This was written into their contracts…and I agree with the Supreme Court on this one for sure and it has plagued physicians for years. This contract provision is probably the works of one of the United big lobbyists groups. They are everywhere and United even hired Steve Larson from HHS and made him a VP at the Optum division. Steve Larsen is credited with writing most of the healthcare reform law. The decision is final and no reruns for Oxford. This goes back to 2003 and if you look at the little guys up against the big guys with millions to spend on legal cases this is a nice victory for the doctors as insurers knew that arbitrating against one MD at a time improved their chances by allowing under payments to continue as well as contract violations.
We can also reflect back on the under payments lawsuit settled by the AMA with United and the other major insurers that licensed their algorithms to short pay doctors and hospitals for 15 years.
AMA Announced Settlement of Class Action Suit of $350 Million with Ingenix (United Healthcare)
Here’s where Aetna just settled their 15 years of short payments using algorithms from Ingenix, now called Optum. If this is not about context and using an advantage of data over one physician at a time, I don’t know what is.
Aetna Payment of $120 Million To Settle 15 Year Ingenix/United HealthCare Out of Network Erroneous Payment Algorithms Cuts Income for 4th Quarter
In addition there are still quite a few lawsuits floating around out there relative to the AMA class action suit that take up the 15 years of short pay, but are their own lawsuits.
Ingenix Data Base Has Some Long Reaching Legal Tentacles with Aetna, Blue Cross, Blue Shield, Humana
Skins game with dermatology offices in California – Ingenix
When I write about articles like this today, I think of Snowden..it’s all about context and with doctors not allowing to group and arbitrate as a group this is as about as close as to what I would call the “bully” effect as when you line up a huge corporation with tons of lawyers on board against one MD and with a big bankroll for court appearance, how do they stand a chance? We get this too as consumers as well in other areas of healthcare so nice to see the Supreme Court cut the bullies down a little with contract provisions. We already know that United and their subsidiaries makes millions selling our data as well.
Contract provisions can easily be taken out of context in court as we see it all the time. This contract provision is could be classified as “corporate algorithm balls” in my opinion. BD
Washington, D.C. – The American Medical Association (AMA) and the Medical Society of New Jersey (MSNJ) heralded yesterday’s decision by the U.S. Supreme Court allowing individual physicians to come together as a group to fight the unfair business practices of large health insurance companies.
“This important ruling allows thousands of physicians to use class arbitration against a health insurer that has underpaid them for more than a decade,” said AMA President Jeremy A. Lazarus, M.D. “Without this broad-scale arbitration, physicians would have no practical means of challenging a health insurer's unfair payment practices.”
“It is a sad commentary that it took a decade for Dr. Sutter and other New Jersey physicians to exercise the dispute mechanism allowed by their contracts,” said MSNJ General Counsel Melinda Martinson. “A timely class-arbitration would have allowed them to have their payment disputes resolved more expeditiously and cost-effectively. The decision is welcome news to physicians in New Jersey and all who are concerned with reducing the cost of medicine in this country.”
The decision in Sutter v. Oxford Health Plans concludes a dispute dating back to September 2003 when New Jersey pediatrician John Sutter, M.D., alleged that Oxford Health Plans had systematically bundled, down coded and delayed payments for his services and those of 20,000 other physicians in its network. Oxford Health Plans had challenged legal decisions supporting class arbitration of the dispute and appealed the case to the U.S. Supreme Court.
The high court’s ruling in favor of physicians gives a boost to the medical profession’s efforts to address unfair corporate policies of large health insurers that are bad for patients and physicians.
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