Profession
N.Y. doctors sue health plan
NEWS IN BRIEF — Posted Sept. 4, 2006
A group of five New York physicians filed a $25-million lawsuit against Health Insurance Plan of Greater New York alleging that the company illegally kept them out of the network and interfered with their patient relationships.
The physicians -- cardiologist Gerald Pekler, MD, pediatrician Marcelina L. Medrano, MD, internist Nkanga U. Nkanga, MD, general surgeon Fanny B. Kasher, MD, and urologist David S. Friedman, MD also are suing their former medical practice, Staten Island Medical Group, where they were employees and shareholders. They allege that the practice illegally dissolved in May and refused to hire them back when it reformed as Staten Island Physician Practice and entered into a new agreement with HIP. The HMO later expelled the five doctors who filed the lawsuit from its network in July without explanation, the suit alleges.
The doctors "seek only to treat their patients, as they have done for decades, but a managed care Goliath has trampled on that relationship," said Robert B. Stulberg, the physicians' attorney.
The doctors also say HIP failed to preapprove medical services for their HIP patients and to reimburse the doctors for treatment they provided in the 90 days preceding their termination from the network.
The health plan's spokesman Ron Maiorana said, "What this case comes down to is that consistent with New York law, HIP has the right not to contract with a physician in the same way that physicians have a right not to contract with health plans."
Staten Island Physician Practice did not return calls for comment.
Note: This item originally appeared at http://www.ama-assn.org/amednews/2006/09/04/prbf0904.htm.
