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Lawsuit says UnitedHealthcare policy a sham

After a brief absence, the "Repair Team" has returned to file another lawsuit against a major HMO, this time accusing UnitedHealthcare of firing doctors who offer too much treatment, misleading the public about its hands-off approach to health care, and denying claims after treatment has already been provided.

UnitedHealthcare's original policy statement

In early November, UnitedHealthcare said it was giving decision-making authority back to doctors. Here's the press release announcing its new policy:

"UnitedHealthcare . . .  announced that it is further advancing its philosophies on consumer choice and physician autonomy through an initiative called Care Coordination. Care Coordination obsoletes certain programs associated with traditional medical management, such as pre-authorization for inpatient hospital procedures, and enhances clinical decision-making between the patient and physician."

Continue to the rest of UnitedHealthcare's press release.

The Repair Team, consisting of dozens of attorneys from firms around the country, has also filed similar lawsuits against half a dozen other major HMOs, including Aetna U.S. Healthcare, the nation's No. 1 health plan, CIGNA, Foundation Health, Humana, PacifiCare, and Prudential.

"While United's doctors are less likely to have to call 1-800-Mother-May-I, Big Brother still looks over their shoulder every time they make a patient-care decision," says Texas internist Dr. Joe Cunningham in a sharply worded press release issued by the squad of lawyers on Feb. 10.

At issue is United's announcement in early November 1999 that it would step back and let doctors, not its administrators, have the final say over patient treatment. While the announcement garnered lots of positive press, the HMO soon wound up clarifying the issue. In fact, United doctors still have to obtain the HMO's preauthorization for high-tech tests such as MRIs and CT scans, for hospitalization, and for mental health care.

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    Richard Scruggs

In the release, attorney Richard Scruggs — having cleaned up in the case against Big Tobacco — accuses the HMO of consumer fraud and medical abuses. "This company tells its customers one thing and then does another," he contends. "The company still requires precertification for many procedures, second-guesses doctors after the fact, and will fire doctors who it feels prescribe too many treatments."

UnitedHealth says suit lacks merit

UnitedHealth Group, the HMO's parent company and the country's No. 2 health plan, issued a statement saying that it had not yet seen the lawsuit but believed it would ultimately be found without merit. "This appears to be another example of the plaintiffs' bar's "one-size-fits-all" litigation," the statement says. "The trial lawyers have filed similar cases against UnitedHealthcare as they did against several other companies, changing only the name of the company involved."

In the statement, the HMO also defends its practice of "care coordination," saying it has been praised by doctors, consumers, and lawmakers. "The program has essentially eliminated medical necessity reviews and now works to provide support to patients and doctors," the statement says.

The lawsuit against UnitedHealth, which is seeking class action status, was filed in U.S. District Court for the Southern District of Mississippi in Hattiesburg. The lawsuit says the HMO violates the federal Racketeer Influenced and Corrupt Organizations Act (RICO) and the Employee Retirement Income Security Act (ERISA). It seeks unspecified compensatory damages, which can be tripled under RICO; punitive damages; and an injunction preventing the HMO from "pursuing the fraudulent and extortionate policies and practices cited in the complaints.

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