Hooper, Lundy & Bookman Sues Out-Of-State Blue Cross Blue Shield Plan for Paying Patients Rather Than Hospital For Emergency Care

LOS ANGELES--()--On behalf of Martin Luther King, Jr. Community Hospital, Hooper, Lundy & Bookman has filed a complaint in federal district court against Blue Cross Blue Shield of Georgia (BCBSG) for its failure to honor terms of the reimbursement agreements the hospital has with its patients.

In a retaliatory move aimed at non-contracted providers, out-of-state Blue Cross Blue Shield Plans have for years refused to pay non-contracted health care providers, but instead have sent payments directly to the patients. The current complaint alleges that BCBSG paid more than $250,000 to three individuals who repeatedly presented at MLK’s emergency department, complaining of pain. After diagnostic tests were done, the three individuals were discharged home.

BCBSG continues to send payments to the patients knowing that MLK is unable to collect from them. The complaint alleges that the practice by the Georgia-based BCBS represents intentional interference with MLK’s contractual relations with its patients, and constitutes unfair business acts and practices. The complaint seeks an injunction prohibiting BCBSG from paying patients directly for emergency department care received at the hospital and reimbursement of damages in excess of $250,000.

“The practice of paying patients rather than providers encourages individuals to make a profession out of obtaining unnecessary health care services and results in the waste of scarce health care resources,” said HLB Attorney Daron Tooch, representing MLK. “Unfortunately, this is not just an issue with this one provider. This is yet another tactic by health plans to force providers to accept low contracts rates.”

Contacts

Hooper, Lundy, Bookman, PC
Daron Tooch, 310-551-8192
MLK Counsel

Contacts

Hooper, Lundy, Bookman, PC
Daron Tooch, 310-551-8192
MLK Counsel