Physician Payment Issues: Kaiser vs. CIGNA

     In the fight against managed care abuses, the Illinois State Medical Society recently announced their support of the lawsuit Kaiser vs. CIGNA.  Supported by the American Medical Association's Litigation Center, the class action lawsuit alleges that through the use of ClaimCheck Software, CIGNA improperly "bundles" and "downcodes" Current Procedural Terminology (*CPT*) procedures in order to reduce its payments to in-network physicians.  CIGNA contends that the AMA sanctions the use of its edits to justify their actions.  The AMA Litigation Center along with the support of the ISMS, is helping the plaintiff physicians work to receive the money they are contractually entitled to.  Nearly 100,000 non-physicians and more than 350,000 physicians are members of the plaintiff case.

     Kaiser vs. CIGNA was certified as a nationwide class action on March 29, 2001, the first of its kind.  The AMA's CPT Department submitted an affidavit to assist the plaintiffs at the class certification hearing.  The affidavit explained to the court that the AMA interpreted CIGNA's software edits differently from the way that CIGNA represented that those edits should be interpreted.   AMA's CPT Department has been consulting the plaintiffs and may provide expert witness testimony in the case.   The Litigation Center, ISMS and the plaintiffs' attorneys are continuing to discuss how they can optimally collaborate in this and similar future lawsuits.