Martis v. Pekin Memorial Hospital, Inc.

917 N.E.2d 598, 334 Ill. Dec. 772, 395 Ill. App. 3d 943
CourtAppellate Court of Illinois
DecidedOctober 20, 2009
Docket3-08-0543
StatusPublished
Cited by17 cases

This text of 917 N.E.2d 598 (Martis v. Pekin Memorial Hospital, Inc.) is published on Counsel Stack Legal Research, covering Appellate Court of Illinois primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Martis v. Pekin Memorial Hospital, Inc., 917 N.E.2d 598, 334 Ill. Dec. 772, 395 Ill. App. 3d 943 (Ill. Ct. App. 2009).

Opinions

JUSTICE LYTTON

delivered the opinion of the court:

Plaintiff, Richard Martis, filed a complaint against defendants, Pekin Memorial Hospital, Data Management, Inc., and Peoria-Tazewell Pathology Group and its individual shareholders. Defendants filed motions to dismiss, which the trial court granted. We affirm.

In October 2004, plaintiff’s physician instructed plaintiff to undergo laboratory testing at Pekin Memorial Hospital. Plaintiff did not have medical insurance at the time of the testing. At the hospital, plaintiff received a form authorizing treatment, which stated in pertinent part:

“I understand, some physicians who furnish professional services to me (the patient), whether that care or service is provided directly or indirectly, are independent contractors and are not agents or employees of the hospital. This provision includes, but is not limited to radiologists, pathologists, anesthesiologists and any physicians called in as consultants. The hospital does not bill for the services rendered by each physician that tends to my needs during the course of my care and treatment. By signing_(initial) I agree to pay these charges for physician services if my health plan does not cover all of the physician charges.”

Plaintiff placed his initials where indicated on the form.

Approximately one month later, plaintiff received two bills for the tests: one from the hospital for $609 and one from the pathology group for $73.30. The bill from the pathology group contained the following explanation of services:

“You recently had some laboratory work performed at the hospital noted on the front of this statement. The laboratory at this hospital is directed by the medical group of pathologists as referenced on the front of this statement. A pathologist is a physician who specializes in applying medical knowledge and judgment to the testing of laboratory specimens.
This bill is for the professional services of a pathologist of the named group. These services do not necessarily involve personal review of your test(s). They include the pathologist’s supervision of the laboratory to make sure that your results are timely and medically reliable. They also include the pathologist’s availability— seven days a week, 24 hours a day — to review any result that is questionable and to discuss various medical issues that might be raised about your test results by your doctor.
The hospital will make a separate charge for its role in your testing. That charge will cover the Hospital’s costs in furnishing the space, equipment, and technician’s service involved with your test(s). ***
PROFESSIONAL COMPONENT SERVICES
You may receive a bill from the pathologists for their professional component services which are required, by law, for the operation of the clinical laboratory. These services are provided on a 24 hours a day, seven days a week basis and include, but are not limited to:
1. Assuring that tests, examinations, and procedures are properly performed, recorded and reported.
2. Interacting with members of the medical staff regarding issues of laboratory operations, quality and test availability.
3. Designing protocols and establishing parameters for performance of clinical testing.
4. Recommending appropriate follow-up diagnostic tests, when appropriate.
5. Supervising laboratory technical personnel and advising them about aberrant results.
6. Selecting, evaluating and validating test methodologies.
7. Direct, performing, and evaluating quality assurance and control procedures.
8. Evaluating clinical laboratory data and establishing a process for review of test results prior to issuance of patient reports.
9. Assuring the hospital’s laboratory’s compliance with state licensure laws, Medicare conditions, JCAHO standards, the College of American Pathologists Laboratory Accreditation Program and federal certification standards.”

Plaintiff filed a two-part complaint against defendants.1 Part II consisted of nine counts that alleged defendants double-billed for their services. Plaintiff alleged that the pathology group and its members violated the Medical Practice Act of 1987 (225 ILCS 60/1 et seq. (West 2006)), the Illinois Consumer Fraud and Deceptive Business Practices Act (Consumer Fraud Act) (815 ILCS 505/1 et seq. (West 2006)), and the Medical Patient Rights Act (410 ILCS 50/1 et seq. (West 2006)), and that they were unjustly enriched. He further alleged that the hospital violated the Medical Patient Rights Act and the Consumer Fraud Act and that it was unjustly enriched. Finally, plaintiff alleged that Data Management violated the Consumer Fraud Act. Plaintiff requested declaratory and injunctive relief against all defendants on behalf of himself and others similarly situated.

Defendants filed motions to dismiss plaintiffs complaint. The trial court granted the motions, holding that professional component billing is not actionable.

We review de novo the trial court’s order granting defendants’ motions to dismiss for failure to state a claim. See Pooh-Bah Enterprises, Inc. v. County of Cook, 232 Ill. 2d 463, 473, 905 N.E.2d 781, 789 (2009).

I. Medical Practice Act Claims

Plaintiff argues that the pathology group’s practice of billing for professional component services violates section 22(A)(14) of the Medical Practice Act because such services are not “actually and personally rendered” to patients. Defendants respond that plaintiff has no private right of action under the Act and, even if he did, defendants did not violate the Act.

The Medical Practice Act is a regulatory statute designed to protect the public health and welfare from those not qualified to practice medicine. Ikpoh v. Department of Professional Regulation, 338 Ill. App. 3d 918, 926, 789 N.E.2d 442, 449 (2003); Tovar v. Paxton Community Memorial Hospital, 29 Ill. App. 3d 218, 220, 330 N.E.2d 247, 249 (1975). Section 22(A)(14) of the Act prohibits fee-splitting and other fee-sharing arrangements. TLC The Laser Center, Inc. v. Midwest Eye Institute II, Ltd., 306 Ill. App. 3d 411, 427, 714 N.E.2d 45, 56 (1999). Specifically, section 22(A)(14) states that a physician may be disciplined for the following conduct:

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Martis v. Pekin Memorial Hospital, Inc.
917 N.E.2d 598 (Appellate Court of Illinois, 2009)

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917 N.E.2d 598, 334 Ill. Dec. 772, 395 Ill. App. 3d 943, Counsel Stack Legal Research, https://law.counselstack.com/opinion/martis-v-pekin-memorial-hospital-inc-illappct-2009.