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Maldonado Medical LLC Champions Physician & Patient Rights for Better Reimbursement Schedules Nationwide

PHOENIX, Sept. 3 /PRNewswire/ -- Maldonado Medical, a Durable Medical Equipment (DME) provider servicing the southwestern United States, in continuing its commitment to physicians, patients and the organized medical community, has joined the American Medical Association (AMA) and other physician associations from several states in filing a nationwide consolidated class action lawsuit. This lawsuit is against the following health insurers: Aetna Inc., Cigna Corp. and other co-conspirators such as Wellpoint, Inc., Oxford Health Plans, Health Net, Inc., and The Health Insurance Association of America over the use of a 'rigged' database used to underpay physicians, providers and patients for more than a decade.

This nationwide class action is brought on behalf of physicians, subscribers, DME providers and other non-physician providers, as well as the American Medical Association (AMA) and several state medical associations, including the Medical Society of New Jersey, the Medical Society of the State of New York, the California Medical Society, the Connecticut State Medical Society, the Texas Medical Association, and the North Carolina Medical Society.

These organized medical communities have been forced to absorb as much as 28% reduction of the costs of treatments and services provided based on the Usual, Customary and Reasonable (UCR) allowable rates. This in turn diminishes the necessary resources to run their health care practices and stands in the way of the patient-physician relationship.

"Being a Plaintiff in this suit is unprecedented in the Durable Medical Equipment industry," states Brandon Maxon Maldonado, whom along with his brother Gregory Maxon Maldonado, own and operate Maldonado Medical. In an ongoing effort to increase reimbursement rates for physicians, Maldonado Medical is helping to spearhead efforts to keep physicians from being systematically trampled into submission and forced to accept the health insurance industry's "Out of Network" UCR reimbursement rates.

Maldonado Medical has also been fighting other types of health insurers' fraudulent claims practices since 2003. "We can no longer ignore the improper business practices of health insurers who decide to play by their own rules without any regard to patients, or the legitimate costs required to care for them," said AMA President Nancy H. Nielsen, M.D.

"We have evidence that multiple health insurance companies have attempted to put us out of business but we have taken a stand, both for the rights of our patients and physicians, as well as our own", says Brandon Maxon Maldonado. With health insurance reform in the forefront of the American political landscape, health insurance companies have spent millions of dollars trying to convince people that patient care is of the utmost importance. The real fact is that the health insurance industry continues to earn billions of dollars and record profits at the expense of its physicians and patients.

According to New York Attorney General Andrew Cuomo, health insurance companies have been able to defraud physician's reimbursements by up to 28% nationwide.

"This class action is about a secret and intentionally concealed agreement among health insurers to depress reimbursements, thereby raising the cost of reimbursed health care services for consumers and providers." (As outlined in the consolidated class action filed on July 1, 2009 in US State District Court, District of New Jersey.)

When plaintiffs such as Maldonado Medical bring class action lawsuits, they are often taking on the wealthiest corporations in the world. These corporations will allocate massive amounts of their resources into the effort to prevent any recovery or meaningful change in practices. The Maldonado Medical legal team is also exploring options to participate in various other class action lawsuits. Examples of other lawsuits may include the practice of using post-payment audit processes to place pressure on providers. The insurer's intention is to claim that the providers have been overpaid in the past for services that are not deemed to be covered under its health care policies for various reasons. This includes stating that the services are purportedly experimental and/or investigational. They feel this will intimidate physicians into not using "Out of Network" benefits that patients have paid substantial amounts for.

"Health Insurance companies consistently invalidate acceptable medical procedures thus making the patient responsible for their health care costs," states Gregory Maxon Maldonado. "In making demands like this, health insurance companies fail to provide even minimal due process, which is required under the Employee Retirement Income Security Act (ERISA), before health insurance companies can make any unfavorable health benefit determinations. These health insurance companies continue to violate the legal rights of physicians, non-physician providers and the premium paying patients."

"We are involved in this historic class action lawsuit to assist physicians and patients in defending themselves. We have expended enormous resources to create a proprietary database of thousands of violations of ERISA and to create transparency in this corrupt system of reimbursement schedules with the intent to change the system in making it more fair for doctors and patients," says Brandon Maxon Maldonado.

On June 15, 2009, in the face of overwhelming accusation and historical precedence, a federal judge ordered the Aetna class action case to a preliminary settlement conference. It is at this conference where Maldonado Medical, along with the American Medical Association and associated plaintiffs, will attempt to reform "Out of Network" reimbursement procedures and provide physicians, non-physician providers and subscribers the recompense that is long overdue from these fraudulent and conspiratorial acts.

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SOURCE Maldonado Medical LLC
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