Kaiser Underpaid for Services, Neurosurgeon Claims
SAN DIEGO (CN) - Kaiser owes an emergency neurosurgeon $82,000 for treatment he provided to its member, the surgeon claims in U.S. District Court for the Southern District of California
Sanjay Ghosh, M.D. sued Kaiser Foundation Health Plan, Inc. for breach of implied-in-fact contract, quantum meruit, unjust enrichment and violations of the California Health and Safety Code and ERISA.
According to Dr. Ghosh’s lawsuit, he performed emergency surgery on a Kaiser member, identified in the complaint as Kenneth D., after a serious fall in Nov. 2010.
“Kenneth D. was rushed to and admitted at the emergency room at Scripps Memorial Hospital in La Jolla, Calif. Plaintiff, an employee of San Diego NeuroTrauma Associates, Inc., is on staff at Scripps Hospital and due to his expertise, he was asked to perform emergency back and cranial surgery on Kenneth D. Plaintiff was not a contracted provider with Kaiser,” the complaint states.
The federal Emergency Medical Treatment and Active Labor Act and the California Health and Safety Code both require hospitals to treat patients in an emergency, regardless of the person’s insurance coverage, according to the complaint.
Dr. Ghosh provides his services on a non-contracted basis as a non-participating physician, according to the complaint. As such, he contends Kaiser should pay him his customary rate, not the discounted rate a contracted Kaiser physician would receive.
“Defendant is obligated to pay emergency doctors, like plaintiff, their usual, customary and reasonable rates for medical services. Nevertheless, defendant pays non-contracting emergency doctors, including plaintiff, arbitrary amounts that are substantially below the cost, value and common range for the services rendered,” the complaint states.
Dr. Ghosh performed five surgeries on Kenneth D. and billed $126,288.86, of which Kaiser paid him $43,522.49, leaving $82,766.37 outstanding, according to the complaint.
Dr. Ghosh seeks declaratory relief, reimbursement and compensatory damages including statutory interest, costs and attorneys’ fees. He is represented by Glenn R. Kantor and Timothy J. Rozelle of Kantor & Kantor in Northridge.