Centinela Freeman Emergency Medical Associates v. Health Net of California

If a patient who receives emergency medical services is an enrollee in a health care service plan, the plan is required to reimburse the emergency service provider for essential emergency medical services and care. Plans are statutorily permitted to delegate this financial responsibility to their contracting medical providers. Here the defendants - health care service plans - delegated their emergency services financial responsibility to their contractor medical providers, three individual practice associations (“IPAs”). The IPAs failed to reimburse the plaintiff noncontracting service providers for the emergency care that they provided to enrollees of the defendant health plans. When the IPAs went out of business, the plaintiff providers brought actions seeking reimbursement from the defendants. The Supreme Court held (1) a health care service plan may be liable to noncontracting emergency service providers for negligently delegating its financial responsibility to an IPA or other contracting medical provider group that it knew or should have known would not be able to pay for emergency service and care provided to the health plan’s enrollees; and (2) a health care service plan has a narrow continuing common law tort duty to protect noncontracting emergency service providers once it makes an initial delegation of its financial responsibility. View "Centinela Freeman Emergency Medical Associates v. Health Net of California" on Justia Law