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Tuesday, Nov 28, 2023

Doctors Draw Blood in Dispute With Health Net

Emergency rooms are known as big money-losers for hospitals, but when the losses extend to individual doctors, attorney Andrew Selesnick thinks enough is enough. Selesnick, a partner at Michelman & Robinson LLP in Encino, recently won an appeals court decision in favor of ER doctors and radiologists in a payment dispute with Health Net Inc., the Woodland Hills insurer. The case dealt with doctors who provided services to people insured by Health Net, but the doctors didn’t belong to Health Net’s network of contracted providers. Health Net had an arrangement with a doctors group named La Vida Medical Group to take care of these situations, but problems arose between 2007 and 2010 when La Vida ran into financial difficulties and stopped paying out-of-network doctors. La Vida later went bankrupt. The doctors worked at four Los Angeles area hospitals: Sherman Oaks Hospital, Valley Presbyterian Hospital in Van Nuys, Centinela Freeman Regional Medical Center in Inglewood and Midway Hospital Medical Center in Los Angeles. Health Net maintained it had already paid, although the doctors never got the money. In a decision on Feb. 19, the Second Appellate District Court in Los Angeles decided that Health Net is on the hook to pay a second time because of “negligent delegation.” “Emergency room doctors are required by law to attend to patients, regardless of their ability to pay,” Selesnick said. “But the physicians shouldn’t have to work for free.” Although Health Net was the defendant in the suit, supporting briefs were filed by other large health insurers, including Anthem Insurance Cos. Inc., Aetna Health of California and Cigna HealthCare of California Inc. On the other side, the California Hospital Association and California Medical Association supported the doctors. “In this particular case, millions of dollars at are at stake, but for emergency providers this decision over time will affect tens of millions,” Selesnick said. “I think there will be a change in behavior by health plans.” A spokesman for Health Net said the company is exploring its options at this point and declined further comment. Selesnick expects Health Net will file an appeal, but he questions whether the California Supreme Court will hear it. “The Supreme Court takes very few cases, but they like health care issues,” he said. Finance Law Firm Esther Hopkins and Terri Hilliard Olson have joined to form a law firm, Hilliard Hopkins LLP. The Westlake Village practice will specialize in mediation and in estate and business planning, representing clients principally in Los Angeles, Ventura and Santa Barbara counties. Hilliard Olson brings extensive background in trusts, elder law, special needs and business planning. Before law school, she had a practice as an investment advisor, and is accredited as a claims agent with the U.S. Veterans Administration and a planner with the state’s Medi-Cal program. She later ran a solo law practice in mediation and estate planning. “Our firm stresses the importance of creating and properly managing cohesive family and business plans,” she said in a statement. Hopkins’ legal practice has focused on serving as general legal counsel and advisor to companies and executives to facilitate business planning and wealth management. Her expertise includes business law and litigation, estate planning, probate and trust administration. She also works as a volunteer with community Advocates for Children’s Rights and Bet Tzedek Legal Services, and she serves on the board for Southeast Ventura County YMCA. The firm’s offices are at 2393 Townsgate Road. Career Case Notes Douglas Bordner is now a partner at Myers Widders Gibson Jones & Feingold LLP. He specializes in real estate, corporate law, mergers and acquisitions. Bordner joined the firm a year ago and manages the Thousand Oaks office. He regularly serves corporations as outside general counsel, advising them on day-to-day legal contracts and employment matters. He also works with software companies in negotiating international licensing and distribution agreements in Europe, Asia and South America. He is the past president of the Calabasas Rotary Club and president of the East County Bar Association. Based in Ventura, Myers Widders is a firm with 17 attorneys focused on business law, real estate and insurance matters. … Melissa Barcena has joined Northrup Schlueter APLC in Westlake Village as an associate. Barcena practices in complex business litigation and construction defect law. She also practices in the firm’s appellate division. She graduated from Pepperdine University School of Law in 2013 and has worked at the firm as a law clerk since 2011. Northrup Schlueter focuses on real estate, construction defect, general business litigation and complex civil litigation and arbitration. … Jeffrey Alpert, family law and business litigation attorney, has launched a solo practice in Encino. Alpert was formerly with Gersh Kaplan LLP, the defunct Encino entertainment law firm. His new ppractice will focus on mediation. Alpert has mediated more than 200 cases, including more than 100 family law cases. Staff Writer Joel Russell can be reached at (818) 316-3124 or jrussell@sfvbj.com.

Joel Russel
Joel Russel
Joel Russell joined the Los Angeles Business Journal in 2006 as a reporter. He transferred to sister publication San Fernando Valley Business Journal in 2012 as managing editor. Since he assumed the position of editor in 2015, the Business Journal has been recognized four times as the best small-circulation tabloid business publication in the country by the Alliance of Area Business Publishers. Previously, he worked as senior editor at Hispanic Business magazine and editor of Business Mexico.

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