NorthBay Healthcare alleges Kaiser tried to monopolize markets with ED underpayments

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Fairfield, Calif.-based NorthBay Healthcare sued Oakland, Calif.-based Kaiser Permanente over emergency care payment it says it's owed.

NorthBay, which filed the lawsuit in federal court in San Francisco, alleges Kaiser Foundation Health Plan led "an anti-competitive conspiracy" to deny or underpay for emergency care provided at NorthBay Medical Center in Fairfield and NorthBay VacaValley Hospital in Vacaville, Calif.

The suit claims Kaiser tried to "starve NorthBay of revenue in an effort to monopolize healthcare and insurance service markets in Solano County."

According to the health system, NorthBay and Kaiser had an agreement until late last year "that provided a contractually agreed upon discount on emergency and hospital services. But even under that contract Kaiser underpaid for services to the tune of well more than $1.5 million."

Following the termination of that contract, NorthBay claims Kaiser did not pay more than $21.7 million in billed charges for emergency services NorthBay provided to Kaiser members.

Nor Jemjemian, senior vice president and Napa Solano area manager with Kaiser, told The Reporter via email the healthcare giant is committed to affordable healthcare and to reimbursing a "fair and reasonable rate for emergency services provided to members by non-Kaiser hospitals."

He added, "We strongly disagree with the claims made by NorthBay Healthcare in its complaint and look forward to defending ourselves in court, as we did successfully in the past when NorthBay sued Kaiser Permanente for higher payments in 2009."

NorthBay said it seeks equitable reimbursement for treating the more than 900 Kaiser members it projects it will treat this year, along with "treble damages for Kaiser's violations of antitrust laws; damages to compensate for losses sustained as a result of Kaiser's conduct, which is ongoing and currently totals more than $21.7 million; a new equitable agreement for future services between NorthBay and Kaiser; and reasonable litigation costs."

Read the full story here.


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