Brookdale University Hospital and Medical Center last week asked a federal judge to reconsider her decision to throw out its racketeering claims against a health plan and a California hospitalist company.
Brookdale brooks setback
Hospital asks judge to reverse decision to dismiss case
The 486-bed New York hospital argued in a court filing that U.S. District Court Judge Roslynn Mauskopf wrongly dismissed its racketeering claims against Health Insurance Plan of Greater New York and Cogent Healthcare.
Brookdales 2007 lawsuit alleged the health plan deployed the California companys hospitalists to conduct utilization reviews in a bid to deny coverage (Aug. 20, 2007, p. 30). Brookdale, one of three MediSys Health Network hospitals, and the health plan entered into an agreement after HIP approached the hospital in 2001 with a plan to employ Cogent as a consultant for members referred to the hospital by a physician practice, according to the hospitals complaint.
The hospital alleged the fraud served to improperly shift to the hospital the financial responsibility for paying a substantial portion of the necessary medical services provided to HIPs members by Brookdale Hospital, according to
Mauskopf rejected the racketeering claims in early April. In her opinion, Mauskopf wrote that the hospitals allegations fell short of fraud but Brookdale has alleged facts sufficient to suggest that the defendants participation in the widespread and unreasonable denials of Brookdales claims was part of some form of wrongful conduct, including an alleged breach of contract.
But the hospital in its request for reconsideration argued that the judge overlooked undisputed facts. Brookdale cited the judges statement that the hospital employed physicians involved in the alleged scheme, which Mauskopf wrote undermined the opportunity for fraud, an element of one standard to establish such an allegation. As such, any suggestion that the defendants were well-positioned to deceive Brookdale regarding the medical necessity of that treatment is implausible on its face, Mauskopf wrote.
Yet, Brookdale did not employ Cogent physicians, the hospital wrote. An attorney for the hospital declined to comment through a spokesman. Anne Hancock, a spokeswoman for Cogent, said in a written statement: We believe the courts ruling was correct and should stand.
Cynthia Neidl, a lawyer for HIP, said the health plan opposes Brookdales bid for reconsideration and the hospital has provided no basis for the judge to reconsider. The health plan was expected to file its response on April 24.
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