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AMA, CMA et al. v. Wellpoint/Anthem Blue Cross

AMA, CMA et al. v. Wellpoint/Anthem Blue Cross (U.S. District Court, Central Dist. of California, filed 3/25/09, CV 09- 2039, Master Consolidated Case File 2:09-ml-02074); AMA, CMA et al. v. Aetna Health Inc. (Dist. of New Jersey, filed 2/9/09, Master File 2:07-CV-3541); AMA, CMA et al. v. Cigna Health Corp. (Dist. of New Jersey, filed 2/9/09, 09- 578)

In three separate lawsuits filed in federal courts, the CMA, American Medical Association (AMA), other state medical societies and individual physicians challenged the use of Ingenix by Aetna, Cigna and Blue Cross in a price-fixing scheme to set artificially low reimbursement rates for out-of-network services to their enrollees. The lawsuits seek to collect past underpayments by the defendants on behalf of a nationwide class of physicians and change the way defendants determine out-of-network reimbursements. The insurer defendants argued that the claims asserted by CMA and other state medical societies in these lawsuits are barred by previous RICO class action settlements benefitting providers. Agreeing with the argument, the district court in Florida, which approved and has jurisdiction over the previous settlements with WellPoint, Aetna and Cigna, ordered that the claims against these insurers be enjoined. Further setting back the cases, the providers’ claims against Aetna and Cigna were also dismissed for lack of standing or insufficient legal merit. The court overseeing the Blue Cross case also denied a motion to certify it for class action. While the cases against Aetna and Cigna have been enjoined or dismissed, Blue Cross agreed to a settlement with CMA and the other medical association plaintiffs, agreeing among other things to provide a contribution to each of the charitable foundations associated with the medical associations.

Status

Opinion filed: 6/18/14

CMA and other medical associations have settled with Blue Cross. The medical associations' cases against Aetna and Cigna remain dismissed.

CMA Staff: Francisco Silva, Long Do

 

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