A Brooklyn hospital has decided to sue one of New York city's largest health plans, arguing that the plan conspired to wrongfully deny coverage. Brookdale University Hospital and Medical Center says that it was forced to eat a major portion of costs that were really the financial responsibility of Health Insurance Plan of Greater New York (HIP). The hospital has filed a civil racketeering lawsuit contending that HIP teamed up with physicians and others to deny coverage. Specifically, the hospital argues that HIP used inappropriate criteria for utilization review, choosing standards that physicians would not have endorsed. For example, the suit mentions a case in which a woman with a malignant brain tumor was denied coverage by HIP after it used guidelines for treating infectious disease rather than cancer. The lawsuit also argues that physician practice Central Brooklyn Medical Group and utilization review firm HealthCare Partners helped HIP to unfairly deny claims. The lawsuit comes at a difficult time for HIP, which is currently seeking New York state approval to become a for-profit company.
To get more information on the suit:
- read this article in The New York Times