Kaiser Stiffs Hospital for $57K, It Claims
SANTA ANA, Calif. (CN) – Kaiser underpaid a Newport Beach hospital by $57,000 for medically necessary emergency services, the hospital claims in Orange County Superior Court.
Hoag Memorial Hospital Presbyterian sued Kaiser Foundation Health Plan and Kaiser Foundation Hospitals on Friday, April 15.
It claims Kaiser deliberately delays payments and underpays claims for reimbursement.
Under the parties’ June 2004 agreement, Hoag agreed to provide discounted hospital services to Kaiser patients if Kaiser paid the hospital’s reimbursement claim within 30 days of receipt. If Kaiser did not pay by 45 working days, the discount would not apply and the hospital would bill Kaiser for 100 percent of the charges, according to the complaint.
Ten years later, Hoag accepted a Kaiser patient experiencing vomiting, abdominal and chest pain and nausea and diagnosed them with stomach cancer. The patient stayed in the hospital for almost two weeks, the complaint states.
Hoag says it billed Kaiser $84,153.98 for the patient’s treatment, but Kaiser improperly denied part of its claim and refused to pay in full.
Since not paying the entire bill breaches the parties’ agreement, the discount no longer applies and Kaiser owes $57,064.03, the complaint states.
Hoag claims Kaiser’s policy of unilaterally removing patients to Kaiser hospitals without consulting their treating physicians and refusing to fully pay for medical services violates California’s unfair competition laws.
It seeks damages according to proof for breach of written and implied contract, quantum merit, an open book account, and unfair business practices.
It is represented by Carrie McLain with Helton Law Group of Huntington Beach.