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HMO Plan Members Seek Truth from Companies

Lawsuits brought by policyholders seeking the truth from managed care giants moved forward after a federal judge's ruling. Plaintiffs want Humana and other big HMOs to tell the truth about how their concern for profits effect their decisions on medical coverage for patients.

Firm attorneys Ed Ricci and Ted Leopold are leading the fight.

Two Riviera Beach, Florida, police officers are among the plaintiffs in several lawsuits alleging that Humana and other managed care companies engage in racketeering and fraud.

The suits says the companies pay cash bonuses to claims reviewers to encourage them to deny claims, and that the companies contract out claims reviews to third parties who aren't medically trained and who use secret, cost-based standards rather than medical necessity to approve or reject payments for medical care.

"They're putting profits ahead of patients," said Mr. Ricci.

The firm, along with leading attorneys in the country, including David Boies and Stephen Neuwirth of Boies, Schiller & Flexner, LLP, are representing the plaintiffs in this national class action litigation.

"The managed care companies lure people into their managed care system but won't tell them how important they consider costs when making coverage decisions," said Mr. Leopold.

Humana Inc., along with Aetna, Cigna Corp., UnitedHealth Group, Pacificare and other major managed care companies are accused of conspiring to deny care and of withholding information about how financial concerns influence medical decisions.

The ruling, in federal court in Miami, asks the plaintiffs for more details on the claims and invites them to redraft and re-file their claims.

"We welcome the opportunity to put before the judge all the information and facts we've learned over the last several months," said Mr. Leopold.