In the first class-action suit of its kind in California, Aetna Inc., one of the nation's largest managed health care providers, was accused Thursday of failing to disclose confidential arrangements with physicians that were injurious to members of the health plan.
The lawsuit, filed in Contra Costa County Superior Court, charges that under the contracts, doctors were barred from disclosing information to patients about monetary incentives based on providing less care.
"Many doctors are fed up with the HMO [health maintenance organization] system, which interferes with the ability to deliver quality health care," said San Francisco attorney Frederick P. Furth, the lead lawyer for the plaintiffs. "We believe they will fully support this lawsuit."
Calls to several Aetna representatives seeking comment Thursday night were not returned. In response recently to lawsuits elsewhere targeting physician payment arrangements, Aetna issued a statement saying its companies' "general practice is to provide full disclosure to potential members on how our health plans operate including how physicians are paid and we encourage participating physicians to discuss their financial arrangements with their patients."
The suit, like class actions filed recently in other states against health maintenance organizations, attacks some of the basic tenets of managed care.
The suit specifically contends that Aetna's payment system to doctors is harmful to patients and contains hidden elements. Aetna, like other HMOs, pays doctors a set amount per patient for providing all the care that person needs.
Consequently, the suit alleges, a primary care physician "has significant financial incentive to give little or no medical services to each Aetna patient since the amount paid to him/her remains the same, regardless of the amount of care the patient receives."
"This financial incentive to reduce patient care . . . is exacerbated by Aetna's policy of paying financial bonuses to [primary care physicians], based on their ability to keep costs down," the suit says.
The suit also contends that the undisclosed financial incentives reward those primary care doctors who keep medical treatment to a minimum while penalizing those doctors who provide a full range of care.
Moreover, the suit contends that these financial arrangements force the primary care physicians into inherent conflicts of interest that prevent them "from making medical decisions unsullied by financial concerns."
