Humana Inc., one of the nation’s largest managed-care companies, was accused in a Federal lawsuit yesterday of misleading health plan members by failing to disclose financial incentives to doctors and case reviewers intended to keep down costs by limiting or denying care.
The suit, filed on behalf of workers in Florida and Texas, asked a United States District Court in Miami to certify a class action on behalf of more than six million customers of Humana health plans nationwide. The suit seeks triple damages under the Federal anti-racketeering law. No amounts were specified.
The plaintiffs say they did not get the health coverage that they thought they were selecting because the company did not disclose incentives to doctors to deny care.
Joseph Sellers, a Washington lawyer who represents the plaintiffs in Miami, said the suit did not question whether managed care was a good idea or whether cost should be a factor. Instead, the suit contends that there was a ”breach of trust” because plan members thought that medical guidelines would solely determine their treatment.