Multi-District Litigation (MDL) Settlements

Have you experienced the following reimbursement issues with health plan payers: bundling, downcoding, refusal to recognize modifiers, delays in payment, retrospective refund requests, failure to pay in accordance with your contract with a health plan payer? If so, you will be interested to know that the protections provided in the Multi-District Litigation (MDL) settlements can help you. Aetna, Inc., CIGNA Corporation, Health Net, Inc., Humana, Inc., and WellPoint, Inc. (Anthem) (MDL) lawsuit settlements are ALL effective. As a result of these settlements, the unfair practices mentioned above are prohibited.

The true value of the settlements is the protections going forward, such as the compliance dispute process, which allows physicians to have a neutral mediator to resolve disputes with the settling health plans. A compliance dispute that was recently filed by physicians resulted in over $12.5 million dollars being refunded to physicians. Did you submit your eligible claims by the deadline to receive your refund? Visit HMO Settlements Web site for more information regarding the compliance dispute process.

The American Medical Group Association, American Medical Association, and Medical Group Management Association are working with the Compliance Dispute Facilitators of the MDL settlements who can assist you in filing compliance disputes free-of-charge.

You are encouraged to stay vigilant in reviewing, auditing and tracking claim payments from the settling health plans to make sure each health plan processes and pays your claims according to its settlement agreements. If you are not being paid appropriately under the health plan payer’s settlement terms, you are encouraged to file a compliance dispute.

The AMA has created informational fliers to assist you in understanding the settlement and lists the key provisions of each settlement.

The links below will take you to documents and Web site links that will help you understand your rights under the Settlement agreements.

• Aetna settlement information
• CIGNA settlement information
• Health Net settlement information
• Humana settlement information
• WellPoint/Anthem settlement information

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