A federal judge gave Brookdale University Hospital and Medical Center permission to return to court with racketeering claims against a health plan and two physician organizations.
U.S. District Court Judge Roslynn Mauskopf agreed in late April to allow the Brooklyn, New York hospital to file an amended complaint against Health Insurance Plan of Greater New York, Cogent Healthcare and Central Brooklyn Medical Group, now Preferred Health Partners.
Mauskopf threw out racketeering claims in Brookdales 2007 lawsuit at the end of March. Brookdale asked Mauskopf to reconsider, a bid she denied as moot after clearing the way for an amended complaint.
Brookdales 2007 lawsuit alleged the health plan deployed Cogent Healthcares hospitalists to conduct utilization reviews of patients referred to the hospital by the Central Brooklyn Medical Group in a bid to deny coverage.
The hospital, one of three MediSys Health Network hospitals, 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 the hospitals complaint.
In her opinion rejecting the racketeering claims, 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.
Michael Brown, a lawyer who is a partner at Ohrenstein & Brown representing 486-bed Brookdale, says the hospitals latest claims will include new allegations and information learned as the lawsuit proceeded.
Anne Hancock, a spokeswoman for Cogent, a Brentwood, Tenn.-based hospitalist company, says in an e-mail that the judges decision to allow Brookdale to file an amended complaint was not unexpected. Brookdale has had more than two years to establish a legitimate claim on the federal issues and has not been able to do so, she says. We are confident that ultimately our position on the allegations in the lawsuit will prevail.
Ilene Margolin, an HIP spokeswoman, describes the judges decision as fair and says that the health plan is waiting to see if Brookdale is able to present any new facts, as the hospital has alleged.
Brian McGovern, a lawyer with Cadwalader, Wickersham & Taft representing Preferred Health Partners, also says that he is waiting to see what the hospitals amended complaint will contain.Submit a letter to the Modern Physician Reader Blog. Please include your name, title, company and hometown. Modern Physician reserves the right to edit all submissions.