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Suit aims at insurance companies

Suit aims at insurance companies

Plaintiffs say profits put above patients suffering from Lyme disease

November 19th, 2017 by Lynn LaRowe in Texarkana News

Major health insurance companies are accused of putting profits over patients suffering from Lyme disease in a lawsuit filed recently in a Texarkana, Texas, federal court.

The suit alleges companies including Blue Cross, Kaiser and Aetna violated RICO and anti-trust laws when conspiring with physician members of the Infectious Diseases Society of America to create guidelines for testing and treating the tick-borne illness that don't identify all of those infected and that leave many patients still suffering after their insurance refuses to cover necessary continued treatment.

The suit alleges that doctors who speak up against the IDSA guidelines or who treat patients with expensive antibiotics beyond the 28-day regimen outlined in the guidelines are subjected to retaliation, which includes the possible loss of their medical licenses. The complaint alleges the members of the IDSA panel who establish the Lyme disease guidelines are on the insurance companies' payrolls and benefit financially from the conspiracy.

The complaint lists 24 plaintiffs from 13 states, including Texas and Arkansas, who are either sufferers of Lyme disease or who are related to a Lyme disease victim. Named as defendants are the IDSA, Blue Cross and Blue Shield Association, Anthem Inc., Blue Cross and Blue Shield of Texas, Aetna Inc., Cigna Corp., Kaiser Permanente Inc., United Healthcare Services Inc., United Healthcare Group Inc., Dr. Gary Wormser, Dr. Raymond Dattwyler, Dr. Eugene Shapiro, Dr. John Halperin, Dr. Robert Nadelman, Dr. Leonard Sigal and Dr. Allen Steere.

Among the plaintiffs is the wife of David Kocurek, Ph.D., of Texas. Kocurek served on NASA's aerodynamics oversight committee and published research internationally, according to the complaint.

The complaint alleges Kocurek suffered with Lyme disease symptoms, including headaches, nerve pain, muscle pain, fatigue, fever, tremors and more for years.

"He visited more than 25 doctors and was told he did not have Lyme disease. He even tested negative for Lyme disease based on the ISDA testing guidelines," the complaint states. "He was finally diagnosed as 'very positive' for Lyme and began treatment. His doctor agreed to treat him for chronic Lyme disease until she was told she could lose her medical degree if she continued to treat chronic Lyme patients. He went from doctor to doctor and was forced to pay out-of-pocket because his insurer refused to cover his treatment. David Kocurek died from Lyme disease on April 13, 2016."

The complaint alleges the insurance companies and the ISDA doctors target doctors who attempt to question the guidelines or treat Lyme disease with longer than a 28-day antibiotic course.

"There are doctors all over the country who have been reported to their medical boards by the insurance defendants because they violate the IDSA guidelines and try to save the lives of their patients," the complaint states.

The complaint alleges that some doctors have spent millions defending themselves.

"Dr. Charles Ray Jones is the world's leading pediatric specialist on Lyme disease. Yet, Dr. Jones has been hounded by the Connecticut State Medical Board for years and his patients and colleagues have had to help to defray the costs of his legal defense," the complaint alleges.

The case is pending before U.S. District Judge Robert Schroeder III in the Texarkana Division of the Eastern District of Texas. The plaintiffs' lawyers include Eugene Egdorf and Ryan Higgins of Houston and Lance Lee of Texarkana.

 

llarowe@texarkanagazette.com

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