Stay ahead of developments in federal and state health care law, regulation and transactions with timely, expert news and analysis.
April 26 — A federal appeals court April 26 reinstated class allegations in a lawsuit alleging medical providers charged unreasonable fees for some emergency services.
The U.S. Court of Appeals for the Eleventh Circuit, in an unpublished opinion, said a federal district court should have allowed limited discovery on whether issues common to a large group of potential plaintiffs would predominate over any questions unique to the individuals in the action, rather than disallowing class certification.
The case involves an issue that is growing: whether medical providers should be stopped from charging allegedly unreasonable amounts for emergency services when they know those claims won't be paid by no-fault insurers, thus rendering the patients liable for the overlap. The billing practices are known as surprise or balance billing.
This putative class action was brought against HCA Holdings Inc. and three of its Florida hospitals, alleging that the hospitals charged unreasonable fees for emergency radiological services. The U.S. District Court for the Middle District of Florida struck the plaintiffs' class action allegations, effectively denying class certification (40 HCDR, 3/2/15).
Florida law requires motor vehicle owners to have personal injury protection, or PIP, insurance coverage. Once an insurer pays the $10,000 policy limit, however, the insured become responsible for any remaining expenses.
The plaintiffs alleged that the defendant hospitals charged PIP-covered patients unreasonable fees for radiological services. In some cases, they said, the fees charged were 65 percent higher than the usual and customary fees charged for similar services.
The plaintiffs asserted violations of Florida's Deceptive and Unfair Trade Practices Act and breach of contract. The district court refused to dismiss the complaint, but struck the class allegations after finding that the key issues, namely the reasonableness of the hospitals' charges and damages incurred by each plaintiff, “would be highly individualized in nature.”
Class certification is appropriate when questions of law or fact common to the class members predominate over questions that affect only individuals. The district court said this requirement hadn't been met in this case.
The Eleventh Circuit disagreed, saying it wasn't apparent on the face of the plaintiffs' complaint that individualized issues would predominate. The parties, the court said, presented conflicting interpretations of the issues and evidence that would be required to establish liability and damages for the whole class.
The court said discovery “could reveal that it is relatively easy to determine that these rates are unreasonable across the board without having to analyze differences between hospitals or patients.” Moreover, it said, the presence of individualized damages issues didn't necessarily prevent a finding that common issues in the case predominate.
The court said its opinion shouldn't be read to suggest how the district court should rule on the certification question. It held only that the lower court should have allowed discovery instead of striking the class allegations.
Judges Beverly B. Martin, Julie E. Carnes and R. Lanier Anderson III issued the per curiam opinion.
Cohen Milstein Sellers & Toll PLLC represented the plaintiffs. Carlton Fields Jorden Burt PA and Buchanan Ingersoll & Rooney PC represented the hospitals.
To contact the reporter on this story: Mary Anne Pazanowski in Washington at email@example.com
To contact the editor responsible for this story: Brian Broderick at firstname.lastname@example.org
The opinion is at http://src.bna.com/eru.
All Bloomberg BNA treatises are available on standing order, which ensures you will always receive the most current edition of the book or supplement of the title you have ordered from Bloomberg BNA’s book division. As soon as a new supplement or edition is published (usually annually) for a title you’ve previously purchased and requested to be placed on standing order, we’ll ship it to you to review for 30 days without any obligation. During this period, you can either (a) honor the invoice and receive a 5% discount (in addition to any other discounts you may qualify for) off the then-current price of the update, plus shipping and handling or (b) return the book(s), in which case, your invoice will be cancelled upon receipt of the book(s). Call us for a prepaid UPS label for your return. It’s as simple and easy as that. Most importantly, standing orders mean you will never have to worry about the timeliness of the information you’re relying on. And, you may discontinue standing orders at any time by contacting us at 1.800.960.1220 or by sending an email to email@example.com.
Put me on standing order at a 5% discount off list price of all future updates, in addition to any other discounts I may quality for. (Returnable within 30 days.)
Notify me when updates are available (No standing order will be created).
This Bloomberg BNA report is available on standing order, which ensures you will all receive the latest edition. This report is updated annually and we will send you the latest edition once it has been published. By signing up for standing order you will never have to worry about the timeliness of the information you need. And, you may discontinue standing orders at any time by contacting us at 1.800.372.1033, option 5, or by sending us an email to firstname.lastname@example.org.
Put me on standing order
Notify me when new releases are available (no standing order will be created)