Managed Care Settlements

Understanding and Enforcing the HealthNet Settlement

On May 3, 2005, counsel for approximately 900,000 physicians and HealthNet, Inc., announced that they have settled a national class action 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. The settlement agreement includes substantial commitments by HealthNet to institute a significant number of business practice changes that will benefit physicians.

The cornerstone of these business practices is HealthNet’s agreement to apply generally accepted medical standards. Additionally, HealthNet 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 HealthNet, reduce administrative complexity in the claims payment system and help to improve the quality of the health care system in general. For more specific information regarding the business practice changes, click on the “Key Aspects of HealthNet Settlement” link below.

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 HealthNet’s compliance with the terms of the settlement agreement.

The compliance dispute process is triggered by filing a brief dispute form describing how HealthNet 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 HealthNet 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 HealthNet settlement
• Step-By-Step Guide for filing a Compliance Dispute
• Healthnet Compliance Dispute Form
• HealthNet Joinder Agreement [doc]