court of Appeals for the 11th Circuit to overturn an earlier ruling by Judge Moreno that granted class-action status in this case. </P>
<P>For more information on CMA's RICO lawsuit, click here. </P>
<P>Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.</P>
<P></FONT>===================================</P>
<P>AHA NEWS NOW</P>
<P>The Daily Report for Health Care Executives</P>
<P></FONT><A href="http://us.f413.mail.yahoo.com/ym/www.ahanews.com"><U><FONT color=#0000ff size=2>www.ahanews.com</U></FONT></A></P><FONT size=2>
<P>===================================</P>
<P>Thursday, Dec. 11, 2003</P>
<P>5) HMO profits climb 81% in 2002 </P>
<P>The nation's HMOs reported an aggregate 81% increase in profits in 2002 to $5.5 billion, up from $3 billion in 2001, according to rating agency Weiss Ratings Inc. Profits from Medicare+Choice plans increased 117.7%, to $1 billion from $462.9 million in 2001, as insurers discontinued or reduced costly plans and realized higher reimbursements rates from the 1999 Balanced Budget Refinement Act, Weiss said. HMOs also capitalized on an increased need for Medicare supplement insurance (Medigap) as seniors left or were dropped by M+C plans and returned to traditional Medicare, Weiss said. </P>
<P>One-quarter of the 544 HMOs studied by Weiss reported a loss in 2002, down from 36.6% in 2001. "Profitability continues to improve as insurers raise premiums and restructure policies to reduce costs," a Weiss official said. "While this bodes well for the industry's overall health, rising premiums have forced many consumers to select more restrictive health plans or opt not to purchase insurance entirely." For more information, see the news release at </FONT><A href="http://www.weissratings.com/News/Latest/"><U><FONT color=#0000ff size=2>http://www.weissratings.com/News/Latest/</U></FONT></A><FONT size=2>. </P>
<P>==================================</P>
<P>Copyright 2003 by the American Hospital Association. All rights reserved. For republication rights, contact Craig Webb.</P>
<P>AHA News is a registered trademark of the American Hospital Association. The opinions expressed in AHA News Now are not necessarily those of the American Hospital Association.</P></FONT></DIV><BR><BR><STRONG>Brian Potts <BR>Managing Editor, CAL/AAEM News Service</STRONG> <BR>MS-IV, UC-Irvine<p><hr SIZE=1>
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