AMA files brief contesting insurer's payment practices

March 13, 2013
AMA files brief contesting insurer's payment practices
A landmark case examining the question of whether physicians can bring a class arbitration against a health insurer who has underpaid them is currently before the U.S. Supreme Court, in a brief filed by the Litigation Center of the American Medical Association and State Medical Societies and the Medical Society of New Jersey.

(HealthDay)—A landmark case examining the question of whether physicians can bring a class arbitration against a health insurer who has underpaid them is currently before the U.S. Supreme Court, in a brief filed by the Litigation Center of the American Medical Association and State Medical Societies and the Medical Society of New Jersey.

The friend-of-the-court brief, recently filed, dates back to September 2003 when John Sutter, M.D., a New Jersey , claimed that Oxford Health Plans bundled, downcoded, and delayed payment for his own services and those of an additional 20,000 physicians in the same network.

In contracts between insurers and , disputes can only be resolved by arbitration. Consequently, Sutter has requested that his claims be filed as a class arbitration. This has been deemed acceptable under the terms of the contract by the arbitrator and other legal opinions, but the case has been appealed to the U.S. Supreme Court by Oxford Health Plans.

"Since health insurers like Oxford know that arbitration is a seldom-used and ineffective way of bringing individual claims, they can violate their contracts with doctors with impunity, underpaying doctors and leaving them with no effective means to challenge such underpayments," the brief states. "It is clear that Oxford would rather pay hundreds of claims individually in arbitration and continue its practices unabated so that it would never have to stop its wrongful—and lucrative—conduct."

Explore further: Democratic Party control could ban mandatory arbitration, UI expert says

More information: More Information

Related Stories

Lawsuit seeks arbitration in Microsoft case

July 6, 2010

(AP) -- Attorneys representing 23 states involved in a class-action lawsuit against Microsoft Corp. have filed a lawsuit over attorney fees against the Iowa lawyer who spearheaded a $179.5 million settlement with the software ...

Nokia sues RIM for breach of contract (Update)

November 28, 2012

Nokia Corp. said Wednesday that it is suing Research In Motion, the maker of the BlackBerry, for breach of contract in Britain, the United States and Canada over cellular patents the two companies agreed on nine years ago.

Recommended for you

Sustaining biomedical research: Med school deans speak out

May 27, 2015

Cuts in federal support and unreliable funding streams are creating a hostile work environment for scientists, jeopardizing the future of research efforts and ultimately clinical medicine, according to leaders of the nation's ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.