Do you support the ADA’s racketeering lawsuit against major insurance carriers?
The ADA in May filed racketeering charges against several major insurance carriers, alleging that they have conspired to "deny, reduce and delay" payments to dentists under contract to their plans.
This latest civil complaint, filed in South Florida’s U.S. District Court, Miami Division, is the third ADA lawsuit aimed at defending the dentist-patient relationship and halting what the Association sees as unlawful industry practices.
"The conduct that we have found with reference to the defendants in this lawsuit is pervasive, unfair to patients and the profession, and I believe, illegal," said Peter Sfikas, ADA chief counsel. "These are matters that should be brought to the attention of the federal courts and rectified there."
The complaint pursues alleged transgressions against "in-network" dentists and seeks redress under the Racketeer Influenced and Corrupt Organizations Act, better known as RICO. The suit also invokes state statutes.
The complaint targets some of the best-known insurers in health care—Cigna Corp., its subsidiary Cigna Dental Health Inc., and its affiliate Connecticut General Life Insurance Co.; MetLife Inc. and its subsidiary Metropolitan Life Insurance Co.; and Mutual of Omaha Insurance Co. The class-action suit levels a stunning array of charges: unlawful "bundling and downcoding" of dental claims, mail and wire fraud, extortion, conspiracy, racketeering and violations of state breach of contract and "prompt-pay" laws.
"This latest lawsuit is another example of the Association’s advocacy for its members, for our profession and for the patients we serve," said Dr. T. Howard Jones, ADA president.
Added Dr. James B. Bramson, ADA executive director, "The Association will use the judicial system to prevent carriers from undercutting or delaying compensation to the dentists."
In response to June JADA’s Question of the Month, two respondents (.5 percent) said they do not support this action, and two respondents (.5 percent) said they do not know. "My sense is that with the power and authority that insurance carriers have acquired over the past decade, this is a plausible allegation," said one reader who was uncertain.
A total of 316 respondents (99 percent) said they do support this legal action. Among the chorus of "go get ’ems" and "thank yous" were such reader comments as "keep up the good work," "best dues money ever spent," "this may be the best thing that ever happened to providers" and "any help in helping patients receive maximum benefits is supported."
Said one supporter, "We need this action badly."
Added another, "I think this is the most practical and useful thing the ADA has done in the 30 years I’ve been a member."
About one-third of respondents listed the difficulties they have with insurance companies on a regular basis. "I am tired of insurance company efforts to stall payments for three to six months by denying patients their insurance, by losing X-rays repeatedly and by not receiving claims electronically, by fax or mail," summed up one reader.
