December 10, 2013
On Thursday, December 5, 2013 federal court Judge Stefan Underhill issued an injunction preventing the removal of hundreds of physicians from Connecticut's United’s Medicare Advantage program. CLICK HERE TO READ DECISION.
The action, initiated by the Fairfield County Medical Association and the Hartford County Medical Association benefits all Connecticut physicians at risk of or in receipt of notice of exclusion from the United Medicare Advantage program, for now. The relief granted - a preliminary injuction - prohibits (for now) -
(a) terminating any of the Associations’ physician-members from United’s Medicare Advantage network;
(b) notifying their Medicare Advantage customers/insureds that certain providers will be terminated from the Medicare Advantage Network as of February 1, 2014; and
(c) removing or failing to advertise/market the Associations’ affected physicians in United’s 2014 directories for the Medicare Advantage Network
The court explains it has ruled for Fairfield and Hartford because of the likelihood of their success on the merits of their breach of contract claims by finding that United was in violation of its contractual obligations by failing to provide written notice of the "reasons for the action, including, if relevant, the standards and profiling data used to evaluate the physician and the number and mix of physicians needed by the [Medicare Advantage] organization." See http://courtweb.pamd.uscourts.gov/courtwebsearch/ctxc/P4aXCeO6.pdf
There is still a long way to go on this matter, and certainly at this stage of litigation Fairfield and Hartford cannot count the decision as a definitive and conclusive win. However, strategically, this decision will likely make insurers large and small take pause prior to terminating en masse.