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AMA Joins Suit Against Regence

by Barbara Kram, Editor | December 05, 2006

Added Dr. Maloney, "At the core of this matter is that true quality improvement programs need the active involvement of physicians to make sure the standards that are applied are fair, accurate, and do not unduly interfere with the doctor/patient relationship."

The causes of action addressed in the suit include:

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* Violation of the Unfair Business Practices Act (also known as the "Consumer Protection Act") RCW 19.86, which prohibits unfair or deceptive acts or practices in trade or commerce.

* Defamation/libel. Regence sent written notice to patients stating that their doctors were not providing quality care. These statements were false, defamatory and adversely impacted physicians.

* Intentional interference with commerce. Regence fundamentally interfered with the doctor/patient relationship, which is based on trust and confidence. This impacts the patients, as well as the physicians.

* Breach of contract. Regence has contracts with these doctors that give them certain rights, such as:

o A promise by Regence that the providers will be allowed to provide medical care to Regence subscribers.

o A credentialing procedure, that if Regence chooses to take away a physician's privileges, he or she has the right to appeal, including a judicial remedy. By de-selecting them from this "Select Network," Regence skirted this credentialing process.

o An appeal procedure that by law provides physicians the right to dispute Regence's unilateral decisions.

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