Aetna Settlement Moves Forward

Settlement of a lawsuit between Aetna Inc. and physicians suing the company hit a snag on October 14 when U.S. District Judge Federico Moreno delayed final ruling on a tentative settlement that had been reached in May. On October 24, however, he approved the settlement.

The lawsuit, In re: Humana Inc. Managed Care Litigation, charged health plans with violations of the Racketeer Influenced and Corrupt Organizations (RICO) Act (Psychiatric News, October 18, 2002; October 3, 2003).

According to the October 14 Boston Globe, Moreno said that 19 objections to the settlement had been filed with the court and that “one of the main objections is the doctors don’t know exactly” the case’s value.

Under the terms of the settlement, Aetna admitted no wrongdoing but agreed to pay physicians $100 million, or an average of $142 each. The company might pay $50 million in attorneys’ fees. It also agreed to invest $20 million in a foundation whose goal will be to improve health care. Aetna also agreed to “reduce administrative complexity” surrounding the approval or denial of reimbursments to physicians.

The Globe reported that physicians who filed claims in the suit could collect between $55 and $165 each without submitting paperwork detailing incidents of reduced payments from Aetna.

On September 4 Moreno gave preliminary approval to a settlement between Cigna and the physicians in the same lawsuit. United Healthcare, Coventry, Wellpoint, Humana Health Plans, Pacifica Health Systems, and Anthem Blue Cross were part of the original suit and have not yet reached settlement agreements. ▪