Friday, October 27, 2000

Lawsuit claims Humana policy shortchanges doctors

By Catherine Wilson
The Associated Press

        MIAMI — Doctors are being “bled to death” by a Humana Inc. policy that automatically cuts claims for intensive medical care, an attorney representing doctors in a suit against the managed care industry charged Thursday.

        Attorney Harley Tropin criticized a Humana policy that cuts the amount of payments on high intensity claims until doctors further document the need for the additional care. It is a policy once only used on doctors that had a history of overbilling that was later expanded to all doctors.

        “Doctors are being cheated a little bit at a time, being bled to death,” Mr. Tropin told U.S. District Judge Federico Moreno. Companies “do it automatically with a software program. ... It saved them literally hundreds of millions of dollars, possibly billions over the years.”

        The complaint is one of several by doctors and 80 million managed care patients suing eight major managed care companies. Humana, one of the nation's largest managed care companies, has its headquarters in Louisville.

        Humana attorney Brian Boyle responded that Mr. Tropin mischaracterized a policy modeled on the federal government's Medicare claims-review process.

        “They're assuming that we close the books” after checks are sent to doctors on initial claims, he said. Humana reviews additional documentation and pays doctors more if justified.


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