Lawsuits & Class Action – It’s All In The Cards

The District (HOSPITAL) argues the insurance cards failed to adequately disclose that the patient’s ELAP plan contracts with MultiPlan only for physician services, not facility services.

In the case of South Broward Hospital District vs Elap and GPA:

SOURCE: FLSD Docket 12/03/2020, Case 0:20-cv-61007-ANS Doc 37

It contends the cards inconspicuously includes a small, grayed out “Practitioner Only” reference under a much larger ALL CAPS “PHCS” logo at the top of the card. The location, font size, color, and wording of the “Practitioner Only” reference fails to adequately disclose to providers that ELAP is involved, and that ELAP will apply its Reference-Based Pricing.

Instead, the prominent PHCS/MultiPlan logo gives providers the reasonable expectation that they will be paid rates contained in their contracts with MultiPlan. And providers do not realize that they have been deceived by Defendants’ scheme until after they receive notices from GPA indicating they will be paid only a fraction of the payments expected pursuant to their contracts with MultiPlan.

The District (HOSPITAL) brings two counts against Defendants: (1) violation of FDUTPA; and (2) unjust enrichment.

According to the Amended Complaint, the District (HOSPITAL) seeks to certify and maintain this action as a class action with the following classes and subclasses:

☐ The Nationwide Emergent Class: All healthcare facility providers in the United States with underpaid emergent claims for healthcare services provided to ELAP plan members.

☐ The Nationwide Nonemergent Class: All healthcare facility providers in the United States with underpaid nonemergent claims for healthcare services provided to ELAP plan members.

☐ The Florida Emergent Subclass: All healthcare facility providers in Florida with underpaid emergent claims for healthcare services provided to ELAP plan members.

☐ The Florida Nonemergent Subclass: All healthcare facility providers in Florida with underpaid nonemergent claims for healthcare services provided to ELAP plan members

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SOURCE: https://www.mavricklaw.com/blog/miami-business-litigation-lawsuits-asserting-deceptive-and-unfair-business-practices/

In the recent case, South Broward Hospital District v. ELAP Services, LLC, 20-CV-61007, 2020 WL 7074645 (S.D. Fla. Dec. 3, 2020), the court affirmed FDUTPA’s versatility.  The South Broward business litigation concerned a plaintiff healthcare provider that sued the administrator of a self-pay ERISA plan.  The plaintiff accused the defendant of making it appear as if its plan participants were participants in a contractual obligation which would require the plan to pay the contracted-for rates.  Instead, the plan participants were not part of those agreements and the plan had no contractual obligation to make payments.  The plaintiff claimed that the defendant’s conduct tricked them into performing medical services that they otherwise would not have performed had it known that the plan’s coverage was not as comprehensive as it appeared to be.

The South Broward defendant claimed that it was not involved in commerce concerning the conduct alleged because the dispute concerned the plaintiff’s services being provided to consumers.  Defendant cited to Williams v. Nationwide Credit, Inc., 890 F. Supp. 2d 1319 (S.D. Fla. 2012), a case where a defendant was not liable under FDUTPA because the conduct was at issue was the collection of a debt, rather than providing goods or services to customers.  South Broward determined that FDUTPA claims could proceed “because ‘billing practices are considered part of ‘trade or commerce,’ […] the claims adjudication process between Defendants and facilities like Memorial amounts to “trade or commerce’ between the parties.”  South Broward Hospital District v. ELAP Sevrices, LLC, 20-CV-61007, 2020 WL 7074645 (S.D. Fla. Dec. 3, 2020).

Peter Mavrick is a Miami-Dade business litigation attorney who also practices business litigation in Fort Lauderdale and Palm Beach.  This article does not serve as a substitute for legal advice tailored to a particular situation.

Posted in: Business Litigation

 

 

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