Prime Healthcare Services, Victorville, Calif., said today that it has filed eight lawsuits in California state courts against subsidiaries of Kaiser Permanente, alleging that Kaiser has wrongly denied more than $25 million in claims related to emergency services provided to members of Kaiser Foundation Health Plan. Prime and Kaiser do not have a contract, but Prime alleges that one is implied by state and federal law, including Primes duties under the federal Emergency Medical Treatment and Active Labor Act.
The lawsuits are broadly similar in their allegations, said Radha Savitala, assistant general counsel for Prime. In the lawsuit filed in Los Angeles County Superior Court on behalf of 153-bed Sherman Oaks (Calif.) Hospital, Prime alleges that Kaiser requires out-of-network hospitals to call its Emergency Provider Response Program when a Kaiser member comes into the emergency room, in contravention of federal law requiring a patient to be stabilized before his or her insurance carrier is contacted. Prime accused Kaiser of pressuring patients and their families to request transfer to Kaiser hospitals before the physician treating the patient has decided that the patient is stable enough to be transferred.
Kaiser had not been served with the lawsuits as of yesterday, even though the lawsuits were filed in January, said Jim Anderson, a Kaiser spokesman. Kaiser contends that Prime hospitals are not notifying the health plan of the admissions of its members once stabilized, as required, Anderson said. -- by Vince Galloro
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