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The long-term effects of the 2001 Racketeer Influenced and Corrupt Organization Act (RICO) class action suit against 10 of the nation's largest insurers are easily overshadowed by the more than $600 million in settlements made by most of the payers over the past several years. However, the true magnitude of the suit is rooted in the changes that providers can expect to see going forward. The key is to understand what will occur, how to monitor it, and what to do if the managed care organizations (MCO) don't play by the rules, says Mike Fleischman, FAAHC, principal of Gates, Moore & Company in Atlanta.