June 2006

ACA’s legal efforts against ACN continue

An adverse ruling in a court case similar to one backed by the American Chiropractic Association (ACA) will not deter the ACA in its challenge of ACN Group Inc.’s practices.

In its lawsuit, Solomon v. Anthem, et al., the ACA alleges that ACN participated with other managed-care companies in a conspiracy to illegally and systematically underpay providers by denying reimbursement for medically necessary treatment.

The case that was dismissed on June 19 was similar to but not the same as ACA’s class action case. A federal judge in Miami dismissed a national class action lawsuit brought against UnitedHealthcare and Coventry Health by 700,000 medical doctors who claimed the insurers had conspired to arbitrarily deny or reduce claims.

U.S. District Judge Federico Moreno dismissed the lawsuit, known as the Shane case, due to “insufficient evidence” that the carriers conspired to deny claims in a coordinated manner.

The ACA acknowledges that the ruling could set a precedent and portend an adverse judgment in the Solomon case, but legal experts point out that the two cases are different and the possibility of prevailing still exists.

In the dismissed (Shane) case, Judge Moreno wrote that he did not condone the insurers’ practices, but he simply could not find enough evidence of a conspiracy after reviewing thousands of documents.

According to ACA’s legal team, the evidence ACA has compiled against ACN, which is not a party in the Shane case, is substantial and the court that made the decision in the Shane case has yet to review it.

MORE THAN LEGAL ACTION

Legal action is just one track in ACA’s multi-pronged strategy against ACN. In addition to filing this national class action, ACA — in cooperation with several state chiropractic associations — is actively engaged with a number of state attorneys general, offices of insurance and boards of licensure, and the Federation of Chiropractic Licensing Boards (FCLB) regarding the tactics undertaken by ACN.

According to ACA officials, these state attorneys general and state offices of insurance are reviewing the practices of ACN and other chiropractic managed-care organizations and some are launching their own investigations.

To augment ACA’s legal efforts, individual doctors of chiropractic and chiropractic state associations are being asked to take action by filing complaints with state regulatory agencies.

Source: American Chiropractic Association, ACA Today, www.acatoday.com

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