PPO Litigation Update

 

Our firm had two clean cases go to trial with Tom Filo (attorney for the provider) in front of Judge Dick [clean case means that we had no late payments and the contractual relationships were direct, not connected with intermediary parties]. Our employer had a contract with the bill review company.  The bill review company had their own PPO which had a contract with Lake Charles Memorial Hospital (LCMH).  We introduced the PPO contract on cross examination.  Tom objected to the admissibility arguing that the payments were not made under the contract because the contract used the term "health plan."  Judge Dick admitted the contract into evidence.  The employer testified on direct regarding the relationship with the bill review company and the contract.  We introduced the contract into evidence once again over Tom's objection.  We also introduced the employer's insurance policy into evidence to show that the employer's policy met the technical term of "health plan" under the PPO contract.  Judge Dick admitted it into evidence.

 

At the conclusion of the testimony, she ruled that we had made a prima facie showing of the contract and the right to pay at the discounted rate.  She had already ruled that contract below the fee schedule was allowed.  She dismissed his case noting that if he had a claim for violation of Title 40 or that the contract terms were violate, the medical provider needed to go to district court as she lacked subject matter jurisdiction to consider those issues.

 

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