Chapter 4.G.2 (or 2.C)--HMO Liability



Class Action Suits. In the late 1990s, a group of prominent plaintiffs’ lawyers brought large class action suits against the major national HMOs under RICO, the federal white-collar crime statute, alleging that HMOs systematically misrepresent how generous they are in making coverage decisions, and fail to disclose utilization review restrictions and methods of physician payment. These claims were largely unsuccessful, for failure to show actual injury or to meet class action requirements. Maio v. Aetna, 221 F.3d 472 (3d Cir. 2000); In re Managed Care Litigation, 209 F.R.D. 678 (S.D. Fla. 2002). For analysis, see Kathy Cerminara, Taking a Closer Look at the Managed Care Class Actions, 11 Annals Health L. 1 (2002); Clark Havighurst, Consumers Versus Managed Care: The New Class Actions, 20(4) Health Aff. 2 (July 2001); David Studdert & Troyen Brennan, 342 New Eng. J. Med. 280 (2000). See generally Kathy Cerminara, The Class Action Suit as a Method of Patient Empowerment in the Managed Care Setting, 24 Am. J.L. Med. 7 (1998).



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