Marrogi v. Gerber

787 So. 2d 1098, 2000 La.App. 4 Cir. 1091, 2001 La. App. LEXIS 1584, 2001 WL 670069
CourtLouisiana Court of Appeal
DecidedMay 16, 2001
DocketNo. 2000-CA-1091
StatusPublished
Cited by7 cases

This text of 787 So. 2d 1098 (Marrogi v. Gerber) is published on Counsel Stack Legal Research, covering Louisiana Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Marrogi v. Gerber, 787 So. 2d 1098, 2000 La.App. 4 Cir. 1091, 2001 La. App. LEXIS 1584, 2001 WL 670069 (La. Ct. App. 2001).

Opinion

I, MURRAY, J.

Dr. Aizenhawer (Aizen) Marrogi appeals a trial court decision granting summary judgment to the defendants on all claims related to “billing, accounting, and/or payment for professional services [of] and/or compensation” to Dr. Marrogi while he was employed by Tulane University School of Medicine. Because we find that Dr. Marrogi failed to meet his burden of proof under our state’s summary judgment law, we affirm.

FACTS AND PROCEDURAL HISTORY

On March 13, 1997, Dr. Marrogi, a pathologist employed by Tulane University School of Medicine, filed a petition for injunction to require his department chairman, Dr. Michael Gerber, to approve his grant application to the National Institute of Health.1 On March 19, 1997, the trial court dismissed the injunction proceeding. On April 18, 1997, Dr. Marrogi filed an amended petition for damages against Dr. Gerber, Janette Breaud, the Tulane University Medical Group Faculty Practice Plan, the Administrators of the Tulane Educational Fund d/b/a Tulane University School of Medicine (“Tulane”), and others, alleging, among other things, that the defendants “under reported” Dr. Marrogi’s income under the Faculty Practice Plan (“FPP”).

| ¡/Specifically regarding the allegation of under reported income, Dr. Marrogi’s petition asserted:

The [Faculty Practice Plan] Statements for the year end June 30, 1993, 1994,1995,1996 and for the current year are incorrect for at least the following reasons: ... (c) Marrogi’s income from his medical practice at Lakeland Hospital (“Lakeland”) and Tulane Medical Center is significantly under reported; and (d) the deductions and/or adjustments applied to the reported income generated by Marrogi are inappropriate under the FPP Agreement and are excessive.

[1101]*1101Dr. Marrogi further alleged that some of the defendants breached the FPP Agreement by failing to distribute income to him pursuant to the Agreement, and some breached their fiduciary duty to him by failing to account for income appropriately under the FPP Agreement.

For discovery on the issue of under reported income, Tulane University Hospital and Clinic (“TUHC”) and Lakeland produced, pursuant to court order of July 27, 1997, approximately 2,000 of Dr. Marrogi’s pathology reports from one representative year selected by the trial court. Each surgical pathology report is signed by Dr. Marrogi and typically contains the following sections: Comment, Pre-operative diagnosis, Specimen, Gross description, Microscopic description, and Diagnosis. Information on the services performed is extracted from each pathology report, encoded on a health insurance claim form, and sent to the appropriate insurance company or Medicare/Medicaid. On the claim form, services performed are identified by the appropriate Physicians Current Procedural Terminology (“CPT”) code.2

hTo find support for the allegation of under reported income, Dr. Marrogi hired Ray Howard as his expert in billing and coding to review the pathology reports. At his deposition in August 1999, Howard stated that he was hired to review and analyze documents prepared for Dr. Mar-rogi by Bonnie Jackson, a former Tulane employee, as well as the pathology reports, and then to change the coding “as needed.” Howard then applied Tulane’s fee schedule, or pricing information, to the level of service provided in order to calculate the amount of money he believed Tulane should have billed for Dr. Marrogi’s services for the representative year.

Howard acknowledged that Tulane allowed individual doctors to alter the fee schedule, and gave examples of special pricing for certain stains and competitive pricing used by Dr. Marrogi for skin biopsies. Howard indicated that his initial calculations were incorrect because he had not known about these changes. In fact, Howard’s opinion on the total value of Dr. Marrogi’s professional services for the representative year changed four times from May 1998 to August 1999.

At his deposition, Howard admitted that health care providers enter into Medicare/Medicaid contracts by which the insurer pays an “allowable,” or a percentage of what is billed by the provider. Howard stated that he would not recommend to a client that one’s income level be based on the amount billed instead of the amount payable or reimbursable, although apparently Howard based his calculations on the amount he believed Tulane should have billed for Dr. Marrogi’s services.

Howard further stated that Dr. Marrogi may only bill for the services that he personally performed. Howard acknowledged that in analyzing the pathology | ¿reports he did not segregate professional services performed by Dr. Marrogi from services, such as reading a slide, which could have been done by other individuals.

Howard stated that he was not informed of the steps in Tulane’s billing process or the extent of Dr. Marrogi’s involvement in the billing process at Tulane. Howard further acknowledged that he used figures provided by Dr. Marrogi in his calculations.

[1102]*1102As documented by a letter dated August 24, 1999, Howard withdrew from the case before his deposition was completed.

On November 4, 1999, the defendants filed a motion for partial summary judgment, asking the trial court to dismiss Dr. Marrogi’s claim that any defendant under billed or under reported his income for services he performed at TUHC and Lake-land. The defendants asserted that Dr. Marrogi “has not and can not show that defendants improperly billed or accounted for [his] professional services.”

In support of their motion for summary judgment, the defendants submitted Howard’s deposition to refute the only evidence they claimed Dr. Marrogi had provided on the issue of improper billing— affidavits and reports from Howard and Dr. Marrogi. The defendants claimed that Howard’s deposition revealed that his earlier reports were inaccurate and his analysis was unscientific and unreliable. Specifically, in their statement of uncontested facts submitted with the summary judgment motion, the defendants asserted that Howard’s reports “are based on miscalculations, misapplications of pricing lists, miscoding of pathology reports and inaccurate information.”

Also in support of their motion for summary judgment, the defendants submitted affidavits from Ted Berggren, the director of the FPP financial services office, and defendant Janette Breaud, department administrator for Tulane’s | .^Department of Pathology. In his affidavit, Berggren stated that “other than those services billed by the Department of Pathology, Dr. Marro-gi’s professional services at TUHC [and Lakeland] were billed and collected by the [FPP] in accordance with Tulane’s standard practices and procedures.” Berg-gren further stated:

7.All FPP-generated reports and accounting documents produced by this office were prepared according to the usual and customary practices of the Tulane Faculty Practice Plan.
8. The Tulane [FPP] did not at any time “under report” Dr. Marrogi’s clinical income.
9. There were no attempts by the Tulane [FPP] or anyone employed by Tulane to systematically “under bill” for Dr. Marrogi’s clinical services.

In her affidavit, Breaud stated in part:

4. During certain periods of time the Department of Pathology has billed for pathologists’ clinical services.

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Bluebook (online)
787 So. 2d 1098, 2000 La.App. 4 Cir. 1091, 2001 La. App. LEXIS 1584, 2001 WL 670069, Counsel Stack Legal Research, https://law.counselstack.com/opinion/marrogi-v-gerber-lactapp-2001.