Cardone v. Boston Regional Medical Center, Inc.

800 N.E.2d 335, 60 Mass. App. Ct. 179, 2003 Mass. App. LEXIS 1387
CourtMassachusetts Appeals Court
DecidedDecember 16, 2003
DocketNo. 02-P-768
StatusPublished
Cited by10 cases

This text of 800 N.E.2d 335 (Cardone v. Boston Regional Medical Center, Inc.) is published on Counsel Stack Legal Research, covering Massachusetts Appeals Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cardone v. Boston Regional Medical Center, Inc., 800 N.E.2d 335, 60 Mass. App. Ct. 179, 2003 Mass. App. LEXIS 1387 (Mass. Ct. App. 2003).

Opinion

Kafker, J.

Dr. Vito Cardone, the plaintiff, entered into an agreement (Agreement) with MedTeam Management Services, Inc. (MedTeam), on February 1, 1989, to provide professional medical and management services at the Fertility Center (Fertility Center or Center) of the Boston Regional Medical Center (BRMC). The Agreement was to run until September, 1994. Disagreements arose, however, over how the plaintiff’s compensation was calculated, and in October, 1993, the Agreement was terminated.

Dr. Cardone filed a scattershot twenty-three count complaint against numerous defendants alleging various claims for damages arising out of the Agreement.2 The defendants moved for partial summary judgment.3 The plaintiff now appeals from the summary judgment entered for BRMC as a separate and final [181]*181judgment on so much of the plaintiff’s breach of contract claim (count II) as alleges that BRMC made improper adjustments to revenue, and count VI, alleging that BRMC tortiously interfered with the Agreement between the plaintiff and MedTeam.4 The plaintiff also appeals the denial of his motion to compel production of confidential Fertility Center records relating to patient services and billing.

The Agreement provided that the plaintiff’s compensation was based on two elements: (1) payment for the patient care services he rendered, and (2) payment for the administrative services he provided as director of the Center. This dispute specifically concerns the second element, the “administrative employment compensation.” According to the Agreement between Dr. Cardone and MedTeam, he was to receive as “administrative employment compensation” annually, “the lesser of seventy percent (70%) of the Center’s net revenues . . . or $750,000.”5 It was “payable ninety (90) days after the end of [MedTeam’s] fiscal year.”

The Agreement, which the defendants drafted, provided that [182]*182MedTeam was to calculate the net revenue of the Center “based upon the following items of revenue and expense and in accordance with generally accepted accounting principles.” Revenue was to “include all collected revenues for management fees received by [MedTeam] arising out of services rendered in the Center to the Center’s patients.”6 Expense items were to “include both operating and capital costs (including marketing expenses, salaries, benefits, supplies, rental charges, depreciation and interest).”

Also in place was a management agreement between MedTeam and BRMC. The management agreement provided that MedTeam would manage the Fertility Center on behalf of BRMC. “As compensation for its management services under [the management] agreement, [BRMC] agrees to pay to MedTeam a fee equal to the Center’s gross collections for services performed in the Center, .... after deduction of [BRMC’s] monthly costs of renting the facilities used by the Center and of services, supplies and materials provided by [BRMC] to patients treated at the Center, which amounts shall be retained by [BRMC].” According to BRMC, this fee was the “collected revenues for management fees” referred to in the Agreement between Dr. Cardone and MedTeam.

Dr. Cardone argues that he was not fully compensated under the terms of his Agreement on account of three adjustments BRMC made to “collected revenues for management fees”; these adjustments are not expressly described in either the Agreement or in the management agreement between MedTeam and BRMC.7

First, a deduction was made to reflect what has been referred to as the “Blue Cross contractual allowance” or the “Blue [183]*183Cross settlement.” Each year, Blue Cross only paid BRMC a percentage of the face value of BRMC’s total charges. According to the affidavit of Russell Wetherell, an officer of both BRMC and MedTeam, “[t]he process worked this way. Blue Cross would pay [BRMC] on an interim basis, usually in the range of about 93% of the face amount of its charges. At the end of a given year, however, Blue Cross and [BRMC] would then perform a ‘settlement,’ in which total charges for the year were subjected to a complicated formula,” which usually resulted in a percentage recovery below 93%. Final resolution of the settlement might not be completed until “some times, much much later after the end of the year,” and it would come in the form of a bill from Blue Cross.

The second adjustment was a deduction for the uncompensated care pool, a share of which each hospital in Massachusetts is responsible. According to Wetherell, “[a]t the end of each year, the Commonwealth would add up the entire cost of free care at all Massachusetts hospitals, and then express the cost as a percentage of total hospital revenues. Each hospital then had to compare its actual percentage of free care to this ideal percentage,” and if its percentage was lower (i.e., if its percentage was 10% and the Commonwealth’s percentage was 12%), it would then have to contribute the percentage difference of its revenues (i.e., 2%) to the uncompensated care pool. The working out of this charge-back could take years. The plaintiff claims that the Fertility Center did not serve indigent patients. The record also does not explain BRMC’s methodology for allocating its uncompensated care bills to the Fertility Center.8

The third adjustment reflected revenues set aside by BRMC, known as “deferred revenue,” to account for a “charge cap” imposed by the Commonwealth of Massachusetts. According to Wetherell, “the charge cap was a consequence of the tight reimbursement controls, and relatively low reimbursement levels, of government programs such as Medicare and Medicaid. [184]*184The Commonwealth’s concern was that hospitals might try to make up what they perceived as shortfalls in reimbursement from government programs by increasing the rates that they charged to private payers such as health insurers and patients who paid their own bills. ... In order to make sure that didn’t happen, the Commonwealth annually calculated the amount of ‘private’ revenue that it thought each Hospital should earn in that year” and established a “charge cap.” According to Wetherell, “[p]rivate revenues that exceeded [that] cap were ... eventually . . . returned to the Commonwealth.” The charge cap was discontinued by legislation in 1991, but it took several years for the settlements to work out. Any surpluses were paid into the uncompensated care pool. The record does not explain BRMC’s methodology for allocating these costs to the Fertility Center.

Dr. Cardone asserts that the three adjustments were not discussed between or contemplated by the parties during the negotiation, execution, or operation of the Agreement.9 An earlier unsigned version of exhibit C to the Agreement, prepared by the defendants, described revenue as including “all charges, net of contractual allowances, bad debt and free care.” Why this language was replaced with the phrase “collected revenues for management fees” is unclear from the record. The three adjustments discussed above were also not made during the first two years the plaintiff’s Agreement with MedTeam was in effect.10 Beginning in 1991, Dr. Cardone requested, but did not receive from MedTeam, an accounting of the manner in which net revenue was calculated. Dr.

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Bluebook (online)
800 N.E.2d 335, 60 Mass. App. Ct. 179, 2003 Mass. App. LEXIS 1387, Counsel Stack Legal Research, https://law.counselstack.com/opinion/cardone-v-boston-regional-medical-center-inc-massappct-2003.