UNITED STATES DISTRICT COURT
WESTERN DISTRICT OF WASHINGTON
RICHARD J. PETERSON, on behalf of himself and all others similarly
situated,
Plaintiffs,
v.
KAISER FOUNDATION HEALTH PLAN, INC., d/b/a KAISER PERMANENTE, KAISER
FOUNDATION HOSPITALS, d/b/a KAISER PERMANENTE, THE PERMANENTE MEDICAL
GROUP, d/b/a KAISER PERMANENTE, KAISER FOUNDATION HEALTH PLAN OF THE
NORTHWEST, d/b/a KAISER PERMANENTE, and KAISER DOES 1-100, INCLUSIVE.
Defendants.
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
)
No. C00-5370
FIRST AMENDED CLASS ACTION COMPLAINT
JURY TRIAL DEMANDED
Plaintiff Richard J. Peterson, by and through his undersigned
attorneys, brings this action individually and as a class action
pursuant to Rule 23 of the Federal Rules of Civil Procedure on behalf
of himself and all others who are participants in health maintenance
organizations ("HMOs"), preferred provider organizations ("PPOs")
and/or point-of-service plans ("POSs") operated by Defendants Kaiser
Foundation Health Plan, Inc., Kaiser Foundation Hospitals, The
SNIPPETS:
RICHARD J. PETERSON, on behalf of himself and all others similarly situated,
KAISER FOUNDATION HEALTH PLAN, INC., d/b/a KAISER PERMANENTE, KAISER FOUNDATION HOSPITALS,
FIRST AMENDED CLASS ACTION COMPLAINT
In support thereof, Plaintiff avers upon information and belief, except as to the allegations
This case is brought pursuant to the Employee Retirement Income Security Act to enforce the
Kaiser Foundation Health Plan, Inc. operates HMOs, PPOs and POSs and provides benefits to
To promote its insurance products, and in fulfillment, inter alia, of its fiduciary duty
These documents uniformly represent or imply that coverage decisions will be based on the
Kaiser defines medical necessity as: A medically appropriate course of treatment required to
In particular, certain kinds of care and/or medication are discouraged altogether, while in
These incentives and restrictions can have a direct and very significant impact on decisions
Defendant Kaiser has breached the fiduciary duties it owes to Class members and has violated
Plaintiff Richard J. Peterson is a resident of Camas,
Through these entities and the subsidiaries which they control, Defendants KFHP, PMG, and KFH
These undisclosed cost-based criteria include, without limitation: Interqual Criteria;
Kaiser has also failed to disclose or represent accurately to Plaintiff and members of the
whether the failure to disclose or accurately represent these facts constitutes a violation
By virtue of the conduct described above, Kaiser breached its fiduciary obligations under §
Declaring this action to be a proper class action pursuant to Rule 23 of the Federal Rules of
|
