Health Reform WK-EDGE Health care co. drops mobile clinic contract, but ACA claim dismissed
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Friday, September 27, 2019

Health care co. drops mobile clinic contract, but ACA claim dismissed

By Cathleen Calhoun, J.D.

A New York physician stated 11 causes of action, but why did only one cause of action survive?

A New York State-licensed physician, who entered into a contract with a health care company to provide services to its plan enrollees, members, and beneficiaries through a mobile clinic, had his claims of violations of the Patient Protection and Affordable Care Act (ACA) (P.L 111-142) and the Health Insurance Portability and Accountability Act’s (HIPAA) Privacy Rule, and all other claims except a breach of contract claim, dismissed by a federal district court in New York. The physician, who argued that he was not paid in full for his services, failed to contest the health care company’s arguments that a number of the claims failed as a matter of law. For claims that were successfully contested by the physician, the court found that they were duplicative of the breach of contract claim (Frankel v. U.S. Healthcare, September 17, 2019, D.J. Ramos).

Contract. The physician and his practice provided cardiovascular testing and prevention services at both traditional settings throughout the state of New York and in two fully-equipped mobile medical offices. The health care company used mobile clinics to reach members who would otherwise not have access to cardiovascular care, including those in urban populations, union workers, and employees of government agencies, churches, and charitable organizations. The physician entered into a specialist physician agreement with the health care company in 1998. Under the terms of the agreement, the physician was to provide covered services to plan enrollees, members and beneficiaries at the mutually agreed contractual rate.

Health care company withdrawal. On May 4, 2017, the health care company sent the physician and his practice an e-mail that they would no longer be covering services provided at the mobile clinics. The physician and the practice replied on June 6, 2017, indicating that they disagreed. On June 19, 2017, the health care company halted payment for claims totaling over $900,000 and began a pre-payment audit review for services rendered at the mobile units. On September 25, 2017, the health care company sent notice that the contract would not be renewed the following April.

Analysis. The health care company argued that all claims except the breech of contract claim should be dismissed as a matter of law. The court noted that the physician and his practice only contested arguments with respect to the claims of: (1) breach of the implied covenant of good faith and fair dealing; (2) promissory estoppel; and (3) tortious interference with contract. The court only considered those arguments and found that all three were duplicative of the breach of contract claim. Consequently, all claims were dismissed except for the breach of contract claim.

The case is No. 18 Civ. 06378 (ER).

Attorneys: Todd Steven Cushner (Cushner & Associates, PC) for Perry A. Frankel and Advanced Cardiovascular Diagnostics, PLLC. Gregory Scott Voshell (Elliott Greenleaf, PC) for U.S. Healthcare, Inc. d/b/a Aetna U.S. Healthcare, Inc. d/b/a Aetna Health, Inc. and Aetna, Inc. d/b/a Aetna.

Companies: Advanced Cardiovascular Diagnostics, PLLC; U.S. Healthcare, Inc. d/b/a Aetna U.S. Healthcare, Inc. d/b/a Aetna Health, Inc.; Aetna, Inc. d/b/a Aetna

Cases: CaseDecisions GeneralNews ProviderPaymentNews NewYorkNews NewsFeed

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