RICO Cases

 

$650 Million Recovery for Insureds Against Health Insurance Companies

 

We were one of 15 firms on the steering committee of a class action asserting RICO conspiracy and aiding and abetting claims on behalf of some 600,000 doctors against 10 of the largest HMOs in the country and almost 60 Blue Cross and Blue Shield insurance companies.

 

The practice of medicine is “coded,” meaning the AMA has assigned codes to virtually everything a doctor does. Doctors use those numerical codes to bill insurance companies, and when they become a network provider for a given insurance company or HMO they are paid agreed upon rates for coded services. The HMOs however, developed claims processing programs that manipulated those codes – by bundling them, changing them, even ignoring them – to cheat the doctors by reducing the amounts they had to pay.

 

Over a 10-year period, and as a result of countless hours of attorneys’ time, settlements were reached that provided the doctors with billions of dollars in prospective relief and $650,000,000 in cash payments for past billing transgressions.