Judge Scales Back HMO Patient Claims

A federal judge in Miami ruled that patients in several of the nation’s largest HMOs can proceed with some of their claims in a lawsuit accusing the health insurers of violating federal racketeering laws.

The widely watched lawsuit accuses the HMOs of using deceptive advertising to misrepresent the quality of health care they would receive.

The defendants are Aetna Inc., Cigna Corp., Health Net Inc., Humana Inc., UnitedHealth Group Inc. and Prudential Financial Inc.

U.S. District Judge Federico Moreno dismissed 10 of 16 claims brought against the insurance companies under the federal Racketeer Influenced and Corrupt Organizations Act, but determined the other six claims to be valid.

Moreno also dismissed some claims brought under the ERISA law regulating employee retirement benefits. But he allowed one claim to proceed, in which the HMOs are accused of interfering with physician-patient communication by imposing “gag orders” on doctors.