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Wednesday, March 21, 2012

Kamhi v. Emblem Health Inc.

March 21, 2012.  In Kamhi v. Emblem Health Inc., et al., the Supreme Court, Kings County, partially denied a managed care organization’s motion to dismiss a complaint by a plaintiff physician for damages resulting from the non-renewal of the physician’s participation in certain managed care networks in violation of Public Health Law (“PHL”) §4406-d. Plaintiff alleged that during a telephone conversation regarding the non-renewal, defendants’ senior Executive of Provider Relations stated “there was no other reason whatsoever that Emblem was not renewing [Plaintiff’s] in-network contract except for [Plaintiff] posed too many complaints about Emblem’s claims reimbursements and even went to far as to take Emblem to Court, on one occasion.”  According to the plaintiff, this conduct by the health plan violates PHL §4406-d (5), which provides in part, “[n]o health care plan shall terminate a contract or employment, or refuse to renew a contract, solely because a health care provider has: (a) advocated on behalf of an enrollee; …”  In denying the motion with respect to this claim, the Court held that “[w]hile the precise nature of the treatment rendered has not yet been revealed, a logical consequence of defendants’ decision to decline to renew plaintiff’s contract is to make him unavailable to plan enrollees and to chill his, and other physicians’, efforts to provide care to enrollees that defendants deem inappropriate or too expensive.  Moreover, since the further consequence of the denial of reimbursement to plaintiff is to place the financial burden of paying for such care upon the plan enrollee, plaintiff’s challenge to defendants’ failure to make payment necessarily inures to the benefit of his patients and would thus fall within the purview of advocacy on behalf of an enrollee under the statute.” A copy of the decision can be found at the following link. Kamhi v. Emblem Health Inc. et al.


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