February 12, 2009

Continuing its commitment to physicians and the organized medicine community, Whatley Drake & Kallas filed class action lawsuits in the District of New Jersey on behalf of medical associations and physicians against Aetna Health, Inc. and CIGNA Corporation, alleging that the companies used flawed data and other improper pricing methods to dramatically under-reimburse physicians for out-of-network services provided to plan enrollees. The actions are brought on behalf of classes of physicians, as well as the American Medical Association (AMA) and several state medical associations, including the Medical Society of New Jersey, the Medical Society of the State of New York, the Connecticut State Medical Society, the Texas Medical Association, and the North Carolina Medical Society.

The two lawsuits, filed on Monday in New Jersey federal court, contend that the two health insurance companies used a flawed system to systematically underpay physicians for out-of-network medical services. Specifically, the complaints allege that Aetna and CIGNA used skewed data provided by UnitedHealth Group subsidiary Ingenix to set reimbursement rates for out-of-network care, among other improper reimbursement practices. Evidence from a recent investigation launched by New York Attorney General Andrew Cuomo found that the Ingenix data is intentionally manipulated to allow health plans to scam physicians by shortchanging reimbursements on medical bills.

These practices, as well as others identified in the lawsuit, affect both physicians and patients. By significantly reducing out-of-network payments, physicians have been forced to absorb much of the costs of treatments and services, which diminishes the necessary resources to run their practices and stands in the way of the patient-physician relationship.

“We can no longer ignore the improper business practices of health insurers who decide to play by their own rules without regard to patients, or the legitimate costs required to care for them,” said AMA President Nancy H. Nielsen, M.D.

“Whatley Drake remains committed to representing physicians and medical associations that are regularly impacted by the abuses of the managed care system. We will continue to work vigilantly to ensure that physicians are able to spend their time treating patients and are not being distracted by the improper business practices of managed care. The goal is for physicians to be treated fairly,” said Edith Kallas.

If you wish to discuss this action or have any questions concerning this press release or your rights or interests, please contact Edith M. Kallas or Laurence J. Hasson at 1-800-695-6750 or 1-212-447-7070, or via e-mail at ekallas@wdklaw.com or lhasson@wdklaw.com.