A district court's decision could turn health care billing across the state on its head - if it's upheld.
A district court's decision could turn health care billing across the state on its head - if it's upheld.
It's safe to say lots of hospital groups and lawyers across the state are anxiously awaiting the outcome of Keisha Desselle et al vs. Acadian Ambulance Service. The class action challenges the Lafayette-based ambulance provider's practice of filing liens against insurance settlements and civil awards paid to accident victims, despite that they are insured by companies that have negotiated contracts with Acadian specifying reduced rates for ambulance transport and emergency medical services.
Strike one was dealt to Acadian Dec. 20 in a blistering district court judgment in Avoyelles Parish that ordered the Lafayette-based ambulance services provider to pay $17 million to a class of approximately 14,000 plaintiffs; 12th Judicial District Court Judge Mark Jeansonne said the practice violates a state law that prohibits a health care provider from collecting or attempting to collect from a patient any amounts in excess of the contracted reimbursement rate. Jeansonne, whose questioned Acadian's truthfulness in his ruling, told the company to stop the practice immediately.
The Desselle case started out with three plaintiffs and, as IND Monthly reported in March, was later certified as a class action: Keisha Desselle and her son, who were injured in a 2009 car accident, and Terry Dupuy, who was hurt in a hunting accident in 2007. All three settled with a third-party insurance company stemming from their injuries, and Acadian went after all three settlements.
The reason so much attention is being paid to the case is because while the practice may be exclusive to Acadian as an ambulance service provider (it is the largest privately held ambulance company in the country and a near monopoly in the state), it is not uncommon among hospitals here. They, too, are facing lawsuits challenging their billing practices.
Lake Charles attorney Lee Hoffoss, who is among the attorneys representing the plaintiffs in the Desselle case, has at least seven lawsuits with similar claims pending against hospitals in Calcasieu, Evangeline, Avoyelles, Jefferson and Webster parishes. He has also filed suit in Avoyelles Parish against Lafayette-based Schumacher Group, which Hoffoss claims for a short time took part in the practice.
Here's how the Acadian billing system works: Acadian routinely enters into contracts with health insurance companies like Blue Cross/Blue Shield of Louisiana in which Acadian offers services to Blue Cross customers at an agreed-upon reduced rate. If Jane Doe, a Blue Cross customer, has a heart attack or suffers some other kind of emergency injury at her home and Acadian transports her to the hospital, the ambulance company will bill Blue Cross at that reduced rate. But, if that same Blue Cross customer is in a car accident and there's a third party involved who may be at fault, Acadian will set Jane Doe's bill aside and wait to see what happens. If Jane Doe gets a settlement from that third party's insurance company, Acadian will bill Jane Doe at the full price, not the reduced rate Acadian and Blue Cross agreed on in the contract.
Observers say this case will likely be decided by the state Supreme Court. For Acadian, huge profits are at stake.
On Dec. 20 an Acadian Ambulance spokeswoman confirmed to IND Monthly that the company would appeal.
"Unfortunately, the verdict announced in the Desselle, et al vs. Acadian Ambulance Service case was not unexpected by Acadian Ambulance," wrote Allyson Pharr, Acadian's senior vice president for legal and governmental affairs, in an emailed response. "Based on factors unrelated to the merits of the case, while we are disappointed, we are regrettably not surprised by this ruling and look forward to having the merits of the case fully and properly examined by the Appeals Court. This suit is about an interpretation of a contract regarding billing procedures and Acadian firmly believes that the evidence and law do not support the verdict as rendered and will continue to defend our rights under the contract and our billing process."
IND Monthly Managing Editor Walter Pierce contributed to this story.