February 2005 Lawsuit Update

Aetna Settlement approved

On January 24, the Boone County Circuit Court and the Hamilton County Common Pleas Court approved Aetna settlement in its portion of the 2002 lawsuit filed by the Academy of Medicine and several other plaintiffs. The suit contends that the insurers kept insurance reimbursements to local physicians at a lower rate through illegal activities.

In the settlement, Aetna agrees to increase local physician payments by $22.3 million over the next three years. In return, the insurer would be dropped from the suit.

This is the second settlement reached in the lawsuit. Last year, Humana, a much larger insurer locally, agreed to increase tri-state physician reimbursement by $100 million over a three-year period.

In addition to the monetary settlements, both agreements call for establishing compliance committees, beginning in 2007, to oversee reimbursement negotiations between physicians and the insurers.

Neither insurer admits any wrongdoing in the settlements.

Meanwhile, the Academy along with the other plaintiffs will proceed with their suit against the two remaining defendants – Anthem and United HealthCare.

"Inadequate physician reimbursement has been a significant, if not the major reason that the Greater Cincinnati area has experienced recruitment and retention problems. We will continue to pursue this matter through the courts and in other ways until we have fully restored our health care community to its rightful place of prominence," said Russell Dean, the Academy of Medicine's former Executive Director.