Humana 2002 Annual Report Download - page 25

sought certification of a class consisting of all members of our medical plans, excluding Medicare and Medicaid
plans, for the period from 1990 to 1999. On September 26, 2002, the Court denied the plaintiffs’ request for class
certification. On October 9, 2002, the plaintiffs asked the Court to reconsider its ruling on that issue. The Court
denied the motion on November 25, 2002. The Court has set a trial date on the individual named plaintiffs’
claims for September 22, 2003.
In the provider track case, the plaintiffs assert that we and other defendants improperly paid providers’
claims and “downcoded” their claims by paying lesser amounts than they submitted. The complaint alleges,
among other things, multiple violations under RICO as well as various breaches of contract and violations of
regulations governing the timeliness of claim payments. We moved to dismiss the provider track complaint on
September 8, 2000, and the other defendants filed similar motions thereafter. On March 2, 2001, the Court
dismissed certain of the plaintiffs’ claims pursuant to the defendants’ several motions to dismiss. However, the
Court allowed the plaintiffs to attempt to correct the deficiencies in their complaint with an amended pleading
with respect to all of the allegations except a claim under the federal Medicare regulations, which was dismissed
with prejudice. The Court also left undisturbed the plaintiffs’ claims for breach of contract. On March 26, 2001,
the plaintiffs filed their amended complaint, which, among other things, added four state or county medical
associations as additional plaintiffs. Two of those, the Denton County Medical Society and the Texas Medical
Association, purport to bring their actions against us, as well as against several other defendant companies. The
Medical Association of Georgia and the California Medical Association purport to bring their actions against
various other defendant companies. The associations seek injunctive relief only. The defendants filed a motion to
dismiss the amended complaint on April 30, 2001.
On September 26, 2002, the Court granted the plaintiffs’ request to file a second amended complaint, adding
additional plaintiffs, including the Florida Medical Association, which purports to bring its action against all
defendants. On October 21, 2002, the defendants moved to dismiss the second amended complaint. The Court
has not yet ruled.
Also on September 26, 2002, the Court certified a global class consisting of all medical doctors who
provided services to any person insured by any defendant from August 4, 1990, to September 30, 2002. The class
includes two subclasses. A national subclass consists of medical doctors who provided services to any person
insured by a defendant when the doctor has a claim against such defendant and is not required to arbitrate that
claim. A California subclass consists of medical doctors who provided services to any person insured in
California by any defendant when the doctor was not bound to arbitrate the claim. On October 10, 2002, the
defendants asked the Court of Appeals for the Eleventh Circuit to review the class certification decision. On
November 20, 2002, the Court of Appeals agreed to review the class issue. The District Court has ruled that
discovery can proceed during the pendency of the request to the Eleventh Circuit, and the Eleventh Circuit
rejected a request to halt discovery.
The Court has set a trial date of December 8, 2003.
Other
The Academy of Medicine of Cincinnati, the Butler County Medical Society, the Northern Kentucky
Medical Society and several physicians have filed antitrust suits against Aetna Health, Inc., Humana Health Plan
of Ohio, Inc., Anthem Blue Cross Blue Shield, and United Healthcare of Ohio, Inc., alleging that the defendants
have conspired to fix the reimbursement rates paid to physicians in the Greater Cincinnati and Northern
Kentucky region. The companion suits are filed in state courts in Ohio and Kentucky and allege violation,
respectively, of the Ohio and Kentucky antitrust laws. Each suit seeks class certification, damages and injunctive
relief. Plaintiffs cite no evidence that any such conspiracy existed, but base their allegations on assertions that
physicians in the Greater Cincinnati region are paid less than physicians in other major cities in Ohio and
Kentucky.
The Hamilton County Court of Common Pleas (Ohio) and the Boone County Circuit Court (Kentucky) have
denied motions by the defendants to compel arbitration or alternatively to dismiss. Defendants have filed notices
19