NEW YORK (AP)_ A lawsuit filed Monday against Humana Inc. accuses the health maintenance organization of misleading members about how it makes coverage decisions.
The suit, seeking class-action status, alleges that Humana didn’t tell customers that cost _ not medical need _ is the main factor behind the health plan’s decisions on what medical care it approves for members.
``Humana used undisclosed criteria that were unrelated to patients’ medical needs,″ said Joseph Sellers, a partner in the law firm of Cohen, Milstein, Hausfeld & Toll.
Louisville, Ky.-based Humana paid cash bonuses to claim reviewers and had financial arrangements with doctors ``that were clearly designed to reduce the number of patient claims that would be approved,″ the suit says.
Humana officials said they could not comment on the allegations because they did not have a copy of the suit.
Humana, one of the nation’s largest managed health care companies, has about 6.1 million members in 15 states and Puerto Rico.
The suit was filed in federal district court in Miami on behalf of two Riviera Beach, Fla. police officers.
The lawsuit is the first of many that several powerful lawyers, including some who gained high profiles in litigation against tobacco companies and Microsoft Corp., plan to file in coming weeks to challenge coverage decisions of HMOs.
Seller’s Washington D.C. firm filed the lawsuit along with the firm of Boies & Schiller of Armonk, N.Y. David Boies of Boies & Schiller, is a leading attorney working for the Justice Department’s antitrust case against Microsoft.