California Supreme Court Holds Balance Billing Illegal

Buchalter Nemer attorneys instrumental in unanimous ruling

January 8, 2009. Los Angeles. The California

Supreme Court today unanimously reversed the Court of Appeal in a

matter titled Prospect Medical Group Inc. vs. Northridge

Emergency Medical Group., to hold that balance billing is

illegal under California law. As the Supreme Court explained,

balance billing occurs when "emergency room doctors directly

bill the patient for the difference between the bill submitted [to

an HMO] and the payment received."

Buchalter Nemer appellate specialists Harry W.R. Chamberlain II

and Robert Dato wrote the successful petition for review and

preliminary briefs on the merits for the prevailing independent

physician medical groups led by Prospect Medical Group, and

Buchalter Nemer attorney Carol Lucas wrote the amicus

curiae brief on behalf of CAPG (California Association of

Physician Groups).

"The decision once and for all takes managed care

patients out of the middle of payment disputes between HMOs and

emergency providers" said Ms. Lucas, Co-Chair of Buchalter

Nemer's Business Practices Group. "It is good for

patients, who have been used to gain leverage, and it is good for

managed care as a whole, because it will compel the providers and

payors to work out between themselves the value of noncontracted

services. Before patients were taken out of the middle,

there was no incentive for noncontracted providers to engage with

payers to determine value. Now they must."

"The Supreme Court held 'A patient who is a member

of an HMO may not be injected into the dispute. Emergency room

doctors may not bill the patient for the disputed amount.'

I think that says it all," said Harry W.R. Chamberlain,

II.

Buchalter Nemer is a full-service business law firm representing

local, regional and national clients in eight major areas of

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