States District Court
For the Southern District of Florida
Action involves all of the direct and indirect subsidiaries and affiliates of
Net, Inc. involved in the health care business,
Health Net of California, Inc.
may be a member of the Health Net settlement class
this Action if you have submitted claims to any of these Health Net entities
to other managed care companies.
Managed Care Litigation
Proposed Settlement of Class Action with Health Net.
you are a physician who provided covered services to any individual enrolled in or covered by certain health care plans at
any time between August 4 1990 and May
10, 2005 or a physician group or a physician organization that includes such physicians, please read this notice
carefully. This class action and the proposed settlement may affect your rights.
is this litigation about?
has been brought by the representative plaintiffs, who are practicing or retired physicians from around the United States,
on behalf of a class of physicians, and by certain medical societies, against a number of health care insurance companies,
including Aetna, Anthem, Inc., Cigna, Coventry Health Care, Inc., Health Net, Inc., Humana Health Plan, Inc.,
Humana, Inc., PacifiCare Health Systems, Inc., Prudential Insurance Company of America, United Health Care, United Health
Group and Wellpoint Health Networks, Inc (collectively the “Defendants”). The complaint in the Action alleges that between 1990 and present, these companies engaged in a conspiracy
to improperly deny, delay and/or reduce payment to physicians, physician groups and physician organizations by engaging in
several types of allegedly improper conduct, including:
and/or failing to disclose the use of edits to unilaterally “bundle”, “downcode” and/or reject claims
for medically necessary covered services;
to pay for “medically necessary” services in accordance with member plan documents;
and/or refusing to recognize CPT modifiers;
and/or misrepresenting the use of improper guidelines and criteria to deny, delay and/or reduced payment for medically necessary covered services;
Misrepresenting and/or refusing to disclose applicable fee schedules;
Failing to pay claims for medically necessary covered services within the required statutory and/or contractual time
and/or failing to disclose the use of inappropriate or unsound criteria to determine
payments due to physicians, physician groups and physician organizations compensated under “capitation”
to pay “actuarially sound” capitation rates;
to timely assign members to physicians, physician groups and physician organizations compensated under capitation systems
complaint claims that this conduct violated various state and federal statutes. The
named plaintiffs in the complaint also seek recovery on various common law theories, including breach of contract, based on
practices such as those summarized above.
Health Net will make a settlement payment of Forty Million Dollars ($40,000,000)
which, together with accrued interest from the date of Preliminary Approval, will be distributed as follows:
Dollars ($1,000,000) will be set aside to fund settlement compliance activities.
Thirty-Nine Million Dollars ($39,000,000) will be distributed to physicians who are members of the class under the proposed
settlement and who file a Proof of Claim. If the settlement is approved by the
Court, these members of the Class will be entitled to payments from the settlement fund in accordance with formulas that are
set forth in the Settlement Agreement.
If you are
an individual physician, or the heir of a deceased individual physician, who is eligible to participate in the settlement
fund, you may submit a claim. Call Health Net Physician Settlement Administrator
for a form 1-866-254-8048.
Claims must be mailed in NO LATER THAN SEPTEMBER 21, 2005.
If you would
like further information about the claims asserted in the Action, you can review a copy of the complaint at www.healthnetphysiciansettlement.com.
It is also available at: