AMA: Court should uphold provisional reprieve on Medicare Advantage terminations

Jan. 22, 2014

To prevent irreparable harm to patient care, the American Medical Association (AMA) and other medical associations have urged a federal court to uphold a preliminary injunction barring UnitedHealthcare from arbitrarily dropping thousands of Connecticut physicians from its Medicare Advantage plan.

The U.S. Court of Appeal for the Second Circuit is hearing arguments today in a nationally monitored case that will decide if the injunction, obtained by two county medical associations in Connecticut, will survive a legal challenge from UnitedHeathcare – the nation's largest Medicare Advantage insurer.

In support of the county medical associations, the AMA joined more than 30 medical associations and physician advocacy groups in a friend-of-the-court brief
 arguing that the injunction is necessary to preserve due process and prevent disruptions to longstanding relationships between patients and physicians.

“The wholesale termination of physicians from United’s Medicare Advantage networks occurred without cause and without a timely and clear means of challenging the network terminations,” said AMA President Ardis Dee Hoven, M.D. “The court granted reprieve should be upheld to provide an opportunity for physicians to formally appeal their termination with United, while preserving the continuity of care for their elderly and disabled patients.”

Lifting the injunction would be “particularly problematic for the elderly and disabled patients enrolled in Medicare Advantage plans, who tend to suffer from chronic and often life-threatening conditions for which continuity of treatment is critical,” according to the AMA-supported brief.

In addition to the Connecticut physicians affected by this case, physicians in at least 10 other states have been identified for removal from Medicare Advantage networks operated by UnitedHealthcare.

The AMA is concerned with the implications of wide-spread terminations in the Medicare Advantage program and has raised objections, with the Centers for Medicare & Medicaid Services (CMS). The AMA is coordinating with state medical societies to provide CMS with documentation to support the position that these terminations will reduce Medicare Advantage networks to the point where they cannot adequately provide care for patients.

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