Cigna Case goes To Court

Doctor-CIGNA case goes to court

By Jessica Szalay
jszalay@selmaenterprise.com

"The most important thing is for the story to be told and for CIGNA to get exposed for what they're doing," said Dr. Linda Halderman right before her small claims court trial Friday against CIGNA Health Care.

Halderman, a breast cancer surgeon in Selma, considers herself just one of the many physicians around the country who have been swindled by the health care concern over what is called "downcoding."

This happened to her one year ago when she agreed to see two CIGNA patients for a minimally invasive biopsy, one in March and the other in April 2006. Since this procedure does not require surgery it is performed in the doctor's office instead of in a hospital.

This procedure results in over $300 in disposable costs per patient for the doctor since the equipment cannot be re-used. According to Halderman, CIGNA forces physicians to accept discounts to see any CIGNA patient. In order to get paid for their work, the doctor presents CIGNA with a specified billing code that represents the procedure they performed, after which CIGNA pays the doctor for their services.

In Halderman's small claims case, CIGNA did not pay her the correct amount, she said.

"They took the code and illegally changed it," she explained. "Which saved them about $400 per case."

According to Halderman, after informing CIGNA of this downcoding, they admitted on the phone to her that they owed her money and that they entered the wrong code in the computer. They also informed her that they would not pay her the correct amount or fix the code in the computer.

"It was a violation of their contract to change the billing code I used, which would allow them to pay $229.77 rather than $608.87," Halderman said to Judge D. Tyler Tharpe at the Selma Superior Court. "CIGNA repeatedly refused to pay what they had contracted to pay."

Because of this hassle, and knowing that CIGNA had done this previously to other doctors across the country, Halderman filed a lawsuit in February against the health care company. Her case came up one year after a class action lawsuit forced CIGNA to pay over $400 million to physicians and foundations for such practices like downcoding.

RICO (Racketeer Influenced and Corrupt Organizations) Act settlements charged 10 for-profit health plans, including CIGNA, for wrongfully denying payment to physicians through fraud and extortion.

Seven of the 10 health care companies agreed to a settlement in January of 2006, one of which was CIGNA.

Just three months later, Halderman said CIGNA illegally changed codes on two of her cases.

"They do this over and over, and we can't fight it, we don't have time," said Halderman. "They hope we'll go away. Most of the time, doctors don't take care of CIGNA patients and that saves them [CIGNA] money."

In addition, more than 70 percent of Halderman's patients are uninsured, have Medi-Cal or are insured through the state Breast Cancer Program, which pays at Medi-Cal rates.

"I could either stop seeing these patients, close my doors or figure out a way to subsidize breast cancer," Halderman said, who performs cosmetic services to augment her practice. "I use the vanity part of the practice to subsidize the breast cancer."

Because of the cosmetic services, she can perform minimally invasive biopsies, therefore saving the patients and the health care companies, such as CIGNA, money.

At her court date, the CIGNA representative requested a continuance in the case, since the two parties had previously settled on an agreement. According to Halderman, this was not the case. It was not until the Tuesday before her Friday court date that someone from CIGNA contacted her regarding the suit she had filed back in February.

On Tuesday, April 3, CIGNA offered Halderman the exact amount they owed her one year ago. Since Halderman declined the offer, CIGNA's lawyer, Nancy Leduc, of Hartford, Conn., called Halderman the next day asking what Halderman would accept. Halderman decided that she wanted $2,000 to be donated from CIGNA to Selma Cancer Support, to which Leduc verbally agreed. Leduc planned on faxing Halderman a new contract, Halderman said.

Yet on Thursday, April 5, Halderman received a fax from Leduc with a complete gag order stating that they would see her in court. Halderman received a repeat copy of this the morning of the trial.

"She never meant to settle," Halderman said of Leduc, who did not return any messages by press time.

At Halderman's court date, friends such as Fresno City Councilman Jerry Duncan and Selma Cancer Support officers Char Tucker and Lance Cardoza came to support Halderman, as she presented her case at the Selma courthouse. Judge Tharpe told both Halderman and the CIGNA representative that he would deliberate and get back to them in a few business days. No verdict had been reached by press time.

No matter the outcome, Halderman still pledges to donate $2,000 to Selma Cancer Support, the local organization that is just for Selma residents and their families who are affected by cancer.

"Every penny that we get goes to good use," said Selma Cancer Support founder Tucker. "This $2,000 is going to help us tremendously. It's not about the money, it's about making the community aware of what's going on."

(April 11, 2007)

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