CALIFORNIA : CMA to Discuss Details of Suit Against 8 HMOs : Health care: Firms are accused of failing to ensure that doctors are paid for treating HMO patients.
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The California Medical Assn. plans to announce today the filing of a lawsuit that accuses the state’s biggest health maintenance organizations of failing to ensure that doctors are paid for treatment provided to HMO patients.
The lawsuit is the latest action in the CMA’s months-long efforts to force health plans to pay doctors separately when medical groups go bankrupt--even if the health plan has already paid the groups it contracts with.
The issue was initially raised last year, after medical group manager FPA Medical Management filed for Bankruptcy Court protection. A number of FPA-contracted doctors continued to provide care, but they would have had to join FPA’s list of creditors in order to be paid, a process the CMA contends would take months and garner them less than what they were owed.
In November, the CMA asked the state Department of Corporations to rule that the health plans were legally obligated to pay the doctors, but state regulators refused. Gov. Gray Davis’ administration has also refused to take up the issue. And this week the state attorney general’s office said it would not become involved.
The CMA, which represents California-based physicians, was waiting for the attorney general’s response before activating its lawsuit, which was filed July 15 in San Diego County Superior Court..
Named as plaintiffs are: Aetna Inc., Blue Cross of California, Blue Shield, Foundation Health System’s HealthNet unit, Maxicare Health Plans, PacifiCare of California, Prudential and United Healthcare of California.
Foundation Health spokesman David Olson said the CMA “appears to be engaging in extreme scare tactics.” He said Foundation closely monitors the 200 physician groups it contracts with.
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