Case: Westside EKG vs. Foundation Health, Health Options, and Humana Medical Plan
MEDICAL DOCTORS SUE HMOs FOR PAYMENT OF MEDICAL BILLS
SC05-870, SC05-871, 4D03-4837, Florida Supreme Court
In Westside EKG vs. Foundation, a group of Broward County medical doctors brought a class action lawsuit against several HMOs to recover payment on medical bills. Under Florida Laws, HMOs like those named in this lawsuit are required to “promptly” pay medical claims. The HMOs in this case argued that no private right existed to sue in court for unpaid medical claims under Florida’s HMO Law and that at best, medical providers like Westside EKG can only seek recovery through a state administrative process rather than sue in court. Westside has argued that the HMOs insurance plan document itself requires it to follow the law and “promptly” pay medical claims. Westside EKG further argued that it is a third party beneficiary of the HMO plan since it rendered medical services to patients in the HMO Plan, therefore, it should be entitled to sue under common law theories. The Fourth District Court of Appeal ruled in favor of Westside EKG and reversed a judgment on the pleadings in favor of the HMOs. The Florida Supreme Court affirmed ruling in favor of Westside EKG. The Florida Supreme Court stated that a medical service provider can bring a lawsuit against an HMO for failure to promptly pay claims.
SC05-870, SC05-871, 4D03-4837, Florida Supreme Court
In Westside EKG vs. Foundation, a group of Broward County medical doctors brought a class action lawsuit against several HMOs to recover payment on medical bills. Under Florida Laws, HMOs like those named in this lawsuit are required to “promptly” pay medical claims. The HMOs in this case argued that no private right existed to sue in court for unpaid medical claims under Florida’s HMO Law and that at best, medical providers like Westside EKG can only seek recovery through a state administrative process rather than sue in court. Westside has argued that the HMOs insurance plan document itself requires it to follow the law and “promptly” pay medical claims. Westside EKG further argued that it is a third party beneficiary of the HMO plan since it rendered medical services to patients in the HMO Plan, therefore, it should be entitled to sue under common law theories. The Fourth District Court of Appeal ruled in favor of Westside EKG and reversed a judgment on the pleadings in favor of the HMOs. The Florida Supreme Court affirmed ruling in favor of Westside EKG. The Florida Supreme Court stated that a medical service provider can bring a lawsuit against an HMO for failure to promptly pay claims.
