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HENRY B. LaTORRACA

Civil Trial Attorney

Prime Healthcare sues Kaiser over unpaid claims

| Feb 13, 2015 | Uncategorized |

The California-based Kaiser Foundation Health Plan is being sued by 13 hospitals operated by the Prime Healthcare system for $60 million. Prime alleges in the suit, which was filed in Los Angeles, that Kaiser refused to pay for treatment that Prime was legally required to provide. This is the latest shot fired in a long-standing legal battle between the two health care giants. Prime made similar claims against Kaiser in lawsuits filed in 2008 and 2010.

The business litigation centers on emergency room treatment provided to Kaiser members. Federal and state law requires hospitals to provide emergency treatment to patients regardless of their health insurance situation. Prime claims that not only does Kaiser routinely refuse to pay for such treatment, but they also employ high-pressure tactics to pressure doctors into transferring patients to medical facilities operated by Kaiser Foundation Hospitals. Prime says that the behavior of Kaiser endangers patients and amounts to a medical hazard.

Kaiser responded to the allegations by saying that Prime had failed to contact them before embarking on treatment, but Prime responded that they were not legally obliged to obtain clearance before treating emergency cases. The lawsuit seeks payment for unpaid claims dating back to early 2013 as well as attorney fees.

Being involved in a lawsuit, either as the plaintiff or defendant, is a situation that most business owners will find themselves in at one time or another. An attorney with business litigation experience may be able to assess the merits of a potential lawsuit and offer advice regarding the most prudent way to proceed. There is always a degree of uncertainty with court proceedings, and an attorney may recommend seeking a settlement if possible. However, an attorney could also advocate vigorously on behalf of their client when attempts to find a compromise solution prove unsuccessful.

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