June 2006

ACA files suit against ACN

The American Chiropractic Association (ACA) has asked the U.S. District Court in Miami to allow ACA to join as a plaintiff in the pending nationwide class action lawsuit, Solomon v. Anthem, et al., and further asked that ACN Group, Inc. and United Healthcare Services, Inc. be named as additional defendants in the case.

The ACA alleges that ACN participated with other managed-care companies in the case in a conspiracy to illegally and systematically underpay providers by denying reimbursement for medically necessary treatment.

ACA, along with other national and state healthcare associations, individual doctors of chiropractic, and other healthcare providers, challenge the utilization review and payment practices of some of the nation’s largest managed care companies, including Health Net, Humana, PacifiCare Health Systems, Aetna, United Healthcare, Wellpoint Health Networks, and Prudential. The case alleges that these companies, including ACN, violated the Racketeer Influenced and Corrupt Organizations (RICO) Act by systematically and illegally denying, delaying, and diminishing payments owed to chiropractors and other healthcare providers.

Joining the ACA in its efforts against managed-care companies, particularly ACN, is the Connecticut Chiropractic Association, which is also seeking to be named as a plaintiff in the litigation. The Florida Chiropractic Association is also a plaintiff.

The suit calls into question the use of financially expedient cost and actuarial criteria rather than appropriate bases of medically necessary treatment for utilization review, and alleges that these criteria are purposely imposed on providers with the knowledge that they cannot be met.

Through this legal action, ACA will seek damages against ACN and the other defendants in the case on a class-wide basis. It will also seek to obtain injunctive relief to bring an end to what it views as the abusive practices and procedures of ACN.

Source: American Chiropractic Association, www.acatoday.org

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