In what maybe a brand new way to hit back at the insurance companies that pillage hospitals and patients alike, a lawsuit was filed by two different hospitals in Queens, N.Y. today.
Jamaica Hospital Medical Center and Flushing Hospital Medical Center filed a joint suit that charges United Health Group and Oxford Subsidiaries violated the U.S. Racketeer Influenced and Corrupt Organizations Act by implementing an illegal business plan that enriched the insurance giant and their extremely wealthy CEO William Mcguire among others.
From the Queens Chronicle:
The hospitals, in their RICO suit, accuse United Health Group and United HealthCare and other subsidiaries of implementing a “rogue business plan” on a “national level” that, for more than three years, “has contributed to UHG’s profits, which, in turn, have been utilized in attempts to justify outlandish compensation to Maguire and to enhance the value of illegally backdated options for UHG stock” which were given to Maguire, other UHG senior executives and to managers of its business units.
These included “the individual defendants who controlled the operation of the Insurer HMO Enterprise to encourage the generation of excess profits by any means — including the violation of New York laws, violation of their contracts with service providers such as plaintiffs, and even the violation of their duties to their members.
David Rosen, president and CEO of both hospitals, said: “UHG, United and Oxford have clearly established and refined a pattern of deceitful practices and myriad means to improperly retain money they owe to service providers, and to arbitrarily and unjustifiably deny payment for their members’ medical services under their plans.
The lawsuit covers all the grievances that the hospitals have incurred from UHG. David Rosen is pissed off and going after the insurance behemoth with a tremendous amount of ammo. The suit accuses them of wronful denial of coverage due to repeated lying to members of the insurance group, economic pressure to influence doctors at the hospitals, not fulfilling contractual obligations, fraud and 'unjust enrichment.'
The New York State government has also gotten involved in trying to bring UHG et al. to justice:
The Attorney General of the State of New York, in a recent “consent decree,” concluded that United Health Care of New York had committed both “fraudulent business practices” and “deceptive business practices” in providing inaccurate information about the network status of approximately 141 participating providers. These acts either improperly shift to the health insurer’s members financial obligations properly belonging to the insurer or to deprive service providers of payment for services properly rendered.
The New York State Department of Health suspended United’s Certificate of Authority to do business in New York for certain important lines of business for repeated citations by Health Department over just an 18 month period for providing inaccurate information concerning the network status of service providers.
These companies have been guilty for a long, long time and using the RICO Act just might be the case to break through their tangled web.
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