Atlantic Medical Specialists, LLC v. Gastroenterology Associates, P.A.

CourtSuperior Court of Delaware
DecidedApril 20, 2017
DocketN15C-06-245 CEB
StatusPublished

This text of Atlantic Medical Specialists, LLC v. Gastroenterology Associates, P.A. (Atlantic Medical Specialists, LLC v. Gastroenterology Associates, P.A.) is published on Counsel Stack Legal Research, covering Superior Court of Delaware primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Atlantic Medical Specialists, LLC v. Gastroenterology Associates, P.A., (Del. Ct. App. 2017).

Opinion

IN TI-[E SUPERIOR COURT OF THE STATE OF DELAWARE

ATLANTIC MEDICAL SPECIALISTS, LLC, a DelaWare Limited Liability Cornpany,

Plaintiff,

V. C.A. N0. N15C-06-245 CEB GASTROENTEROLOGY ASSOCIATES, P.A., MICHELE CAMPONELLI, THOMAS SPAHR, MARK CORSO, M.D., DAVID R. BESWICK, M.D., IRA F. LOBIS, M.D. and JOSEPH F. HACKER III, M.D.,

Defendants.

\_/\_/\_/V\_/V\/\/\/\./\./\./\_/VV\_/V

Submitted: February 13, 2017 Decided: April 20, 2017

MEMORANDUM OPINION Upon Defendants ’ Motz'ons for Summarjy Judgmenz‘. GRANTED in Part and DENIED in Part.

Laurence V. Cronin, Esquire, SMITH KATZENSTEIN & JENKINS LLP, Wilmington, Delaware. Attorney for Plaintiff.

Art C. Aranilla, Esquire, MARSHALL DENNEHEY WARNER COLEMAN & GOGGIN, Wilmington, Delaware. Attorney for Defendant Michele Camponelli.

C. Scott Reese, Esquire and Christopher H. Lee, Esquire, COOCH AND TAYLOR P.A., Wilrnington, Delaware. Attorneys for Defendants Gastroenterology Associates, P.A., Thomas Spahr, Mark Corso, M.D., David R. BeSWick, M.D., Ira F. Lobis, M.D., and Joseph F. Hacker, III, M.D.

BUTLER, J.

THE PARTIES

The Endoscopy Center of DelaWare (“ECD”) is an “ambulatory surgical center” (“ASC”) operated near the Christiana Hospital primarily for the purpose of conducting endoscopic services.1 lt has been in operation for approximately 20 years.2

The ECD Was founded by a medical practice of gastroenterologists that operates as a corporation called Gastroenterology Associates (GA).3

In 2001, a company based in Kentucky called Amsurg purchased a 51% stake in the ECD from GA.4 Amsurg has a controlling interest in approximately 260 ASCs nationwide5 The remaining 49% interest in ECD Was retained by the

physicians of GA.6

Dr. Michael Katz (“Katz”) is an anesthesiologist Who formed an

anesthesiology practice called Outpatient Anesthesia Services (“OAS”) in 2002.7

1P1.EX.17at1. 21>1.E><.66@1t9.

3lot at9.

41¢1. at 11.

5P1.EX.2at16.

614 at6-13;P1.EX. 66 at 11.

71>1. EX. 1 at 13.

OAS performed anesthesiology services for a number of medical practice groups, GA being one of them.8

We Will also be hearing about Atlantic Medical Specialists (“AMS”). When Katz Was preparing to leave OAS, he created AMS. At all times relevant to this case, KatZ Was the sole shareholder of AMS. 9

The other major player in this dispute is Diamond Medical Management Services, LLC (“DMMS”). This group Was founded by doctors at ECD and includes most of the GA doctors as members The function of DMMS is to provide medical billing, insurance, payment and related “back office” services to medical practices -the primary one being GA.10

FACTUAL BACKGROUND 2002 - 2011 Dr. Katz and 3 other anesthesiologists formed OAS.ll Katz Wrote the

business plan.12 The purpose of the business Was to provide anesthesia services to

814 at17-18.

9161. ar 29, 33-34.

10 Pi. EX. 67 at 20; Pi. EX. 10;P1. EX. 68 at13-16. 11P1.EX.1at13.

12 ld. at 15.

ASCs.13 OAS Was successful at obtaining business from several ASCs, including the ECD.1‘1

OAS made fee reimbursement arrangements With various insurance companies With Whom it had “participating” relationships15 _ these are called “par” in the industry.16 These “par” arrangements set the rates at Which the insurance payer Will compensate the physician for his services. Services performed for insureds With Which the physician is “non-par” are paid at the “usual and customary” rate as determined by the insurance company, less any copay, With the patient left to pay the physician any balance of the bill.17

The specific rate that a physician and insurance company Work out in a “par”

arrangement is considered confidential between the insurance company and the

13 ld. at 14.

14 Id. at 18.

15 1a at 53.

16 Healthcare lnformation Guide, Participating Provl`der Versus Non~Participatz`l/zg (Out-of~ Nel“work) Provider, WWW.healthcare-information-guide.com/participating-nonparticipating.htm (last visited Feb. 27, 2017).

17 Id. See also Joy Hicks, Par vs. Non-Par Providers.' The Differences Bel‘ween Partl`cl`pal‘ing and

Non-Particlpating Medical Provl`ders, Very Well (Nov. 20, 2016), WWW.veryWell.com/par-vs- non-par-providers-23 l 71 77.

physician. lndeed, disclosure of a physician’s reimbursement rate is fraught with legal peril.18

As outsiders might well imagine, medical practices are supported by accountants, bookkeepers, billing clerks, insurance liaisons, and various other “bacl< office” assistance. GA created DMMS to support its own back office and, over time, offered its services to other medical practices.19 The record indicates that today DMMS is the largest support service to emergency service providers state wide.20

When OAS obtained its contract to provide services at the ECD, it elected to contract with Dl\/ll\/IS to provide back office support to OAS.21 DMMS typically bills its clients a percentage of the practice’s billings.22 Indeed, DMMS billed GA

-the very physicians that founded it - 10% of GA’s monthly billings.23

18 This issue is worthy of its own discussion, but exceeds the scope of this opinion. Terms like “price fixing” and “collusions in restraint of trade” are enough to intimidate any doctor tempted to share reimbursement rate information In addition, “par” contracts with insurance companies typically contain their own confidentiality provisions. For a fuller discussion, see generally Cristina Olson, Note, Desperate Doctors and Antitrust Laws, 10 Nevada L.J. 811, 813-14 (2010). See also Frank T. Herdman, Comment, Doctors, Insurers and the Antitrast Laws, 37 Buff. L. Rev. 789 (1989).

19 Pi. EX. 69 at 19-20. 20 P1. EX. 3 ar 28.

21 Pi. EX. 1 ar 24-25. 22 Id_ atzs.

21 Pi. EX. 3 at 162.

Through his work with OAS, Katz worked at the Endoscopy Center on a daily basis and he became friendly with the gastroenterologists working there, in

particular with Dr. Joseph Hacker, the president of GA.24

2011-2013

In early 2012, Katz approached Dr. Hacker - who was a member of both GA and DMMS - and told him that he (Katz) believed that his partners at OAS were going to remove him as a partner with OAS.25 Katz asked Hacker if Hacker and GA would consider keeping him at the ECD, where KatZ had developed relationships with most of the staff.26

Hacker and Katz were personal friends and they discussed several different employment scenarios, including simply hiring Katz on to GA as a partner or employee.27 Those conversations ultimately led to Hacker recommending - and ECD formally terminating - the OAS/ECD service agreement and signing a new

agreement with AMS, which Katz had formed several months earlier.28

24 Pl. EX. 66 at 12, 24, 43, 50.

25 Pl. EX. 1 at 30-33.

26 Pl. EX. 66 at 14;1>1. EX. 68 at 23-24. 21 Katz Aff. 11 2.

28 Pl. EX. 1 ar 29, 37-38;1>1. EX. 70.

The AMS/ECD agreement worked in much the same way as the OAS/ECD agreement did. KatZ/AMS would draw no income directly from ECD but would instead derive his/its income from insurance payers that insured clients of the ECD.29

As had OAS before him, Katz/AMS signed a separate agreement with DMMS, the billing company, to provide the billing and collection function for the arrangement between KatZ/AMS and ECD.30 lt is to be noted here that while DMMS performed billing and collection services for OAS, the predecessor to AMS, as well as the doctors of GA, there is no evidence that either DMMS or GA forced AMS to use DMMS for its billing and collection services.31 The AMS/DMMS agreement contained one provision that looms large in this litigation: a provision that bound DMMS to keep financial information about AMS confidential32

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