|
Psychology Gains Second Settlement in Class Action Lawsuit
In August 2006, a federal judge in Miami gave preliminary approval to Humana’s settlement with a nationwide class of psychologists and other non-physician health care professionals. The settlement calls for Humana to implement a number of policy improvements for the benefit of the class and to pay $3.5 million toward a settlement fund.
The Humana settlement fund will be available to psychologists who – between January 1, 1990 and August 16, 2006 -- provided covered services to any defendant in the case. Psychologists who never submitted claims to Humana can participate, as long as they submitted claims to other defendants in this lawsuit: Aetna, Anthem, CIGNA, United, Wellpoint, Pacificare, Prudential, Coventry and Health Net. However, larger payment shares will go to psychologists with a large volume of Humana claims. Eligible psychologists may submit claims online or by mail.
The deadline for filing claims is January 13, 2007. Licensed psychologists can find a set of questions and answers about the Humana settlement – including the simple steps for filing a claim – on the homepage at APApractice.org
This is the second settlement in ongoing Florida class action that the APA Practice Organization and its outside attorneys have negotiated on behalf of psychology. In this litigation, a class of non-physician health professionals, along with the Florida Psychological Association, alleges that the managed care defendants conspired to reduce and delay provider payments in violation of federal law.
The Humana settlement will be similar to the $11.5 million CIGNA settlement from 2004 in terms of the policy changes and the process for submitting claims. However, the dollar amounts paid to eligible claimants will be smaller, in part because CIGNA has many more covered lives than Humana.
The court will decide whether to give final approval to the Humana settlement after a “fairness hearing” scheduled for December 1, 2006.
In the APA Practice Organization’s companion case against the nation’s 70 Blue Cross Blue Shield companies, the judge has ordered the parties to participate in mediation by mid-November. The APA Practice Organization hopes that this action will lead to the next favorable settlement for practicing psychologists.
Statement from the APA Practice Organization About 2007 Medicare Fees
Russ Newman, PhD, JD
Executive Director for Professional Practice
APA Practice Organization
The Centers for Medicare and Medicaid Services (CMS), the federal agency that runs the Medicare program, released the final 2007 physician fee schedule rule on November 1, 2006. This final rule contains both the 5 percent sustainable growth rate (SGR) cut and a 9 percent cut in psychologist reimbursement associated with the 5-year review rule initially proposed on June 29.
The 5 percent SGR cut is required by statute to contain the rate of Medicare cost increases. The APA Practice Organization has successfully fought back this cut in years past. The 9 percent 5-year review cut is associated with CMS's increase of payments for evaluation and management services. Under Medicare law, when CMS increases payments for certain Medicare services, it must decrease payments for other services to maintain budget neutrality, and in this instance, CMS has provided an across-the-board cut to a part of the payment formula for all provider services. While it is of little comfort, all Medicare providers are facing these cuts to a varying degree.
With your support and the support of many of our members, we have been fighting to prevent these cuts, particularly the 9 percent 5-year review reduction. Specifically, we have met with many members of key Congressional committees to assist us in this effort. In addition, I am calling on the Speaker of the House of Representatives and the Senate Majority Leader to avert these cuts due to their impact on our provider reimbursement rates and on Medicare patient access to the services that we provide.
Unfortunately, we do not know if we will be able to attain a resolution before Congress adjourns before the end of the year. It is possible that Congress will not address this issue this year and the cuts will occur in January. We are working for any opportunity this year, but if Congress does not act we will seek a resolution early next year. Our experience is that such a resolution will likely include a retroactive adjustment to payments if the cut is implemented in January 2007.
Please contact our government relations office at (+1/202) 336-5889 with your comments or questions.
Back to November/December homepage |
