Articles Posted in Health Law

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Defendant Horizon Healthcare Services, Inc., New Jersey’s largest health insurer, maintained a two-tiered provider-hospital system. Plaintiff Saint Peter’s University Hospital, Inc., and plaintiff Capital Health System, Inc. and others, commenced separate lawsuits claiming Horizon treated them unfairly and in a manner that contravened their agreements when they were placed in the less advantageous Tier 2. Plaintiffs assert Horizon’s tiering procedures were pre-fitted or wrongfully adjusted to guarantee selection of certain larger hospitals for the preferential Tier 1. The New Jersey Supreme Court was asked, by way of interlocutory appeal, to settle multiple discovery disputes that arose in the course of the litigation. The Supreme Court concluded the Appellate Division exceeded the limits imposed by the standard of appellate review both by assessing the disputed information’s relevance against the panel’s own disapproving view of the merits and by giving no apparent weight or consideration to the protections afforded by confidentiality orders. Having closely examined the record, the Supreme Court rejected the Appellate Division’s determination that the chancery judges encharged with these matters abused their discretion. It was not an abuse of discretion for the chancery judges to find the information sought was relevant to plaintiffs’ claims that Horizon violated either the network hospital agreements’ contractual terms, or the overarching implied covenant of good faith and fair dealing, when they were relegated to the less desirable Tier 2. View "Capital Health System, Inc. v. Horizon Healthcare Services, Inc." on Justia Law

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Plaintiffs Tamar and Ari Ginsberg, now New Jersey residents, lived in New York during Tamar's pregnancy and at the time of the birth of their daughter, Abigail. Abigail tragically died from Tay-Sachs disease, a genetically inherited, incurable neurological disorder, at the age of three. Plaintiffs sued a New York laboratory owned and operated by defendant Quest Diagnostics Incorporated (Quest), a New Jersey-based medical testing company, alleging failure to provide correct blood test results when Ari sought to determine whether he was a Tay-Sachs carrier. Quest, in turn, asserted a third-party claim against Mount Sinai Medical Center, Inc., a New York hospital, which allegedly tested Ari's blood sample in New York pursuant to its contract with Quest. Plaintiffs also sued several New Jersey-domiciled defendants whom they alleged to have provided plaintiff Tamar with negligent advice and treatment in New Jersey. The issue this case presented for the New Jersey Supreme Court's review in this interlocutory appeal was whether the choice-of-law principles set forth in 146, 145, and 6 of the Restatement (Second) of Conflict of Laws (1971) should have been applied uniformly to all defendants in a given case, or whether courts should undertake a defendant-by-defendant choice-of-law analysis when the defendants are domiciled in different states. Although the appellate panel agreed that New Jersey and New York law diverged in material respects, it concluded that New York constituted the place of injury because it was the state of plaintiffs' domicile during Tamar's pregnancy, the state in which prenatal testing would have been conducted and the pregnancy would likely have been terminated, and the state in which Abigail was born. The panel then considered the contacts set forth in Restatement 145 and the principles stated in Restatement 6 to determine whether New Jersey had a more significant relationship to the parties and the issues than New York. The panel rejected the trial court's assumption that the law of a single state must govern all of the issues in this lawsuit and instead undertook separate choice-of-law analyses for the New Jersey and New York defendants. The panel found that the presumption in favor of New York law was overcome with regard to the New Jersey defendants, but not with regard to Quest and Mount Sinai. Finding no reversible error in the appellate court's decision, the New Jersey Supreme Court affirmed. View "Ginsberg v. Quest Diagnostics, Inc." on Justia Law

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In 2013, the State Board of Nursing invoked N.J.A.C. 13:37-1.3(c)(2) to deny accreditation to the Licensed Practical Nurse to Registered Nurse Bridge Program (Bridge Program), a nursing program instituted by Eastwick College (Eastwick). Interpreting the term graduating class in N.J.A.C. 13:37-1.3(c)(2) to include all graduates of the program who took the licensing examination during a given calendar year, regardless of the year a particular student graduated from the program, the Board found that Eastwick's Bridge Program's first and second graduating classes failed to achieve the 75% pass rate mandated by the regulation. Eastwick appealed the Board's determination, challenging the methodology used by the Board to calculate the pass rate of the Bridge Program's graduates on the licensing examination. Eastwick contended that only students who graduated during a specific calendar year and took the licensing examination in that year should be included in that year's graduating class. Using that methodology, Eastwick argued that its second graduating class had a pass rate in excess of 75%, and that the Board improperly declined to accredit its nursing program. An Appellate Division panel affirmed the Board's determination denying accreditation. Based on the plain language of N.J.A.C. 13:37-1.3(c)(2), the New Jersey Supreme Court concluded that the Board's construction of its regulation was plainly unreasonable, and accordingly held that the Board improperly denied accreditation to Eastwick's Bridge Program. The Court therefore reversed the Appellate Division's judgment affirming the Board's action, and remanded this matter for further proceedings. View "In the Matter of the Revocation or the Suspension of the Provisional Accreditation of and/or the Imposition of Probation on Eastwick College LPN-to-RN Bridge Program" on Justia Law

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A "discrete, narrow legal question" came before the Supreme Court: is a health care provider who has received an assignment of personal injury protection (PIP) benefits from an insured obligated upon request to furnish to the insurer broad information with respect to the provider’s ownership structure, billing practices, and regulatory compliance? Plaintiffs in this matter consist of six “Selective Insurance Company” entities. Individuals insured by Selective sought medical treatment from defendants for injuries received in automobile accidents. Those insureds assigned to defendants the benefits to which they were entitled under their PIP coverage, giving defendants the contractual right to seek PIP reimbursement under those policies. In reviewing claims submitted for payment, Selective detected what it considered to be suspicious patterns in both the treatments defendants had provided and the corporate links among the treating entities. Selective requested that defendant supply to it a variety of data with respect to their ownership, structure, billing practices, and compliance with certain regulations. In support of its request, Selective cited the provision within the insureds’ insurance policies requiring the insureds to cooperate with Selective in the investigation of any claim under the policy. When defendants refused to supply the material Selective sought, Selective sued, alleging that defendants' failure to supply the information was a breach of they duty to cooperate and a violation of the PIP discovery statute. After hearing oral argument, the trial court denied defendants’ motion to dismiss and granted Selective the relief it had requested by directing defendants to respond to Selective’s discovery requests. Defendants thereafter moved for reconsideration, but the trial court denied that motion, together with defendants’ request for a stay. Upon review of the matter, the Supreme Court held that an insured had no duty to provide information to plaintiff with respect to the ownership structure, billing practices, or referral methods of the medical providers from whom he or she sought treatment for his or her injuries. Because an insured had no obligation to supply that information to plaintiff, the assignment of benefits executed by an insured could not serve to impose that duty on the providers. View "Selective Insurance Company of America v. Hudson East Pain Management" on Justia Law