Florence Urgent Care v. Healthspan, Inc.

445 F. Supp. 2d 871, 2006 U.S. Dist. LEXIS 25844, 2006 WL 1209367
CourtDistrict Court, S.D. Ohio
DecidedMay 2, 2006
Docket2:04-cv-00177
StatusPublished
Cited by4 cases

This text of 445 F. Supp. 2d 871 (Florence Urgent Care v. Healthspan, Inc.) is published on Counsel Stack Legal Research, covering District Court, S.D. Ohio primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Florence Urgent Care v. Healthspan, Inc., 445 F. Supp. 2d 871, 2006 U.S. Dist. LEXIS 25844, 2006 WL 1209367 (S.D. Ohio 2006).

Opinion

OPINION AND ORDER

SPIEGEL, Senior District Judge.

This matter is before the Court on the parties’ cross motions for summary judgment: Defendants’ Motion for Summary Judgment (doc. 38), Plaintiffs’ Response (doc. 45), and Defendants’ Reply (doc. 46); Plaintiffs’ Motion for Summary Judgment (doc. 39), Defendants’ Response (doc. 40), and Plaintiffs’ Reply (doc. 41). For the reasons indicated herein, the Court GRANTS IN PART Defendants’ Motion for Summary Judgment as to Plaintiffs’ claim pursuant to Kentucky’s “Any Willing Provider” statute, and as to Plaintiffs Drs. Zineddin and Kutmah’s claims for breach of implied duty of good faith and fair dealing, but DENIES the balance of Defendants’ motion (doc. 38). Plaintiffs’ Section 1981 claims, as well as Plaintiff Florence Urgent Care’s claim for breach of implied duty of good faith and fair dealing, survive Defendants’ motion. The Court DENIES Plaintiffs’ Motion for Summary Judgment in its entirety (doc. 39).

I. BACKGROUND

On March 2, 2004, Plaintiffs filed their Complaint, alleging that Defendants Healthspan, Inc., (“Healthspan”), and Robert Strub, M.D. (“Dr.Strub”) illegally discriminated against Plaintiffs by terminating Plaintiffs as preferred providers in the preferred provider organization (“PPO”) operated by Defendants, and by refusing to allow Plaintiffs to apply for preferred provider status, on the grounds of their Arabic race (doc. 1). Plaintiffs’ Complaint includes three causes of action: 1) a claim pursuant to 42 U.S.C. § 1981 for racial discrimination, 2) a claim based in a violation of the implied covenant of good faith and fair dealing, and 3) a claim pursuant to Kentucky’s “Any Willing Provider” statute, Ky.Rev.Stat. Ann. § 304.17A-270 (doc. 1).

Healthspan is an Ohio Corporation that does business in Ohio and Kentucky as a preferred provider network (doc. 38). In its role as a preferred provider network it contracts with physicians, hospitals, urgent care centers, and other service providers who agree to perform their services at discounted rate (Id.). Taken together, these entities form Healthspan’s “network,” which Healthspan sells to self-insured employers who then realize discounted rates for health care services (Id.). Dr. Strub is Healthspan’s Medical Director (doc. 1). Plaintiff Florence Urgent Care, Inc., (“Urgent Care”) is a Kentucky corporation, while Plaintiffs Mohamed Zineddin, M.D. (“Dr.Zineddin”) and Kheder Kutmah, M.D. (“Dr.Kutmah”) are shareholders of Urgent Care (Id.). All three Plaintiffs were Healthspan providers until July 9, 2002 (Id.).

Healthspan plays a limited role in the delivery of medical care (doc. 38). It primarily serves a contracting role in piecing together the network (Id.). Many of Healthspan’s customers engage the services of a third-party administrator (“TPA”), that receives the bill from the service provider, reviews it for appropriateness of the services and charges, and then pays the appropriate amount from an account established by the employer (doc. 38). Healthspan does not process claims itself (Id.). Some thirty TPA’s process claims for Healthspan’s customers (Id.).

Plaintiff Dr. Zineddin, who is Syrian-born, started an urgent care practice with other physicians in 1999, a practice that *874 ultimately became Florence Urgent Care (Id.). On November 4, 1999, the urgent care practice became a member of the Healthspan network under an Ancillary Services Agreement (“ASA”) that covered two Arab-owned facilities (Id.). In the beginning, two Arab doctors, Dr. Ghassan Haj-Hamed and Dr. Abdulkader Al-Ab-dulrazzak, each owned fifty-percent of Florence Urgent Care (Id.). Plaintiff Dr. Kutmah became an employee of Urgent Care in June 2000, and in April 2001 purchased a thirty-five percent ownership interest in the entity (Id.). Dr. Kutmah continues to own his share, while Dr. Zin-nedin also now owns a thirty-five percent share, and Dr. Al-Abdulrazakk continues to own a thirty percent share (Id.).

According to Defendants, in late fall 2001, one of the TPA’s, Principal Financial Group (“Principal”), contacted Healthspan to complain that physicians at Urgent Care had been inappropriately coding patient encounters such that more money would be paid to the physicians (Id.). Healthspan indicates it requested documentation from the TPA, and then Defendant Dr. Strub asked two other TPA’s about their experiences with Urgent Care (Id.). Dr. Strub indicates that these two TPA’s also found inappropriate billing practices on the part of Urgent Care (Id.).

Defendants state that Plaintiffs do not deny that Healthspan received complaints from TPA’s and admit that Humana had placed them on a Corrective Action Plan with threats of removal from its network (Id.). However, Plaintiffs argue that the complaint from Principal Financial Group involved a patient who is not a member of Healthspan, and so they question why Healthspan ever discussed this individual with the TPA (doc. 45). Moreover, Plaintiffs question Defendants’ claim that other TPA’s complained about billing issues, arguing that Defendants provided no written discovery response on the issue, that Dr. Strub’s recollection of the two phone calls is hazy, that Dr. Strub only identified the persons with whom he spoke by their first names, and that one of those persons is no longer employed by the TPA (Id.). Plaintiffs state that though they had a billing dispute with Humana and United Healthcare, these companies handled the situation in a race-neutral manner, did not terminate them, and Plaintiffs are still providers for Humana and United Healthcare (doc. 45). In short, Plaintiffs question the veracity of Defendants’ proffered reason that Plaintiffs allegedly inappropriately coded and billed (Id.).

Healthspan indicates that in response to the coding concerns raised by Principal Financial Group, Healthspan terminated the ASA agreement by letter on April 9, 2002 (Id.). The notice of termination listed no reason for the termination, and Urgent Care did not appeal the removal, despite a contractual right to do so (Id.).

After Healthspan terminated its ASA with Urgent Care, Dr. Kutmah, Dr. Zined-din, and a few other physicians affiliated with the Plaintiffs began to seek admission to the Healthspan network as individual physicians (Id.). Healthspan denied the individual doctors into the network and admits giving Plaintiffs a false reason for denying them access to the network (Id.). Instead of confronting Plaintiffs about the alleged coding problems, Healthspan indicated to Plaintiffs that there was no geographic need for them in its network (Id.). Dr. Strub indicates that this “conflict-avoidance approach” to removing physicians is common in the industry (Id.).

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Bluebook (online)
445 F. Supp. 2d 871, 2006 U.S. Dist. LEXIS 25844, 2006 WL 1209367, Counsel Stack Legal Research, https://law.counselstack.com/opinion/florence-urgent-care-v-healthspan-inc-ohsd-2006.