NU Online News Service, Sept. 26, 8:46 p.m. – A federal judge in Miami has certified a class of 600,000 U.S. doctors in litigation against large managed care companies, but he has denied the request of the plaintiffs' lawyers to certify a second class that could have included as many as 145 million managed care plan members.
U.S. District Judge Federico Moreno today issued an order arguing that the doctors seem to share enough concerns about fraud and racketeering to form a manageable class.
"Numerous issues are common to all claims and, in fact, predominate in this action," the judge writes.
The judge cites allegations in a complaint filed on behalf of the doctors about the managed care companies' use of medical necessity requirements, actuarial guidelines, automated claims systems, and tactics for delaying and denying claims as some of the issues relevant to questions about conspiracy.
But "this conditional class is subject to decertification" if the plaintiffs fail to prove, "even by circumstantial evidence," that reliance on misrepresentations by the managed care companies injured the doctors, the judge adds.
The judge has ruled that the proposed plan member class is too unwieldy to make a good class.
"To the extent that there are common issues of law and fact, they do not predominate, and this case, if treated as a class action, would not be manageable" the judge writes.
The ruling deals only with procedural issues and not with the merits of the plaintiffs' allegations, but the judge writes extensively about evidence that managed care companies' use of similar claims-processing systems and procedures could be evidence of the existence of a "common scheme" against the doctors.
