Managed Care Settlements

Understanding and Enforcing the Wellpoint Settlement

On July 11, 2005, counsel for approximately 900,000 physicians and WellPoint, Inc., announced that they have settled two national class actions pending in federal court for the Southern District of Florida before U.S. District Judge Federico Moreno as well as multiple state court actions filed against the company. WellPoint is the fourth company named as a Defendant in the Managed Care Litigation in Florida to settle with physicians. The agreement includes the resolution of two national lawsuits against both pre-merger companies, WellPoint Health Networks Inc. and Anthem, Inc. ("WellPoint") and includes substantial commitments by WellPoint to institute a significant number of business practice changes that will benefit physicians.

This agreement includes industry-leading improvements to physician-related business practices. The cornerstone of these business practices is WellPoint's agreement to apply generally accepted medical standards. Additionally, WellPoint has committed to increase transparency in paying claims and has agreed to an enforcement mechanism to help ensure compliance with the terms of the settlement. The business practice changes and transparency add significant value to physicians in terms of ensuring reduced overhead and greater focus on patient care. The agreement will also streamline communication between physicians and WellPoint, reduce administrative complexity in the claims payment system and help to improve the quality of the health care system in general.

Critical to the success of this settlement is the enforcement process, which will be led by Cameron Staples, Esq., Partner with Neubert, Pepe & Monteith, P.C. In his role as the Compliance Dispute Facilitator, Mr. Staples will oversee the compliance dispute resolution mechanism which is designed to address physician complaints regarding Wellpoint's compliance with the terms of the settlement agreement.

The compliance dispute process is triggered by filing a brief dispute form describing how Wellpoint has violated the terms of the settlement agreement. Documentation which illustrates the violation should be included with the form. Filing a compliance dispute involves no cost to physicians or their practices, since Wellpoint is required to pay the full cost of the enforcement process. For further information about the compliance dispute process or a copy of the dispute form, just click on the appropriate links below.

Links:

• Key Aspects of Anthem/Wellpoint settlement
• Step-By-Step Guide for filing a Compliance Dispute
• Anthem/Wellpoint Compliance Dispute Form
• Anthem/Wellpoint Joinder Agreement [doc]