Pathologists’ victory in fair compensation lawsuit to stand

| May 9, 2008

The latest development in a lengthy legal battle concerning fair compensation for physicians is good news for pathologists—and marks another victory for the Litigation Center of the AMA and state medical societies.

A Florida court of appeals ruled last month that Health Options Inc. (HOI), a health maintenance organization (HMO) subsidiary of Blue Cross Blue Shield of Florida, must pay pathologists with Palmetto Pathology Services in a case centered on the reasonable value of their services. The ruling upholds a jury decision to award more than $1.5 million to the pathologists after HOI refused to pay them for professional clinical pathology laboratory services they performed at two hospitals within HOI’s network.

The Litigation Center assisted with the interpretation of various Current Procedural Terminology (CPT®) codes at issue in the trial and joined the College of American Pathologists in filing an amicus curiae, or “friend-of-the-court,” brief in support of the pathologists during the appeal process.

The case is one of 14 different lawsuits, some of which were consolidated, in which 11 separate pathology groups sued three HMOs in Florida courts. At issue in the suits is whether Florida law requires HMOs to pay out-of-network pathologists based at in-network hospitals for hospital-based services. The Litigation Center is supporting the lawsuits because the AMA believes that physicians should be fairly compensated for their professional services.

Download (PDF, 66KB) a copy of the opinion.


Category: Business

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