Greg Ganske: “Here are a couple other provisions in the Senate GOP bill. Remember, this bill made its first appearance in the light of…”

“Here are a couple other provisions in the Senate GOP bill. Remember, this bill made its first appearance in the light of day about an hour before it was offered on the floor, and it was offered to the minority about 15 minutes before it was offered. So not much chance to review the language. And that bill has never had any hearings. There are a couple of provisions in there that are very significant. One provision would basically preclude class actions under the new ERISA remedy in the Senate GOP bill no matter how widespread the misconduct of the defendant. For example, an HMO might engage in a practice of systematically denying every request for treatment in order to push individuals into external review and delay treatment. They could just do that all the time. They could deny, deny, and push everybody into an external appeals thing. They could save a lot of money on the float that way. But under this provision that is in the Senate bill, even were the defendant pursuing such a strategy as a matter of design, the way they are setting up their plan, an individual could not seek any class action relief. Here is another problem. We know from a case, Humana v. Forsythe, that the United States Supreme Court held RICO applicable to a managed care company that has systematically defrauded thousands of health plan members out of millions of dollars in benefits by systematically lying to members about the proportional cost of the treatment they were being required to bear.”