On July 13, 2006, the American Chiropractic Association (ACA) asked the U.S. District Court in Miami to join the plaintiffs in the pending nationwide class-action lawsuit Solomon, et al., v Anthem, et al., originally filed in October 2003, and specifically requested that ACN, Inc., and United Healthcare Services, Inc., be named as additional defendants in the suit.
The ACA, along with other state and national health care organizations, accuses ACN and other managed care companies of participating in a conspiracy to underpay health care providers by denying reimbursement for medically necessary treatment, allegedly violating the Racketeer Influenced and Corrupt Organizations (RICO) Act. Managed care companies named in the original Solomon suit include Anthem, Health Net, Humana, Aetna, Wellpoint Health Networks, Prudential, Coventry Health Care, and the newly merged United Healthcare and PacifiCare Health Systems.
The ACA action is the latest attempt to address perceived managed care abuses by ACN and other managed care networks. The association's long-standing campaign to rectify the unlawful practices of some managed care networks is an expansion of a resolution, passed by the ACA House of Delegates in March 2002, which formally outlined the organization's opposition to such misconduct.
"There is simply no greater priority for ACA than to oppose what we view as the abusive tactics of ACN and other managed care organizations who systematically deny needed chiropractic care to our patients," said ACA President Richard G. Brassard, DC. "Doctors from across the country have provided us with reports of intimidation and coercion conducted under the guise of utilization control. This can no longer be tolerated by a profession dedicated to quality patient care. The ACA intends to expend every effort and seek every possible legal remedy to put a halt to these harmful practices."
ACN and the other defendants in the class-action lawsuit are accused of the following:
- systematically refusing to compensate health care providers for covered services;
- processing health care providers' claims using automated programs, which manipulate standard coding processes, or using unqualified personnel to determine whether or not the service provided was medically necessary and covered;
- downcoding and bundling legitimate claims to less costly procedures;
- arbitrarily refusing or reducing payment for certain categories of treatment;
- systematically failing to recognize valid assignments of benefits;
- delaying payments to health care providers by requesting addition-al documentation, even when such documents should not be required.
At the state level, several chiropractic organizations are working with state attorneys general, offices of insurance and boards of licensure, and the Federation of Chiropractic Licensing Boards (FCLB) regarding ACN's questionable business practices. The Florida Chiropractic Association already is a plaintiff in the Solomon suit, and the Connecticut Chiropractic Association is seeking to join the litigation as a plaintiff.
Doctors of chiropractic and other chiropractic state associations are encouraged to file any related complaints with their state regulatory agencies. DCs are urged to utilize the ACA's ERISA pre-service template letter, accessible at www.ACAtoday.org/networks, to notify a patient's employer that the benefit they purchased for the employee is not accessible when medically necessary treatment is denied.
"Like the generations of chiropractors before us, the ACA will not back away from its responsibility to protect the profession and the patients we serve." Dr. Brassard said. "We ask the entire profession to unite with us in this effort, as the outcome will profoundly affect the way chiropractic care is provided now and in the future."
To view copies of pleadings filed by the ACA in the U.S. District Court in Miami, or for more information on ACA's ongoing managed care initiative, visit www.amerchiro.org.
Editor's note: For background information on this topic, please visit the following Web links on ChiroWeb.com: