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Boro hospitals sue United Health over coverage

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But last week Jamaica and Flushing Hospitals, which are run by parent company MediSys Health Network, filed a RICO suit in federal court that accused health insurance giant United HealthGroup and two of its subsidiaries, Oxford and United HealthCare, of implementing a "rogue business plan" and using corrupt business practices to increase profits."Our federal RICO suit starts to connect the dots of United's and Oxford's documented egregious and indefensible avoidance of their contractual obligations to their members and services providers," said David Rosen, who as president and CEO of MediSys runs both Jamaica and Flushing Hospitals.In a prepared statement, Maria Gordon-Shydlo, United's spokeswoman, said the company remains dedicated to providing "comprehensive quality services for our members." "Jamaica's most recent action clearly demonstrates its unwillingness to address its issues directly with us," the statement said.Rosen and United Health Group have been engaged in legal wrangling since April, when Jamaica Hospital sued Oxford after the insurance company sent out letters to patients informing them that Jamaica Hospital was no longer in its network. The dispute stemmed from a three-year contract Rosen signed with Oxford in late 2004.Rather than implementing the contract, Rosen said Oxford sat on it for about five months while it pressured a group of anesthesiologists working at Flushing Hospital to join its network.After the lawsuit was filed, Oxford agreed to keep providing in-network coverage at Jamaica Hospital while the suit was being adjudicated.And while the suit is still working its way through the court system, Rosen said Oxford has continued to deny coverage to patients at the Jamaica and Flushing hospitals. The lapses are normally blamed on computer glitches or other technicalities, Rosen said.Rosen essentially raised the curtain on the charges contained in the RICO suit in December, when he testified about United's practices at a state Assembly health-care hearing in Manhattan.Rosen said then that mergers in the insurance industry are the "800-pound gorilla" in the conversation about reducing state health- care costs that has emerged in recent months. Rosen also said Jamaica's problems with Oxford began after it was taken over by United.Reach reporter Craig Giammona by e-mail at news@timesledger.com or by phone at 718-229-0300, Ext. 146.

Posted 7:08 pm, October 10, 2011
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