The California Department of Managed Health Care is trying to end the practice of emergency care "balance billing," just as thousands of new HMO members are being created.
The Department of Managed Health Care recently secured a court-order against Jeannette Martello, MD, stopping her from allegedly billing ED patients unfairly to collect balances disputed with health plans.
"The court's ruling will finally put an end to Dr. Martello's illegal attempts to make patients pay her money they don't owe," said DMHC director Shelley Rouillard in a media release.
An emergency plastic surgeon at hospitals in Pasadena and Burbank and also a lawyer, Martello allegedly asked patients to sign forms agreeing to pay what their health plans did not pay in full, before filing excessive charges and pursuing patients through collections litigation, in at least one case filing a lien on a man's home.
The case dates back to 2010, when the DMHC first filed a cease and desist order, and a year after the California Supreme Court banned balance billing for emergency services, making California the 45th state to ban at least in-network balance billing.
According to the court, the ban on the practices dovetails with state law that requires HMOs to reimburse out-of-network providers while limiting what those providers can charge.
Along with the injunction, issued by the Los Angeles Superior Court, Martello was fined $562,000 and sentenced to 5 days in jail.
The Department's enforcement of the recently-settled ban comes as thousands of Californians enroll in HMO plans through the state insurance exchange, Covered California.