Doctors Sue Regence BlueShield for Defamation

Doctors Sue Regence BlueShield for Defamation

Six physicians and The Washington State Medical Association filed a lawsuit against insurance company, Regence BlueShield, for defamation, breach of contract, deceptive business practices, and more.

The suit, filed in King County Superior Court, stems from Regence’s implementation of their Select Network plan. Regence BlueShield told about 8,000 plan members that they could no longer go to about 500 physicians because the practitioners were not up to the insurer’s quality and efficiency standards.

The indicated physicians were offended, and their long-time patients were angry at the possibility of no longer being able to go to their lifelong doctors, having to find new Regence-approved ones, and going through the painstaking process of transferring medical records.

One of the plaintiffs, Dr. Michael Schiesser was told he rated 12 percent on Regence’s quality and efficiency scale, when just months earlier, he had been given a 90 percent rating.

“From 90 to 12 in one year! I was shocked, and I’m still shocked. I looked at the data and it was grossly incorrect.” He found that he was reproached for poor treatment of two diabetes patients who didn’t have diabetes.

Another doctor was given a bad rating because he failed to order a mammogram for a patient who had already had both her breasts removed, said WSMA president W. Hugh Maloney.

Regence was also found to have faulted at least one doctor for not treating someone who was not even his patient.

According to physicians, instead of basing their physician evaluations on medical records, they based them on billing information that was up to four years old.

Regence agreed to postpone implementation of the Select Network plan for a year, but did little to respond physicians’ requests to change the rating system.

WSHA attorney, Richard Creatura said, "When we advised Regence the methodology was wrong, they did nothing about it."

“Good programs need input of physicians and shouldn’t interfere with the doctor/patient relationship,” Maloney said.

The suit seeks money damages for Regence’s inaccurate and improper statements to patients that certain physicians did not meet their quality and efficiency standards. The suit also seeks an injunction to prevent Regence from implementing the Select Network program, and claims breach of contract, intentional interference with contract, and violation of the Unfair Business Practices Act.

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