Federal Appeals Court Allows Claims Against United Healthcare to Proceed

Last week, the 11th Circuit Court of Appeals ruled that the state based claims against United Healthcare (UHC) were not precluded by the previous dismissal of the national class-action RICO lawsuit.  This is a significant victory for the state medical societies, including MSNJ, who are parties in the underlying national class-action lawsuit.

By way of background, the underlying class-action lawsuit alleged that UHC’s business practices, including bundling, down-coding, and proprietary edits, were unfair business practices, and that UHC had participated in a conspiracy with other defendants to deprive physicians of monies due, and that the defendants violated the Racketeer Influenced & Corrupt Organization Act (RICO). Many state based causes of action were filed and consolidated with the pending national class-action suit.  The lower federal court dismissed the RICO claims and that decision was upheld on appeal. A lower federal court also dismissed the state-based cases, but this decision was also appealed. Now, the federal appellate court has ruled that those state-based claims may go forward.

MSNJ believes that these actions may address the continuing unfair business practices that continue. It should be noted that Aetna, CIGNA, Healthet, and the Blue Cross Blue Shield companies all agreed to settlement terms that have resulted in more fair business practice for physicians. UHC did not settle and at least some of the claims will go forward. MSNJ will keep members apprised of developments in this case.

About MSNJ

Founded in 1766, the Medical Society of New Jersey is the oldest professional society in the United States. The organization and its dues-paying members are dedicated to a healthy New Jersey, working to ensure the sanctity of the physician–patient relationship. In representing all medical disciplines, MSNJ advocates for the rights of patients and physicians alike, for the delivery of the highest quality medical care. This allows response to the patients’ individual, varied needs, in an ethical and compassionate environment, in order to create a healthy Garden State and healthy citizens.

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