Justia Consumer Law Opinion SummariesArticles Posted in Health Care Law
Anderson v. Ochsner Health System
The Louisiana Supreme Court granted this writ application to determine whether a plaintiff had a private right of action for damages against a health care provider under the Health Care and Consumer Billing and Disclosure Protection Act. Plaintiff Yana Anderson alleged that she was injured in an automobile accident caused by a third party. She received medical treatment at an Ochsner facility. Anderson was insured by UnitedHealthcare. Pursuant to her insurance contract, Anderson paid premiums to UnitedHealthcare in exchange for discounted health care rates. These reduced rates were available pursuant to a member provider agreement, wherein UnitedHealthcare contracted with Ochsner to secure discounted charges for its insureds. Anderson presented proof of insurance to Ochsner in order for her claims to be submitted to UnitedHealthcare for payment on the agreed upon reduced rate. However, Ochsner refused to file a claim with her insurer. Instead, Ochsner sent a letter to Anderson’s attorney, asserting a medical lien for the full amount of undiscounted charges on any tort recovery Anderson received for the underlying automobile accident. Anderson filed a putative class action against Ochsner, seeking, among other things, damages arising from Ochsner’s billing practices. Upon review of the matter, the Supreme Court found the legislature intended to allow a private right of action under the statute. Additionally, the Court found an express right of action was available under La. R.S. 22:1874(B) based on the assertion of a medical lien. View "Anderson v. Ochsner Health System" on Justia Law
Via Christi Reg’l Med. Ctr., Inc. v. Reed
Via Christi Regional Medical Center, Inc. filed a hospital lien to collect on its bill for medical services provided to Ivan Reed after Reed's car collided with a Union Pacific Railroad train. The lien purported to encumber a portion of Reed's settlement with Union Pacific. Via Christi subsequently brought this action against Reed to enforce its lien. Reed counterclaimed, asserting that Via Christi, in an effort to enforce the lien, had engaged in deceptive and unconscionable practices in violation of the Kansas Consumer Protection Act. The district court judge entered judgment in favor of Via Christ on the lien and against Reed on his counterclaims. The court of appeals affirmed the enforceability of Via Christi's lien. The Supreme Court reversed, holding (1) Via Christi's failure to strictly comply with the requirements of Kan. Stat. Ann. 65-407 rendered its lien ineffective and unenforceable against Reed; (2) a genuine issue of material fact existed as to whether Via Christi knew or should have known that it misrepresented the amount it was owed for services rendered; and (3) the lower courts erred in ruling as a matter of law that a hospital's filing and pursuit of a lien could never be unconscionable. Remanded.View "Via Christi Reg'l Med. Ctr., Inc. v. Reed" on Justia Law
Scull v. Groover, Christie, & Merritt, P.C.
Petitioner had health care insurance as a member of the United Healthcare Select HMO (the HMO) when he visited a healthcare provider (GCM) for an x-ray of his knee. After Petitioner paid a bill he received from GCM for the x-ray exam he filed a complaint alleging that the bills GCM sent Petitioner were an illegal attempt to "balance bill" an HMO member in violation of State law and that the bills constituted an unfair and deceptive practice in violation of the Consumer Protection Act (the Act). The circuit court dismissed the complaint. The court of special appeals affirmed. The Court of Appeals affirmed in part and reversed in part, holding (1) the state HMO law prohibiting balance billing by health care providers as part of the legal foundation for the establishment of HMOs does not include a right of action by an HMO member against a healthcare provider for violation of that prohibition; but (2) an HMO member may bring an action under the Act against a healthcare provider who improperly bills the member in violation of the state HMO law in a way that also violates the prohibition against unfair or deceptive trade practices in the Act.View "Scull v. Groover, Christie, & Merritt, P.C." on Justia Law