 |
 |
|
|
August 6, 1999
Psychiatrists and mental health professionals who are angry about the way mental health carveout companies deal with them and their patients may soon get their long-awaited day in court.
In June U.S. District Court Judge Lewis Kaplan refused to grant the managed care firms' motion to dismiss a class-action lawsuit filed by mental health clinicians and organizations against nine carveout companies charged with violating federal antitrust laws.
The suit was filed in May 1998 by seven clinicians with patients whose mental health care these companies managed. Among the plaintiffs are two psychiatrists-APA Treasurer Maria Lymberis, M.D., of California and R. Anthony Moore, M.D., of Texas. Also joining in the suit are the American Association of Private Practice Psychiatrists, Black Psychiatrists of America, American Couples Center of New York, and New Jersey Society for Clinical Social Work.
The defendants in this multibillion-dollar suit include the nation's largest behavioral health carveout companies, which are responsible for managing the care and insurance coverage for about 115 million Americans. The companies named are Green Spring Health Services, Human Affairs International, Merit Behavioral Care, CMG Health, Options Healthcare, Value Behavioral Health, United Behavioral Health, Foundation Health Systems, and MCC Behavioral Care. (In the year since the suit was filed, Merit took over CMG, and Magellan absorbed Green Spring and Merit.)
The suit, which is known as Russell Holstein, Ph.D., et al. v. Green Spring Health Services, et al., charges the companies with engaging in an illegal conspiracy to restrain trade by agreeing to fix prices and reimbursement levels, which has resulted in severe financial harm to the plaintiffs, including all members of the four organizations who filed suit. It also contends that as a class, all patients whose care was affected by decisions made by these companies have suffered harm as a result of reduced access to the care their treating clinicians determined they required.
The suit, which was originally filed in New Jersey, is very similar to one filed against the same companies in 1996 in New York. In that case, which was dismissed last year, Judge Kimba Wood of the U.S. District Court for the Southern District of New York ruled that the plaintiffs did not allege sufficient details of an antitrust conspiracy to warrant allowing the case to proceed. Her ruling was upheld on appeal. Kaplan, who presides in the same U.S. District Court, found that the current suit does contain adequate details to proceed to trial.
The Holstein suit was filed in New Jersey, but the federal judge to whom the case was originally assigned agreed with the managed care companies that since it was almost identical to the earlier New York case, it should be removed to the U.S. District Court there. This ruling distressed the plaintiffs because of the New York court's dismissal of the similar case, but the case has now ended up in the courtroom of a judge who appears to be more receptive than Wood to such class-action antitrust suits.
The suit alleges specifically that the companies, who are direct competitors, for at least the four years preceding the filing of the complaint "entered into and engaged in a continuing nationwide contract, combination, and/or conspiracy in unreasonable restraint of trade and commerce" in violation of the Sherman Act, a federal statute governing antitrust practices. The purpose of the alleged conspiracy, according to the plaintiffs, was "to fix, lower, maintain, and stabilize the professional fees that could be earned by plaintiffs and the class members, and to exclude from competition by boycotts, coercion, and intimidation any class member who attempted to thwart the [managed care firms'] price-fixing goal. . . ."
Lymberis, one of the two individual psychiatrists who have joined the suit, is pleased about Kaplan's ruling. "It means that we, the clinicians who are working on the front line of actual practice, will finally have a chance to be heard in court," she told Psychiatric News. It is especially gratifying, she added, "because Judge Kaplan has extensive experience in antitrust, having been an antitrust attorney for 30 years. He knows what is at stake, and he stated that the case clearly has merit."
Lymberis noted that she became a plaintiff to protest "the sacrifice of the values and standards of medicine, especially the ability of patients to choose their doctors and decide with those doctors on treatment choices. . . . By joining this suit I feel that I am fighting for the right cause the right way."
The New York State Psychiatric Association "is very happy about what has happened with this case," said Herbert Peyser, M.D., the Area 2 (New York State) representative to the APA Board of Trustees, "and is studying the best way [it] can support the action."
Despite the favorable ruling from Kaplan, however, Peyser is urging caution rather than excitement about the case's future. The judge's decision "is not an end in itself," Peyser told Psychiatric News. The managed care defendants will probably fight requests for disclosure of data they consider confidential and proprietary. "It will take many years and be very expensive for both sides," he said.
The suit is being supported financially by voluntary contributions from individuals and organizations, said Joseph Sahid, the lead attorney on both cases. At its July 10 meeting, the APA Board of Trustees voted to support the litigation and contribute $10,000 to the suit.
He is hoping that psychiatrists and others will help out as well by contacting him with any information about their experiences with these companies that could bolster the evidence in the plaintiffs' case.
Sahid's telephone number in New York City is (212) 308-5930, and his e-mail address is ahid@worldnet.att.net.