Professional Documents
Culture Documents
COLLECTION CASES
ALAN A. ALOP
July, 2001
PAGE
I. INTRODUCTION.................................... 1
B. HOSPITAL OWNERSHIP........................ 2
C. HOSPITAL STRUCTURE........................ 5
A. ACCOUNT STATED........................... 12
B. FAMILY EXPENSE ACT....................... 24
C. STATUTE OF LIMITATIONS................... 33
D. MIXING CAUSES OF ACTION.................. 34
V. BILL OF PARTICULARS............................ 34
VI. ANSWER......................................... 46
B. PRACTICAL SUGGESTIONS.................... 59
1. Excessive Charges.................. 59
2. Comparable Charges................. 61
3. Hospital Surplus................... 62
4. Irrational Pricing System.......... 62
5. Regulatory Condemnation............ 63
6. Audits............................. 63
7. Hospital Expenditures.............. 64
8. Teaching Hospitals................. 66
9. Administrative Waste............... 68
10. Other Waste........................ 69
11. Jury Question...................... 69
A. ESTOPPEL................................. 95
B. FAILURE OF HOSPITAL TO PROCESS PUBLIC AID
APPLICATIONS........................... 103
C. PAYMENT IN FULL DEFENSE (Medicaid/Medicare) 132
D. LACK OF MEDICAL NECESSITY................ 136
E. BREACH OF STATUTORY DUTY PURSUANT TO STATE
TAX EXEMPTION.......................... 146
F. CONSUMER FRAUD ACT: FAILURE TO PROVIDE
FOREIGN LANGUAGE TRANSLATION........... 153
G. FAILURE OF HMO TO PAY DUE TO INSOLVENCY.. 155
H. DURESS................................... 155
VIII. COUNTERCLAIM
MALPRACTICE................................... 156
1
Charles B. Inlander, Take This Book to the Hospital With You,
at 2 (1985).
DEFENDING HOSPITAL COLLECTIONCASES
I. INTRODUCTION
less than half this amount of their GNP on medical care each
year. Health care costs in this country have risen each year for
B. Hospital Ownership
- 2 -
profit hospitals, and public hospitals.
the model for the last century, and this form of hospital was
from real estate taxes, income taxes, and sales taxes. Non-
restaurants.
does not necessarily mean that its organizers are not making
- 3 -
run by two doctors who were siphoning off large amounts of money.
Trustees and had loaded the Board with their close friends.
tech equipment.
2. Proprietary Hospital.
2
The desire to maximize profits may result in disturbing
consequences. "Some hospitals welcome doctors of dubious
reputation to their staff as long as they bring plenty of paying
patients with them. Other hospitals pay bonuses of questionable
legality to persuade a doctor to switch patients to them. As a
result, patients who don't need a hospital stay--or who might do
better at a different hospital--may unwittingly find themselves
wrongly admitted to an institution that's secretly paying their
doctor." Chicago Tribune Book Review, Nov. 25, 1991, at Sec. 5.
- 4 -
that for-profit hospitals usually charge about 11% more than the
conflict of interest.
3. Public Hospitals.
last decade, Cook County Hospital has not brought legal action
C. Hospital Structure.
1. The Triad.
3
Chicago Tribune, October 10, 1993, at Section 7, page 8.
- 5 -
the three legs are the board of trustees, the chief
torn among the three competing legs. One commentator has said
things. It brought the doctor and his private patients into the
hospital for the first time, and began the shift of power in that
most hospitals, the last century has seen the dramatic rise of
- 6 -
But as we move into the 21st century hospitals are receiving a
our health care system and, most important for our purposes, for
2. Revenue Sources
a. Research grants.
b. Equity (stocks) portfolio.
c. Grants and donations.
d. Interest.
e. Wholly-owned subsidiary businesses.
3. Teaching Hospitals
the medical school. They are responsible not only for the
- 7 -
teaching hospital probably is pulling in a significant amount of
has no third party payer that will cover the medical expense, she
- 8 -
III. PRELIMINARY INQUIRY IN ALL HOSPITAL CASES
- 9 -
federal government for Medicare reports could also
prove useful.
- 10 -
10. INVESTIGATE A "CHARITY WRITEOFF". Most hospitals have
procedures to write-off "charity" debts of patients
unable to pay. In discovery find out the hospital's
formal procedure for doing so and then apply on behalf
of your client. Make sure the application is routed
through your opposing counsel. As early on in the
litigation as possible, alert opposing counsel that
she is spinning her wheels in that collection of
any judgment will be problematic.
- 11 -
IV.MOTIONS TO DISMISS
A. ACCOUNT STATED
included at page 17. Note the following about the account stated
theory:
transactions that all items of such accounts are true and that
- 12 -
account stated between the parties is one of fact rather than
law, and thus properly resolved by the jury. 1 Illinois Law and
v. Goldblatt Bros., Inc., 356 F.2d 906, 909 (7th Cir. 1966); and
v. Corral, 227 Ill.App. 3d 221, 591 N.E.2d 111 (2d Dist. 1992), a
ruled that
- 13 -
(5) Mutual assent. An account stated can only be
Ill. App.3d 508, 545 N.E.2d 379, 383 (1st Dist. 1989). Usually
bill to the debtor and the debtor did not dispute this bill. But
if the debtor asserts that she did not receive the bill, a
1977).
Documents Attached
- 14 -
IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
MUNICIPAL DEPARTMENT, FIRST DISTRICT
ANTHONY HOSPITAL, )
)
Plaintiff, )
vs. ) No. 01 M1 100800
)
RYNE SANDBERGSKI, )
)
Defendants. )
accounts are true and that the balance is correct; and (d) a
- 15 -
Swiftsure Beer Serv. Co., 17 Ill. App. 2d 54, 149 N.E.2d 447 (1st
Dist. 1958); O'Neill v. Reamon, 335 Ill. App. 327, 81 N.E.2d 749
ALAN A. ALOP
ALAN A. ALOP
LEGAL ASSISTANCE FOUNDATION
OF METROPOLITAN CHICAGO
- 16 -
MEMORANDUM IN SUPPORT OF MOTION TO DISMISS (ACCOUNT STATED)
O'Neill v. Reaman, 335 Ill. App. 327, 336, 81 N.E.2d 749, 753 (2d
not give any fixed sum as to the cost of the hospital services.
charges for standard follow up visit, long arm cast applied, and
- 17 -
assistance and examination of health care professionals.
- 18 -
stated. The court noted that a debtor's silence for a long time
306, 379 N.E.2d 773, 781 (1st Dist. 1978). See also Lieberman v.
Stollman, 230 Ill. App.3d 203, 595 N.E.2d 8 (1st Dist. 1991);
Yowell v. Ringer, 217 Ill. App. 353, 577 N.E.2d 468 (2nd Dist.
- 19 -
513 (2nd Dist. 1985); Blum and Sang v. Kurtzon, 351 Ill. App.
and the fact that no fixed market value exists for hospital
stricken.
- 20 -
defendant depends." 1 I.L.P. Account Stated 6 (1988). These
861, 341 N.E.2d 101 (5th Dist. 1976), the bare allegation that an
stated claim.
1053, 436 N.E.2d 645, 651 (1st Dist. 1983). Plaintiff failed to
agreement that the items in an account were true; (c) that there
was an agreement that a balance struck was correct; and (d) that
- 21 -
there was a promise to pay such balance. See W.E. Erickson
260, 268, 477 N.E.2d 513, 519 (1st Dist. 1985); and Allied Wire
______________________________
ATTORNEY FOR DEFENDANT
- 22 -
ACCOUNT STATED/INTERROGATORIES
that
agent(s).
- 23 -
IV. MOTIONS TO DISMISS:
- 24 -
1888).
4. PARENT OF AN ADULT CHILD. A parent's responsibility
for a child's expenses terminates when the child reaches
majority, Sapp v. Johnson, 15 Ill. App. 3d 119, 303 N.E.2d 429
(3rd Dist. 1973); Graham v. Graham, 44 Ill. App. 3d 519, 358
N.E.2d 308 (5th Dist. 1976), or is emancipated. In re Estate of
Hardaway, 26 Ill. App. 2d 493, 168 N.E.2d 796 (1st Dist. 1960);
Proctor Hospital v. Taylor, 279 Ill.App.3d 624, 665 N.E.2d 872
(3d Dist. 1996). Check to see if the patient was eighteen or
older--or emancipated-- at the time services were rendered. See
the Proctor case for how a minor may become emancipated in
Illinois. 665 N.E.2d at 876. If the child was eighteen or
emancipated at the time services were rendered, then the parent
is not liable under the Family Expense Act-- unless the parent
signed a guarantor agreement.
5. EFFECT OF DIVORCE. There now appears to be a rule that
the Family Expense Act will allow a creditor to recover against a
non-custodial parent for expenses incurred on behalf of a child.
Proctor Hospital v. Taylor, 279 Ill.App.3d 624, 665 N.E.2d 872
(3d Dist. 1996); Mercy Center v. Lemke, 199 Ill. App. 3d 958,
557 N.E.2d 943 (2nd Dist. 1990).
6. EFFECT OF SEPARATION. The case law regarding spouses
living apart is cloudy and, depending on the court, may turn on
which spouse was "at fault" in the departure. Abraham Lincoln
Memorial Hospital Corporation v. Gordon, 111 Ill. App. 2d 179,
249 N.Ed.2d 311 (4th Dist. 1969); Fortner v. Norris, 19 Ill. App.
2d 212, 153 N.E.2d 433 (3rd Dist. 1958); and St. Mary of Nazareth
- 25 -
Hospital v. Kuczaj, 174 Ill. App. 3d 268, 528 N.E.2d 290 (1st
Dist. 1988); or whether the individuals actually "constitute[d] a
family." Schlesinger v. Keifer, 30 Ill. App. 253, aff'd, 131
Ill. 104, 22 N.E. 814 (1889). Where "fault" is at issue, the
burden is on the creditor to prove the facts necessary to
establish liability. Berenson v. Berenson, 34 Ill. App. 2d 376,
181 N.E.2d 357 (1st Dist. 1962). See also, CILCO v. I.C.C., 204
Ill. App. 3d 1, 562 N.E.2d 4 (3d Dist. 1990).
7. RECOVERABLE AMOUNTS. Under the Family Expense Act the
creditor may only recover the reasonable value of services
rendered. Valentin v. D.G. Swanson & Co., 25 Ill. App. 2d 285,
167 N.E.2d 14 (1st Dist. 1960). But the creditor may also
recover attorney fees and interest if the patient signed an
agreement authorizing this. Boswell Memorial Hospital v.
Bongiorno, 732 N.E.2d 137 (2d Dist. 2000).
8. ESTABLISHMENT OF LIABILITY. The Family Expense Act
will only require a responsible parent or spouse to pay those
expenses which were actually provided and for which the hospital
has proved its charges were reasonable. In Dreyer Medical Clinic
v. Corral, 227 Ill.App. 3d 221, 591 N.E.2d 111 (2d Dist. 1992), a
medical clinic's Family Expense claim was rejected because the
clinic failed to establish the underlying liability of the
defendant. The plaintiff in Corral failed to produce any
evidence as to what services were provided to the patient and
whether the charges were reasonable. As a consequence, the Court
stated:
Even if we were to agree with Plaintiff that it
- 26 -
proved that Jorge was the minor son of defen-
dants...such findings do not negate the trial
court's conclusion that plaintiff failed to
present any proof of the services rendered and
the value of those services.
Corral, 591 N.E.2d 114.
9. ATTORNEY FEES TO THE PATIENT WHEN NO RECOVERY IS
Ill.App.3d 624, 665 N.E.2d 872 (3d Dist. 1996) holds that if the
Act in 1990 to the effect that creditors cannot recover for the
65/15(b)and(c).
- 27 -
Documents Attached
- 28 -
MOTION TO STRIKE/FAMILY EXPENSE ACT
states as follows:
Expense Act."
Pirie Scott & Co. v. Hyde, 39 Ill. 2d 433, 235 N.E.2d 643 (1968);
Enoloe's Estate, 109 Ill.App.3d 1089, 441 N.E.2d 868 (4th Dist.
- 29 -
Ill. App. 2d 179, 249 N.E.2d 311 (4th Dist. 1969); Louis Berman &
Co., Inc. v. Dahlberg, 336 Ill.App. 233, 83 N.E.2d 380 (1st Dist.
1948).
601.
services be provided.
5/2-613(a).
- 30 -
b. The three purported causes of action are not set
proper.
- 31 -
MEMORANDUM/FAMILY EXPENSE ACT
Pirie Scott & Co. v. Hyde, 39 Ill. 2d 433, 235 N.E.2d 643 (1968);
In re Enloe's Estate, 109 Ill. App. 3d 1089, 441 N.E.2d 868 (4th
111 Ill.App. 2d 179, 249 N.E. 2d 311 (4th Dist. 1969); Louis
Berman v. Dahlberg, 336 Ill. App. 233, 83 N.E.2d 380 (1st Dist.
1948).
- 32 -
ground its complaint on the theory that because it provided
should be stricken.
- 33 -
IV. MOTIONS TO DISMISS
C. Statute of Limitations
by partial payment; the five years runs from the date of the last
287, 289, 576 N.E.2d 1230, 1231 (5th Dist. 1991). One fuzzy
which the hospital may bring suit? See Sexton v. Brach, 124
Ill.App.3d 202, 464 N.E.2d 284 (3d Dist. 1984), for a discussion
of a similar issue.
the hospital bill, the hospitals attorney will argue that a ten
- 34 -
applicable, arguing that a bill for services constitutes "other
parent or spouse of the patient under the Family Expense Act, 750
Kaleta, 90 Ill. App. 2d 61, 234 N.E. 2d 109 (1st Dist. 1967).
V. BILL OF PARTICULARS
- 35 -
MUNICIPAL DEPARTMENT, FIRST DISTRICT
RESURRECTION MEDICAL CENTER, )
)
Plaintiff, )
)
-vs- ) No. 00 M1-187777
)
GIOVANNA PIROGI, )
)
Defendant. )
Co., 85 Ill. App. 3d 631, 407 N.E.2d 156 (2d Dist. 1980).
particulars.
______________________________
ATTORNEY FOR DEFENDANT
- 37 -
IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
MUNICIPAL DEPARTMENT, FIRST DISTRICT
)
RESURRECTION MEDICAL CENTER, )
)
Plaintiff, )
)
-vs- ) No. 00 M1-187777
)
GIOVANNA PIROGI, )
)
Defendant. )
DEFENDANT'S RESPONSE TO PLAINTIFF'S MOTION
TO STRIKE THE DEMAND FOR BILL OF PARTICULARS
various times.
- 38 -
though the complaint did not allege any factual allegations that
demand for bill of particulars for being overbroad and "for being
Interrogatories disguising themselves as a Bill of Particulars."
This motion is a frivolous attempt by the plaintiff to avoid
ARGUMENT
App. 3d 835, 838, 349 N.E.2d 902, 905 (1st Dist. 1976); Hemingway
N.E.2d 1272, 1279 (4th Dist. 1983); Hemingway, 117 Ill. App. 2d at
requests:
- 40 -
[t]he amount claimed by plaintiff for each of the said
hospital services and facilities including the amount
paid for each purchase of medicine, surgical supplies,
and medical facilities provided to defendant and/or
member or her family as alleged in paragraph three of the
complaint.
1031, 424 N.E.2d 1302, 1305-1306 (5th Dist. 1981). See also Victory
Memorial Hospital v. Rice, 143 Ill. App. 3d 621, 493 N.E.2d 117 (2d
Dist. 1986).
- 41 -
B. PLAINTIFF'S COMPLAINT DOES NOT STATE THE PARTY WHO RECEIVED
SERVICES THEREBY REQUIRING A DEMAND FOR BILL OF PARTICULARS
member other than Giovanna Pirogi the demand for the name of the
person provided with services was requested. Such a request is
clearly within the scope of a demand for bill of particulars.
C. PLAINTIFF'S COMPLAINT DOES NOT STATE THE EXACT DATES OF
SERVICES THEREBY REQUIRING A DEMAND FOR BILL OF PARTICULARS
- 42 -
complaint." See Notice of Demand for Bill of Particulars, attached
Exhibit B.
The date and nature of the services provided are unclear from
would have had to been the result of two different oral contracts.
It is not clear from the hospital bills whether these actions are
viewed to have arisen from the same set of facts. Unless plaintiff
alleges that the two hospital bills arise under the same cause of
hospital stays should not be set out in the same cause of action.
Due to the confusion as to when the services may have been
way, the demand for the name of the person and specific allegations
- 43 -
into the nature of the services provided were requested. Such
particulars.
______________________________
ATTORNEY FOR DEFENDANT
- 44 -
IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
MUNICIPAL DEPARTMENT, FIRST DISTRICT
- 45 -
7. The exact date[s] that there were repeated demands for
payment due as alleged in paragraph five of the complaint.
______________________________
Attorney for Defendant
- 46 -
VI. ANSWER: DENY THAT THE AMOUNT SOUGHT REPRESENTS THE
REASONABLE VALUE OF SERVICES RENDERED
the bill, the hospital's Complaint must ground its cause of action
Related Documents
- 47 -
REASONABLE VALUE OF SERVICES: The Law and Practice
1031, 424 N.E. 2d 1302, 1305-1306 (5th Dist. 1981). See also
Victory Memorial Hospital v. Rice, 143 Ill. App. 3d 621, 493 N.E.
2d 117 (2d Dist. 1986).
Thus, every hospital collection action offers a potential
- 48 -
service; (b) the method of pricing each good and service; (c) the
Clinic v. Corral, 227 Ill. App.3d 221, 591 N.E.2d 111 (2d Dist.
860, 216 S.E. 2d 680 (1975); Culverhouse v. Jackson, 127 Ga. App.
635 (1972).
For example, the medical records may show results of six blood
tests while defendant is being charged for nine. Any billed
- 49 -
challenge. Examine the bill for anomalous charges such as a charge
accurate.
b. Duplicate billings.
first test.
4
I would.
- 50 -
e. Human Error. Has your client been charged for 200 face
your client is admitted late in the day, they may only receive four
hours worth of solution and should not have to pay for a full day's
utensils, and all other goods and services normally related to this
g. Mis-Coding.
- 51 -
the wrong DRG (diagnostic related grouping) code to label--and
inquire into the DRG coding of your client's bill at the deposition
or obtain expert assistance in this regard.
h. Unnecessary Staffing.
2. Hospital Negligence.
5
See page 73 for discussion of DRG.
- 52 -
client's hospital bill to increase as a result of some error or
February, 1989 at 112. The findings of this study are that a full
should have been a four day stay ended up staying seven days.
scheduled for Tuesday. But the hospital may have overbooked the
particular test for Monday meaning the test could not be scheduled
until Tuesday. This means the surgery is pushed back to Wednesday-
delays. The hospital may have a typical 8 hour lag to get the
- 53 -
pathology is running late or if they lose the results of the test
and it has to be done over, your client is going to have to pay for
the hospitals mistakes that lengthen the hospital stay. They will
even have the nerve to bill your client for two tests when they
hospital sets too many elective surgeries for one day. Your client
may get bumped to the next day and have to pay for this even though
discharge from the hospital was delayed for any reason--see if they
know why. Check the medical records of the hospital carefully.
- 54 -
patient is discharged after 12:00 noon. Inquire carefully with
b. Nosocomial Infections.
to the patient.
6
Walt Bogdanich, The Great White Lie: How America's Hospitals
Betray Our Trust and Endanger Our Lives, (Simon & Schuster,
1991).
7
Chas. Inlander, Take this Book to the Hospital With You, at
135.
- 55 -
institutions--because the teaching institutions have more people
floating around the hospital thus increasing the chances for the
washing of the hands. Find out whether your client's hospital stay
that they are the usual and customary charges of that particular
164, 523 N.E.2d 220, 222 (2nd Dist. 1988). See also Dreyer Medical
Clinic v. Corral, 227 Ill. App.3d 221, 591 N.E.2d 111 (2d Dist.
- 56 -
493 N.E. 2d 117 (2d Dist. 1986), the court stated:
Rice, supra at 143 Ill. App. 3d 625, 493 N.E.2d 120 (emphasis
120.
hospital's annual cost report) for the hospital's reports for the
- 57 -
relevant year. See page 93.
that the charges imposed are the regular charges of the hospital
and that the charges are comparable to other similarly situated
637, 589 N.E.2d 1045 (3d Dist. 1992), offers important lessons to
charges for such surgery by two local surgeons; she testified that
she had telephoned the offices of these two doctors to learn their
Supreme Court Rule 286(b), the trial court allowed the hearsay
Majid, 226 Ill. App. 3d at 641, 589 N.E.2d at 1048. Where the
normal rules of evidence are at play, a hospital should not be able
- 58 -
unprepared hospital counsel.
Ill. App. 3d at 644, 589 N.E.2d at 1049. The typical hospital bill
mere fact that testimony is presented that the daily room charges
v. Corral, 227 Ill. App.3d 221, 591 N.E.2d 111 (2d Dist. 1992),
1/27/93. Look for specific charges that seem vague or too high,
such as $75.00 for a laxative, $30.00 for a "thermal therapy kit"
- 59 -
excessive charges consider hiring a firm to review the hospital
8
In early 2001 the Justice Department revealed it was invest-
igating a scheme in which a number of drug manufacturers were
inflating the AWPs and then heavily discounting certain drugs.
This encouraged doctors to buy these drugs at the heavy discount
and get reimbursed by Medicaid at the higher, inflated AWP.
- 60 -
lists AWPs for thousands of drugs. If the AWP for a Tensilon
tablet (10mg) is $1.09, the hospital that charges $56.00 for that
outrageous--fashion.
(c) Markups of 200 to 400 percent are common, but some drugs
can buy a Cepacol throat lozenge wholesale for 4.5 cents, then turn
- 61 -
a witness from the IHCCCC.9
many hospitals use across the board increases that are arguably
price of a drug ten percent each year for four years even though
the price the hospital paid for that drug dropped each of those
years. A deposition may reveal hospital inadequacies in this area.
9
During discovery the records the hospital submitted to the
IHCCCC for the relevant period could be obtained. If discovery
is not available--as in small claims cases--a FOIA request to the
IHCCCC might produce these records. See page 93 for sample.
- 62 -
explaining the methodology used to set prices, those responsible
for doing so, and whether any hospital documents set out these
practices.
under the Medicaid program because their charges were deemed too
high. Find out whether the plaintiff hospital has even been
excluded from Medicaid as were St. Joseph Hospital and the J.F.K.
Medical Center.
these audits.
10
Many hospitals have a "utilization review" department or
committee which daily reviews the treatment rendered to
- 63 -
Note: In recent years small companies have set up to
conduct inexpensive "mini-audits" that consist of
expert review of the itemized hospital bill.
One example is RN Solutions, a small outfit run
by registered nurse Yvonne Schensted in
Minneapolis. Call Ms. Schensted at 1-800-851-
3323 or email at ycsrns@aol.com. Or get a list
of hospital bill advocates at www.billadvocates
.com/affiliates.htm.
imprudent expenditures you can argue to the jury that this unwise
spending has wrongfully increased the bill your client is being
built too many wings and that its beds are now 40% empty you could
- 64 -
machine. If you dig you might further find out that the hospital
only uses that machine three or four times a week. You might be
this. Maybe you can show the jury that it would have made more
another hospital. If you can get the jury to second guess the
try to discover as much as you can about the project. Did any
staff object to the building and why. Get any documents that exist
in relation to this. Some states have regional or state health
planning commissions or some equivalent state agency that are
You can score more points with the jury if you show them that the
regional commission had suggested that the hospital's purchase of
its MRI machine was inadvisable. If your state has the equivalent
of a FOIA law use this to get relevant records from the regional
Finally, you may wish to let the jury know that the hospital
is handsomely compensating its administrators. The jury can be
- 65 -
salary.12
research.
22, (1985).13
hospital and gets billed $8,000. Yet if she had spent that week in
12
Non-profit hospitals are required by the IRS to file a Form
990 annual report. This lists revenues, expenses, executive
compensation and lobbying payments. These forms are required to
be available for public inspection at the facility.
13
Some teaching hospitals, like Illinois Masonic, only have
thirty medical students in their programs.
- 66 -
might have been $6000.14 Your argument to the jury is going to be
hospital can train some med students who are going to go out and
jury that your client should be responsible for paying for services
ask that jury to begin their deliberations by slashing the bill 20%
institution may cost your client is when your client has a malady
that is interesting to the student doctors:
But what is always good for resident training...
is not necessarily good for patient care. Some-
times the patient feels his body is no more than a
custodian of an interesting and rare disease.
A house staff can increase the length of the hosp-
ital stay through "roundsmanship." With the
patient due to go home Wednesday, but with a
conference scheduled Friday morning, hold the
patient. This is diagnostic assault and battery,
and its costly....
Medical World News, Vol. 12, at 29, (December 17, 1971). Find out
14
James Obriecht, former vice-president of finance at
Chicago's Illinois Masonic Hospital, has stated that "being a
teaching hospital, our costs for teaching are $17 million to $18
million a year. That adds perhaps a thousand dollars per case in
costs". Crain's Chicago Business, July 18-24, 1994 at 33.
15
In 1963 the American Hospital Association issued its
"Principals of Payment for Hospital Care." The document
proclaimed that expenditures for medical research over and beyond
the usual care of patients should not be included in reimbursable
costs.
- 67 -
in discovery whether the hospital is affiliated with any medical
the jury that the CEO of the hospital receives an annual salary
campaign.
16
All hospitals submit voluminous data to Medicare each year
for use in the calculation of their Medicare reimbursement rates.
Such data is probably available for FOIA request. At least one
private company, Health Care Investment Analysts. Inc. (HCIA),
300 East Lombard Street, Baltimore, MD 21202, digests all this
cost data and can, for a fee, produce an analysis of a hospital
that will include features such as the percentage of budget
devoted to administrative expense.
- 68 -
Hospital". The author exposes how most hospitals are extremely
and makes the point that many hospitals are now using re-useable
pure question of fact for a jury, thus getting you by a motion for
141 N.W. 1049 (1913); and Cole v. Wagner, 150 S.E. 339, 197 N.C.
692 (N.C. 1929). Cf. Sisters of St. Francis v. Summerson, 217 Ill.
App. 3d 377, 577 N.E.2d 177 (3d Dist. 1991). See also Section XII.
C. Cost Shifting; Variable Pricing
- 69 -
portion of their hospital confinement..." Report of Illinois
the poor, who do not have insurance, pay more for the same medical
client is being charged more than other patients for the same
services. A memorandum of law regarding cost shifting is included
at page 200.
- 70 -
for differing reimbursement amounts to be paid for the same
are able to negotiate with the hospital. All hospitals enter into
a. Blue Cross
hospital to pay less for the services rendered to its insureds than
These contracts have generally been renewed each year over the last
40 years. This has resulted in Blue Cross typically reimbursing the
hospital for only about 50-60% of its so-called "usual charges".
each DRG (there are more than 500 of them) is based on the
diagnosis of the patient at the time of admission. Every medical
procedure and illness is assigned a code and an associated dollar
17
Blue Cross in some jurisdictions may use different payment
plans, such as the "Competitive Allowance Program ("CAP") under
which hospitals sign a "contracting provider agreement" with Blue
Cross for direct payment of hospital bills of Blue Cross
subscribers. Payments are based on a "MAP" (Maximum Allowable
Payments) plan, where the hospital and Blue Cross agree to a
maximum reimbursement amount for a wide schedule of particular
services. See Bumgarner v. Blue Cross of Kansas, 716 F.Supp.
493, 495 (D. Kan. 1988).
- 71 -
amount and length of stay (LOS). The hospital is paid a specific
sum based on the DRG and a complicated formula, no matter how long
The hospital will get the same DRG amount for that patient whether
The hospital will contract with all major private insurers and
18
The provider discount is not disclosed to the patient. Thus,
an insured patient who pays a 20% "co-payment" of $2000 on a
$10,000 hospital bill will probably assume that the insurance
company is paying $8000 to the hospital. In fact, the insurance
company will pay considerably less due to the provider discount
- 72 -
stunning. In Forsyth v. Humana, Inc., 827 F. Supp. 1498 (D. Nev.
knowing where your client is being asked to pay the full amount of
the bill.19 Note that some HMO's are now negotiating per diem
contracts with hospitals that call for a flat, daily rate no matter
How does the typical hospital set its usual and customary
charges--that is, the rates it imposes solely on the self-payers?
- 73 -
This produces a deficit figure which forms the basis for what the
concluded that:
20
Berman, at 236.
- 74 -
Health Care Financing Review, Spring 1985, at 58. Another victim
three reasons: (1) it results in people who may be at the low end
uninsured--are not reasonable in that they are not the "usual and
customary" charges--indeed, most patients pay less.22
As indicated above, the amount the hospital accepts in
reimbursement for particular services varies depending on the
21
The Senior vice-president for finance at Northwestern
Memorial Hospital in Chicago admitted that to make up for
shortfalls caused by low Medicaid reimbursement payments, the
hospital charged its full paying patients "at a rate
significantly above the expense of actually serving them." He
figured that full paying patients were charged about 25% above
the hospital's cost. Chicago Tribune, July 9, 1991 at Section 1,
page 12.
22
Cost shifting may violate state laws which prohibit unfair or
deceptive actions in trade or commerce, so-called Little FTC
laws. Cost shifting may also be unconscionable conduct within
common law doctrines of unconscionability. Some states have
enacted laws that restrict cost shifting by prohibiting the
negotiation of discounted rates by large purchasers of health
care.
- 75 -
services it has rendered, the trier of fact must be apprised of the
charged more for the same services than a private insurance company
all the arrangements the hospital has effected with various third-
has paid its portion of the bill and the hospital is suing your
client for the remainder--the co-payment. A typical co-payment
arrangement may have the insurance company responsible for 80% of
the charges. So you may find a client being sued for $2000 when
- 76 -
of Ohio, 898 F. Supp. 545 (N.D. Ohio, 1995) where, in a suit
against the insurer on this theory, the court ruled that it was
reasonable for the patient to expect to have to pay only 20% of the
Two caveats: (a) Many hospitals try to claim that they charge
every payer the same amount; do not get hung up on this semantical
Ill. App. 3d 713, 489 N.E.2d 351 (3d Dist. 1986). In Taylor the
defendant asserted the hospital's policy of cost-shifting as six
affirmative defenses and counterclaims, alleging that this practice
violated the Social Security Act, the equal protection and due
process clauses of state and federal constitutions, the public
policy of Illinois, etc. The court rejected these claims. In
- 77 -
reasonableness of the hospital's charges to our client. Surely it
- 78 -
(DEPOSITION NOTICE)
IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
MUNICIPAL DEPARTMENT, FIRST DISTRICT
date, time and place stated, the said Deponent for oral examination
- 79 -
payments, charges, and reimbursement procedures for 1986.
plaintiff.
6. The hospital's Revenue and Expense statement for 1986.
7. The hospital's IRS Form 990 report for 1986.
STEVEN T. LAFMCER
- 80 -
DEFENDANT'S FIRST SET OF
INTERROGATORIES TO PLAINTIFF
[INSERT DEFINITIONS]
payment for charges for the goods and services rendered to the
these four payment sources, list the per diem amount that would
a) self payers;
b) insured by private insurance companies
- 81 -
(including Blue Cross);
c) insured by governmental programs such
as Medicaid and Medicare?
that would have been used for determining the charges for the
services rendered.
- 82 -
please describe these procedures.
18. State the DRG code that the hospital assigned to the
defendant's treatment.
- 83 -
19. Has the hospital, in the last five years, been charged
details.
- 84 -
Additional Interrogatories Regarding
Financial and Accounting Information
[Optional]
equivalents:
(a) a balance sheet;
(b) an income and expense statement;
(c) a statement of sources and applications of funds;
(d) a statement of changes in financial
position.
5. Identify all monthly, quarterly, or annual, as
appropriate, financial and statistical reports submitted to the
June, 1986.
6. Explain fully the methodology which the hospital employs
for each payor for cost finding, i.e., allocating direct and
- 85 -
rendered. Identify specifically all revenue-producing and non-
- 86 -
IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
COUNTY DEPARTMENT, LAW DIVISION
- 87 -
5. All documents regarding the plaintiff hospital's practice
third-party payers).
plaintiff.
9. All documents describing the manner in which, or the
basis upon which, plaintiff has determined the cost of each
- 88 -
studies, records, and reports which contain a determination or
reimbursed the plaintiff, or the fee Blue Cross was charged for all
medical services during the year 1999 or any other year for which
payment is sought.
expenditures.
- 89 -
FOIA REQUEST
Director, IHCCCC
Illinois Health Care Cost Containment Council
4500 South 6th Street Road
Springfield, Illinois 62703
- 90 -
Masonic Medical Center, for July through December of 1999 and for
all of 2000. Pursuant to 20 ILCS 2215/4-2(b), this data shall be
released on a hospital specific basis to facilitate comparisons
among hospitals by purchasers.
Sincerely,
- 91 -
A. AFFIRMATIVE DEFENSE: ESTOPPEL
judgment. Vaughn v. Speaker, 109 Ill. Dec. 245, 509 N.E. 2d 1084,
- 92 -
6 Ill.App.3d 306, 285 N.E. 2d
560 (1st Dist. 1972) (abstract only)
Full Opinion:
IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
MUNICIPAL DEPARTMENT, FIRST DISTRICT
No. 56597
MICHAEL REESE HOSPITAL )
A Corporation )
)
Plaintiff-Appellee, ) APPEAL FROM THE CIRCUIT
) COURT OF COOK COUNTY
vs. )
)
RAUL SANDOVAL and CELIA, ) HONORABLE GEORGE A HIGGINS
SANDOVAL, ) PRESIDING JUDGE
)
Defendants-Appellants. )
- 93 -
insurance policy. Subsequently, the defendants' child underwent
extensive out-patient treatment until January, 1966, when he was
admitted to the hospital for the first of three operations. Prior
to admission Mrs. Sandoval was again interviewed by Mrs. Heller
relative to the family financial situation. She was told that
there would be no charge for the operation with the exception of a
charity room rate of $5.00 per day. Mrs. Sandoval again mentioned
the medical insurance policy which the family had.
- 94 -
did so. It was unclear as to who requested this interview, the
accounting department of plaintiff or its charity clinic.
- 95 -
In assessing the validity of the defendants' contention that
the trial court erred in granting judgment to the plaintiff because
plaintiff's evidence was insufficient to sustain relief on a theory
of account stated or on any other theory, we are mindful of the
off-stated rule that a trial court's findings will not be disturbed
unless against the manifest weight of the evidence. Atkins v.
County of Cook, (1960), Ill. 2d 287, 163 N.E. 2d 826.
Nevertheless, it is the duty of the reviewing court to carefully
examine the record to determine whether the evidence justifies the
judgement; and if from a consideration of the whole record it
appears that the evidence does not justify the judgment, it must be
reversed. Friedman Electric Co. v. St. Clair County Housing
Authority of the City of East St. Louis, (1959), 23 Ill.App. 2d 16,
161 N.E. 2d 473.
- 96 -
"charitable allowance." Rather, they simply went to the clinic as
requested, were interviewed on all occasions by the same person,
and on each of these occasions were told they would not be charged
except for certain specified minor costs. The plaintiff itself
admits that defendants' son was rendered free treatment in 1966 and
1969, and this admission was made in the face of defendants'
testimony that they did not request a "charitable allowance" on
these occasions.
- 97 -
AFFIRMATIVE DEFENSE - ESTOPPEL
rent.
5. Defendant had no health insurance to cover medical
expenses for his children.
medical costs.
- 98 -
9. Subsequent to the subject hospitalization, defendant made
- 99 -
B. AFFIRMATIVE DEFENSE - WHERE HOSPITAL FAILS TO PROCESS
PUBLIC AID OR MEDICARE APPLICATION FOR ELIGIBLE PATIENT
and sue the patient for collection after it is too late to have the
23
See 89 Ill.Admin. Code Section 140.20(c) for time limits
on the submission of certain hospital claims to IDPA.
- 100 -
B) an individual presents the provider with
his or her medical card and the provider
does not indicate that other payment
arrangements will be necessary; or
- 101 -
Services Administration, 997 F.2d 231 (7th Circ. 1993);
Serafini v. Blake, 213 Cal. Rep. 207 (Cal. Super. 1985);
O'Neil v. Montefiore Hospital, 202 N.Y.S. 2d 436 (1960).
See also Mt. Sinai Hospital v. Korneqay, 347 N.Y.S.2d
807 (1973); Shaw v. Tait, Clearinghouse No. 30,025 B
(N.Y. Sup. 5/6/80); and Amsterdam Mem. Hosp. v. Cintron,
384 N.Y.S.2d 225 (1975). See pleading at page 109 and
memorandum of law at page 121.
- 102 -
[Hospital's Failure to Secure Payment
From IDPA Constitutes Negligence/Breach of Fiduciary Duty.]
AFFIRMATIVE DEFENSE
Public Aid.
the period of October 1, 1983 through March 31, 1984 with a spend-
down of $2,822.44.
5. Plaintiff's action against the defendants is in the
- 103 -
Department of Public Aid, the medical services provider must submit
the claims within six months from the date on which medical
the bill exceeded the spend-down amount this bill would have been
- 104 -
WHEREFORE....
- 105 -
[Hospital Breaches Statutory Duty
to Secure Payment From IDPA.]
AFFIRMATIVE DEFENSE
Cook County.
- 106 -
8. At no time relevant hereto did plaintiff initiate any
- 107 -
[Estoppel by virtue of hospital's failure
to secure payment from MANG.]
AFFIRMATIVE DEFENSE
services would be paid) that her application had been processed and
- 108 -
that therefore the Department of Public Aid would pay same.
plaintiff's agent and therefore was never processed while she was
not been lost, such application would have been accepted, and the
- 109 -
IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
COUNTY DEPARTMENT, LAW DIVISION
- 110 -
5. All documents relating to intake procedures in use at the
insurance programs.
- 111 -
INTERROGATORIES: SET ONE
these interrogatories.
required deposit.
- 112 -
seeking services for state medical assistance? If so, describe the
and that the responsible state agency takes appropriate action with
in question. State the name, title and current home address of the
person(s) administering such procedures with regard to defendant.
- 113 -
defendant's ability to meet the hospital expenses incurred herein?
If so, state the name, title and current home address of the
person(s) making the inquiry, when the inquiry was made, the
inquiry.
eligible for state medical assistance for the medical bills which
are the subject of this lawsuit? If the answer is yes, state the
title and current home address of the person(s) with whom he had
such discussions(s), when each such discussion was had, the content
of each such discussion, and identify all records regarding each
discussion.
medical bills which are the subject of this lawsuit? If the answer
is yes, state the title and current home address of the person(s)
who made such determination, when, what determination was made, and
determined;
- 114 -
b) whether, in what manner, when, and by whom action
during or after the hospital stay? If so, state the name, title
and current home address of whomever was so informed, and state
what information was had and when and how it was obtained.
12. Describe with specificity the hospital's responsibilities
- 115 -
INTERROGATORIES: SET TWO
expenses of which are the subject of this cause, did the plaintiff
Public Aid?
did plaintiff hospital submit such form to IDPA? State the name
- 116 -
and position of the person who so submitted such form.
determination?
- 117 -
MEMORANDUM: Fiduciary Relationship, Estoppel and Mitigation
which exist whenever one man trusts and relies upon another."
The existence of a fiduciary relationship is not restricted
only to such traditional legal relationships as attorney/client,
IDPA, patients trust and rely upon the hospital to timely submit
- 118 -
to process the Medicaid application was justified and reasonable.
against another person when the other person relies in good faith
on the party's conduct and is led thereby to change his position
for the worst." Hartford Accident & Indemnity Co. v. D.F. Bast,
Inc., 56 Ill. App. 3d 960, 962, 372 N.E.2d 829, 832 (1st Dist.
1977).
Defendants' Second Amended Affirmative Defense as alleged,
clearly sets forth facts sufficient in law to establish the defense
- 119 -
Where one party has committed a tort, breach of contract,
Park District, 409 Ill. 91, 98 N.E.2d 738 (1951). Plaintiff is not
the loss. Corydon & Ohlrich v. Kusper Bros. Co., 345 Ill. App.
- 120 -
IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
MUNICIPAL DEPARTMENT, FIRST DISTRICT
I. INTRODUCTION
Plaintiff seeks to strike Defendants' Amended Affirmative
Defenses as insufficient as a matter of law pursuant to 735 ILCS
5/2-615. Based on the facts as alleged in their Amended
- 121 -
("MA-NG") which is a Medicaid program administered by the Illinois
be properly processed.
that Defendant Juan Van Alop's family had been approved for MA-NG
assistance for the period of October 1, 1983 through March 31, 1984
statutory duty to process the claim; and fourth, that plaintiff had
a duty to mitigate its damages by promptly filing its claim with
IDPA.
- 122 -
III. ARGUMENT
facts could be proved under the pleadings which would entitle the
Ill. App. 3d 529, 420 N.E.2d 429 (1st Dist. 1981); Interway, Inc.
v. Alagna, 85 Ill. App.3d 1094, 407 N.E.2d 615 (1st Dist. 1980).
In determining the sufficiency of a complaint on a motion
to dismiss, the trial court, as well as appellate court, is
required to accept all well-pleaded facts as true and then to
School District No. 230, 82 Ill. App.3d 856, 403 N.E.2d 470 (1st
Dist. 1979).
B. A Hospital Participating As a State Authorized
Medical Provider Has a Statutory Duty To Properly
Process Medicaid Applications Of Its Patients, and
Therefore, Plaintiff's Motion to Strike Defendant's
Third Amended Affirmative Defense Should be Denied.
- 123 -
plaintiff in amount of $2,822.44. Plaintiff cannot now seek
programs is to provide:
- 124 -
than six months from the date on which medical goods or services
and (c).
the indigent.
- 125 -
the Court imposed a broad duty on the hospital to help potential
to sue when it was breached. The court held that the state's
- 126 -
Even if this court should find that no statutory duty existed
law, the state is the sole guarantor of payment to the health care
Pennsylvania, 396 A.2d 913 (Pa. Commw. Ct. 1979), cert denied, 488
U.S. 907 (1980); Serafini v. Blake, 213 Cal. Rptr. 207 (App. Dep't
Cintror, 384 N.Y.S.2d 225 (App. Div. 1976); Mount Sinai Hosp. v.
Kornegay, 347 N.Y.S.2d 807 (Civ. Ct. 1973); Society of N.Y. Hosp.
24
See 42 U.S.C. 1396h(d) and 42 C.F.R. 447.15
- 127 -
C. PAYMENT IN FULL DEFENSE--MEDICAID AND MEDICARE.
Medicaid:
- 128 -
In Evanston Hospital v. Hauck, 1 F.3d 540 (7th Cir. 1993), a
of money. The court did not permit the hospital to do this, ruling
that the hospital could not pursue the patient once it accepted the
could not bill a patient for services rendered where the patient
placed his mother in the nursing home the son applied for medicaid
coverage for his mother and medicaid did pay the nursing home a
substantial sum. But the nursing home then sued the son for the
rest of the bill even though he had paid for the period up to the
point medicaid coverage kicked in.
The court ruled that the federal regulatory scheme precluded the
nursing home from seeking additional funds from the son. It said
payment in full rule then every provider would soon use that
approach, in direct contravention of public policy. The case was
- 129 -
paying patient. Later he agreed to treat her as a Medicaid
patient, but still asked her to pay him $260 in connection with a
childbirth. The patient sued the doctor for the $260 she had paid
him and for punitive damages. The appellate court ruled that once
not ask her to pay anything. The court awarded the patient her
Serv Administration, 997 F.2d 231 (7th Cir. 1993), the Seventh
540, 544 (7th Cir. 1993) and Rybicki v. Hartley, 792 F.2d 260 (1st
Cir. 1986).
- 130 -
Illinois Department of Public Aid
MEDICAID CLAIM INQUIRY
If you wish to have the Department of Public Aid determine if one of your medical
bills was or should have been paid by the Department; you must fill out this form
completely , sign and date it, and send it to the address listed below. YOU MUST
ALSO ATTACH EVIDENCE OF PENDING LAWSUIT, THREATENED LITIGATION, OR CONTACT FROM A
COLLECTION AGENCY ON BEHALF OF A PROVIDER. The Department of Public Aid will
investigate your inquiry and send you a written response within 30 days. You should
keep a copy of this form before you mail it.
Your Name:
Address:
Phone: ( )
Medical Provider:
Address (Street)
Date(s) of service:
service(s) Provided:
( ) office visit ( ) Hospital Inpatient Services
( ) outpatient Surgery ( )
Additional Information:
I wish to have the Department of Public Aid review medicaid coverage for the above
medical provider and date(s) of service.
Signed: Dated:
An investigation of your Medicaid Claim Inquiry has been completed and the following determination has been
made:
() The Department rejected the claim submitted by the provider for these medical services by mistake. The
Department is tak ing actio n regarding the provider's cla im, wh ich m ay re sult in pa ym ent of the cla im. W e w ill
(x) The Department has not received a claim for these services from the provider. The provider has twelve
mo nths from the date of service to su bm it a claim . If the provider accepte d you as a M edicaid recipien t,
the provider may not bill, demand or otherwise seek reimbursement from you for services for which
reimbursement is available or for which reimbursement would have been available if the provider had
( ) The Department has already paid the provider in full for the medical services. Medicaid payment to a
( ) The claim for payment was not timely and/or properly submitted by the provider. If the provider accepted
you as a Medicaid recipient, the provider may not bill, demand or otherwise seek reimbursement from you
for services for w hich reim bursement is av ailable or for wh ich reim bursement wo uld have been ava ilable if
( ) The patient received a service for which a third party is liable fo r payme nt. The provider may not se ek to
collect from you if the total liability of the third pa rty equ als or e xceeds the D epa rtme nts rate for the service.
( ) The patient received a se rvice for wh ich th e provider wa s required to su bm it a request for prior approval.
The Dep artme nt received no such req uest. Th e failure to request prior app roval con stitutes provide r error,
( ) Dental issues prior to March 01, 1999 should be referred to Delta Dental at 1-800-323-1743.
( ) The patient received a service for which the provider was required to submit a request for prior approval.
Such a request was received and denied by the Department. You sho uld have received a Notice of that
() Pa tient wa s en rolled in________for the above date(s) of service. Provider should contact the
( ) Dental issues after March 01, 1999 should be referred to Doral Dental at 1-888-281-2070.
( ) Long Term Care issues s hould b e review ed w ith the local office cas ewo rker.
Provider
I
IL478-2208
therefore the hospital may not recover for such service. If, for
for the unnecessary x-ray. The issue of whether the hospital bears
Sherman Hospital v. Wingren, 169 Ill. App. 3d 161, 164, 523 N.E.2d
220, 222 (2d Dist. 1988); Dreyer Medical Clinic v. Corral, 227
Ill.App.3d 221, 591 N.E.2d 111, 115 (2d Dist. 1993), and Estate of
Third Order of St. Francis v. Summerson, 217 Ill. App. 3d 377, 577
- 131 -
N.E. 2d 177 (3d Dist. 1991).
that the services were indeed unnecessary, then the hospital should
hand, if the hospital can persuade the trier of fact that the
Related Documents
- 132 -
AFFIRMATIVE DEFENSE: LACK OF MEDICAL NECESSITY
her hospitalization was not medically necessary and that she did
- 133 -
denied payment for defendant's hospital bill.
- 134 -
inform her that she did not require in-patient hospital care.
prejudice.
- 135 -
MEMORANDUM RE AFFIRMATIVE DEFENSE OF LACK
OF MEDICAL NECESSITY
- 136 -
hospital field.
App. 3d 867, 875, 400 N.E. 2d 614, 620 (1st Dist. 1980), "A
contract for services with the hospital was that she would be
Hospital, 396 F.2d 931, 935 (D.C. Cir. 1967). See also Dreyer
Medical Clinic v. Corral, 227 Ill.App.3d 221, 591 N.E.2d 111, 115
N.E 2d 86, 90 (5th Dist. 1976), where the court reversed an award
of attorney fees because more than just the number of hours billed
- 137 -
had to be considered in assessing fees. The court found that the
for and results of the services billed. The plaintiff in this case
(1975), the court held that the hospital's failure to prove the
Jackson, 127 Ga. App. 635, 636 (1972), the court similarly denied
judgment to a physician due to his failure to prove the ordinary
which were owed to her by St. Elizabeth and which the hospital
- 138 -
of all Blue Cross medically necessary. Upon information and belief
hospital's duty of care owed to patients. The court held that the
The Darling court noted that the "medical profession and other
- 139 -
that a hospital ensure certain responsibilities for the care of the
patient. Id. at 332, 211 N.E.2d at 253. The Supreme Court found
upheld the jury finding that this was negligence. Id. at 333, 211
dismissed.
- 140 -
E. AFFIRMATIVE DEFENSE: HOSPITAL HAS BREACHED
STATUTORY DUTY IMPOSED BY CHARITABLE EXEMPTION
FROM AD VALOREM TAXES
state taxes. In return for such status, the hospital must use its
facilities for 'charitable' purposes. Arguably this encompasses
- 141 -
Chicago Reporter, "Profits, Reform Threaten Tax Breaks for Non-
Related Documents
- 142 -
AFFIRMATIVE DEFENSE
(charitable exemption)
financial benefit.
- 143 -
subsequently demanding payment for said service;
- 144 -
MEMORANDUM RE TAX EXEMPTION AFFIRMATIVE DEFENSE
status, the hospital must have assured the state that its property
378 N.E.2d 753 (4th Dist. 1978); People ex rel County Collector v.
- 145 -
without charge. The breach of this obligation may be raised as an
First, counsel should argue that the State and the hospital
patients for free, which consequently will lessen the burden of the
See Bates and Rogers Construction Corp. v. Greeley and Hansen, 109
Ill.2d 225, 232, 486 N.E.2d 902, 906 (1985); Vinylast Corp. v.
Gordon, 10 Ill. App. 3d 1043, 295 N.E.2d 523 (1st Dist. 1973).
Ill. App. 3d 151, 454 N.E.2d 1038 (1st Dist. 1983); Methodist Old
Peoples Home v. Korzen, 39 Ill. 2d 149, 157, 233 N.E.2d 537, 541
(1968). Such trusts may arise where a party has obtained property
by virtue of a confidential or fiduciary relationship which has
- 146 -
property from taxation, has allowed it to retain that amount which
however was not "given" to the hospital for its general purpose,
(1975).
- 147 -
and if hospital personnel speak with the defendant (executor of the
- 148 -
AFFIRMATIVE DEFENSE:
- 149 -
G. FAILURE OF HMO TO PAY DUE TO INSOLVENCY
fold. Those insured by the HMO may face hospital bills that should
have been paid by the HMO but were not. Illinois law at 215 ILCS
125/2-8 does not allow hospitals or other providers to take any
circumstances.
H. DURESS
- 150 -
VIII. COUNTERCLAIM: MALPRACTICE
ILCS 5/13-212.
- 151 -
IX. A. THIRD PARTY COMPLAINT: VS. INSURANCE CO. FOR BREACH OF
CONTRACT/VIOLATION OF INSURANCE CODE
can save them a buck by getting the hospital to take less than full
25
If the insurance company was an employer-sponsored group
health plan, see Section IX B.
- 152 -
preempted state claims against employee health plans. Instead, a
fees to the prevailing party. The Supreme Court has held that
Firestone Tire & Rubber Company v. Bruch, 489 U.S.101 (1989), held
that the "de novo" standard will apply unless the health plan gives
the administrator discretionary authority to determine
empted by ERISA has gone both ways. The 7th Circuit answered
- 153 -
affirmatively in Pohl v. Natl Benefits Consultants, 956 F.2d 126
Complaint against a health benefits plan, the Plan that you sue
Court under federal removal rules set out at 28 U.S.C. Sec. 1446.
so you will just have to litigate the claim in federal court under
those circumstances.
(3) ERISA, at 29 U.S.C. Sec. 1133, establishes minimum
procedural requirements when a health plan administrator denies a
claim. Seventh Circuit cases hold that an employee may have to
exhaust her remedies under the health plan before bringing suit.
Robyns v. Reliance Standard Life Insurance Co., 130 F.3d 1231 (7th
Cir. 1997).
Investors Life Insurance Co., 733 F. Supp. 342 (S.D. Fla. 1990)
with Hollenbeck v. Falstaff Brewing Corp., 605 F. Supp. 421 (D. Mo.
1985).
- 154 -
is the situation where your client has a health plan at work that
after the employer only after being fully advised on the possible
may choose not to file third party actions against their place of
employment under such circumstances because they fear losing their
jobs as a result; their job may be more important to them than a
four thousand dollar hospital bill.
Related Documents
- 155 -
C. THIRD PARTY COMPLAINT vs. EMPLOYER
current employer.
D. COBRA
1986. The COBRA statutory provisions are found at 29 USC Sec 1161-
1169.
Thus, workers (and their dependents) laid off of a job where there
are 20 employees or more, are entitled to continue their health
- 156 -
coverage for up to 18 months.
Of course the catch is that the worker has to pay the full
without saying that most workers who suffer a qualifying event like
developments under the COBRA law that offer our clients remedies in
a number of situations.
health plan to give the employee two separate and distinct notices
of their rights under the law. 26 U.S.C 4980B(f)(6). The first
notice has to be given at the time the worker initially enters the
group health plan. It is a general explanation of the workers
rights under COBRA. The second notice has to be given at the time
of the qualifying event. And this notice has to adequately advise
the worker of his or her COBRA rights. The worker or the dependent
then has 60 days from the date the second notice is provided in
which to elect to obtain continuation coverage under the Act.
In the case of Phillips v. Riverside Inc., 796 F. Supp. 403
- 157 -
against the insurance plan and the court ruled for Mr. Phillips.
The court required the plan to pay the $38,000 in hospital bills
that would have been covered during the 18 month period following
penalty for the 2 yrs between the qualifying event and the day the
suit was filed. The COBRA law allows the Court to impose a
(N.D. Ill. 1993) an employee resigned from his job and the health
2d 686 (11th Cir. 1992) the plan did send the second COBRA rights
notice to the employee. But the Court ruled that the notice sent
was insufficient to allow the employee to make an intelligent
decision as to whether or not to elect to continue coverage. The
court held that the employee could elect to continue coverage and
that it would be retroactive to the date of the qualifying event.
So you will always want to inquire about COBRA related
medical bills. Find out their employment history and whether there
were health plans at the prior jobs. You will need to see if the
health plan complied with its duties under COBRA.
- 158 -
may report that they were laid off from their job less than sixty
days ago and now their son was just hospitalized. COBRA can help.
qualifying event. The client can elect to pay for COBRA continuing
coverage and get the health plan to pick up the tab for the
Bernd Co. 955 F.2d 1574 (11th Cir 1992), where the court said that
days to elect to continue coverage and that COBRA did not exclude
- 159 -
IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
MUNICIPAL DEPARTMENT, FIRST DISTRICT
HOSPITAL, )
)
Plaintiff, )
)
vs. ) No.
)
ALEX, )
)
Defendant, Third-Party )
Plaintiff, )
)
vs. )
)
INSURANCE COMPANY, )
)
Third-Party Defendant. )
- 160 -
insured, and on information and belief, none was ever sent.
5. Alex has paid each and every premium due under the policy.
about June 5, 1992, and was discharged on July 6, 1972, from said
reproduced herein.
- 161 -
Insurance Code by:
215 ILCS 5/155, any other relief deemed just and proper.
- 162 -
IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
MUNICIPAL DEPARTMENT, FIRST DISTRICT
- 163 -
4. Maurey Mfg. Co. is an Illinois corporation; it
- 164 -
liable pursuant to the Illinois Family Expense Act.
ALAN A. ALOP
ALAN A. ALOP
LEGAL ASSISTANCE FOUNDATION
OF CHICAGO
General Office
- 165 -
X. CLAIM AGAINST PUBLIC AID/BREACH
OF STATUTORY DUTY/NEGLIGENCE
by the hospital, and where Public Aid has never ruled on the
App. 3d 951, 491 N.E.2d 103 (1st Dist. 1986). The pleadings at
page 172 allege that Public Aid's failure to process and decide
defendant's application constitutes a breach of an (amorphous)
statutory duty and/or negligence.
- 166 -
IN THE CIRCUIT COURT OF COOK COUNTY
IN THE COURT OF CLAIMS
COUNT I
WATSON, a minor, and VELMA WATSON and EUGENE WATSON, his parents,
- 167 -
the MA-NG program.
the Public Aid programs, including the MA-NG program in Cook County
program, in Cook County as agent for, and under the direction and
- 168 -
or at any time thereafter.
proximate and direct result that the hospital bill sued upon herein
COUNT II
1. Plaintiffs incorporate herein paragraphs 1-8 or Count I
as paragraph 1-8 of Count II.
9. Upon receiving the application defendants had a duty to
exercise due care in processing the application and in notifying
negligence.
County Department never paid the bill for hospital through the MA-
NG program.
13. But for the negligence of the defendants, this bill would
have been paid by the County Department through the MA-NG program.
- 169 -
14. Defendants are liable to the plaintiffs in the amount of
- 170 -
XI. DEPOSITION OF HOSPITAL WITNESS
NAME
HOME ADDRESS
PRIOR JOBS
DOES THE HOSPITAL CLASSIFY PATIENTS BY THE WAY THEIR BILL WILL BE
PAID? CATEGORIES: SELF PAY, THIRD PARTY PAY, INSURED, MEDICAID
ETC
PATIENTS OR INSURANCE COMPANIES EVER DISPUTE PORTIONS OF THE
HOSPITAL BILL? (EITHER THE AMOUNT OF BILL OR WHETHER GOODS OR
SERVICES ACTUALLY PROVIDED)
- 171 -
HOW OFTEN?
DOES THE HOSP EVER AUDIT ANY PATIENT'S BILL? UNDER WHAT
CIRCUMSTANCES? PLEASE EXPLAIN THE PROCEDURES--WHO WHEN, WHY.
DRG CODING
State what DRG code the hospital assigned to the treatment provided
the defendant. When? Who did this?
Any possible alternative code that could have been assigned? Cost
implications had the other code been assigned.
What charges are normally "bundled" into the DRG code that was
assigned?
Has the hospital been charged with miscoding or inappropriate
coding by any governmental agency or insurance entity? Details.
UTILIZATION REVIEW
- 172 -
overutilization?
HAS THE HOSP EVER HAD ANY REVIEW BY ANY PRO ? WHEN, UNDER WHAT
CIRCUMSTANCES, WHY?
WHICH PRO?
WAS THIS DEFENDANT's treatment EVER SUBJECT TO A REVIEW BY A PRO?
ANY WRITTEN DOCUMENTS REGARDING THE PRO REVIEW OF THE DEFENDANT'S
CASE?
ANY DOCUMENTS WHICH DESCRIBE THE PRO AND ITS PROCEDURES?
- 173 -
DID THE DEFENDANT EXPERIENCE ANY DELAYS RELATED TO SURGERY?
E.G. BUSY HOSP SCHEDULE; NO OPENINGS.
HOSPITAL'S RATES
ARE YOU FAMILIAR WITH THE PRICES OR RATES CHARGED BY THE HOSP?
FAMILIAR WITH THE RATES OF THE HOSP CHARGED IN 19--?
WHO IS...WHAT DEPARTMENT?
DOES THE HOSP MAINTAIN A LIST OF ITS RATES? What is this list
called? (CHARGEMASTER?)
EXPLAIN THE PROCEDURES THE HOSP USES TO MODIFY ITS CHARGES FOR AN
INDIVIDUAL ITEM SUCH AS AN EKG TEST.
- 174 -
DOES THE HOSPITAL USE ANY PRINTED FORMS IN MODIFYING INDIVIDUAL
CHARGES? WHAT FORMS? WHERE MAINTAINED?
WHAT WAS THE HOSPITAL'S AVG RATE INCREASE IN THE LAST 5 YEARS
(OR THE AVG RATE INCREASE BETW 19-- AND 19--)
COST CONTAINMENT
- 175 -
THE POOR? DO YOU HAVE A CHARITY COMMITTEE? WHO IS ON IT?
ARE THERE WRITTEN PROCEDURES THAT DETERMINE WHO WILL GET FREE
HOSPITAL SERVICES?
COSTING
WHAT DEPT SETS THE USUAL CHARGES OF THE HOSPITAL? WHO DIRECTS THAT
DEPARTMENT? IS IT THE BUDGET DEPT?
HOW DOES THE HOSPITAL ESTABLISH ITS USUAL CHARGES FOR ITS SERVICES
AND GOODS?
DOES THE HOSPITAL MAINTAIN A MASTER LIST OF ALL CHARGES FOR ITS
SERVICES AND GOODS? WHAT IS THIS LIST CALLED? UPDATED ANNUALLY?
COST SHIFTING
- 176 -
DETERMINE THE HOSPITAL'S REIMBURSEMENT RATE?)
SO MEDICAID DOES NOT PAY THE HOSPITAL ITS NORMAL CHARGES, CORRECT?
IF TWO PATIENTS ENTER THE HOSPital, STAY THE SAME LENGTH OF TIME,
HAVE THE IDENTICAL SERVICES PROVIDED, BUT ONE IS ON MEDICAID AND
THE OTHER A SELF-PAYOR, THE HOSP WILL RECEIVE LESS REIMBURSEMENT
FROM MEDICAID THAN IT WILL ASK THE SELF-PAYOR TO PAY, CORRECT?
REPEAT ABOVE.......
REPEAT ABOVE....
THIS COST PLUS 5% WILL RESULT IN A BILL THAT IS LESS THAN THE HOSP
NORMAL CHARGES WILL IT NOT?
IS THIS AGREEMENT IN WRITING?
HOW IS THE COSTS PORTION OF THE BLUE CROSS FORMULA DETERMINED? WHO
DETERMINES THIS?
TRY TO GET THE WITNESS TO ADMIT THAT PATIENTS THAT HAVE NO PRIVATE
OR GOVERNMENTAL HEALTH INSURANCE--A SMALL GROUP--ALSO GET STUCK
- 177 -
WITH SUBSIDIZING INSURED PATIENTS WHERE THE PROSPECTIVELY-SET RATES
DO NOT ADEQUATELY REIMBURSE THE HOSP. THAT IS-- HOSPITALS MAY FIND
IT NECESSARY TO OFFSET REVENUES LOST FROM A WIDE RANGE OF
PROSPECTIVELY-SET RATES BY INCREASING CHARGES MORE THAN USUAL TO
THE SELF-Payers.
AND BECAUSE OF THIS PRACTICE, THE DEFENDANT IN THIS CASE WAS ASKED
TO PAY CHARGES WHICH WERE HIGHER THAN THEY WOULD BE IF THE HOSPITAL
DID NOT ACCEPT MED/MED PATIENTS?
OR: MR SMITH HAD TO PAY MORE IN THIS CASE BECAUSE MEDICAID AND
MEDICARE ARE NOT PAYING THEIR FAIR SHARE
COMPARISON STUDIES
HAVE YOU EVER SEEN THE REPORT OF THE IHCCCC REGARDING HOSP CHARGES
FOR THE YEAR 19--?
DO YOU YOURSELF HAVE ANY OTHER KNOWLEDGE REGARDING HOW THE CHARGES
AT YOUR HOSP COMPARED TO OTHER HOSPITALS' CHARGES IN THE YEAR 19--?
- 179 -
IN THE MEDICAL RECORD.....
does the hosp contact potential third party payers? DID THEY IN
THIS CASE? WHO DID, WHEN, WHAT WAS LEARNED?
ITEMIZED BILL
AT THIS POINT REVIEW THE ITEMIZED BILL WITH THE WITNESS. ACSERTAIN
WHETHER THE WITNESS HAS PERSONAL KNOWLEDGE THAT ITEM X IS ACTUALLY
PRICED CORRECTLY AND WHETHER THAT ITEM WAS NECESSARY GIVEN THE
DEFENDANT'S DIAGNOSIS. SHE PROBABLY WILL ADMIT THAT SHE DOES NOT
KNOW IF IT WAS NECESSARY.
- 180 -
AMOUNT FOR THE EKG. SOME PATIENT'S BILLS ARE
DISCOUNTED BY VIRTUE OF COST SHIFTING (the bill
is discounted due to a negotiated agreement between
the hospital and the patient's insurer).
PLEASE LIST ALL PAYMENTS MADE TOWARD THE DEFENDANT'S BILL, GIVING
THE DATE OF EACH AND THE SOURCE OF EACH.
MISCELLANEOUS
DOES THE HOSPITAL SUE ALL PATIENTS WHO HAVE NOT PAID THEIR HOSP
BILLS? IF NOT, WHICH ONES DO THEY NOT SUE AND WHY? Who makes
- 181 -
these decisions?
DID YOU BRING WITH YOU A COPY OF THE HOSPITAL'S BUDGET FOR 1999?
FROM WHOM OBTAINED? WHO WAS RESPONSIBLE FOR PUTTING THIS TOGETHER?
STILL EMPLOYED AT HOSPITAL?
DOES THE HOSP EXPEND ANY FUNDS FOR PHYSICIAN RESEARCH ACTIVITIES?
- 182 -
XII. SUMMARY JUDGMENT
The hospital may move for summary judgment. This motion may
stating that the charges are excessive; (b) deposing the hospital's
Vaughn v. Speaker, 156 Ill. App. 3d 962, 968, 509 N.E.2d 1084, 1088
- 183 -
MEMORANDUM RE SUMMARY JUDGEMENT
St. Anne's Hospital, 132 Ill.App. 3d 1073, 1079, 478 N.E.2d 464,
- 184 -
a matter of law." 735 ILCS 5/2-1005.
have constituted all of the evidence before the court and upon such
272 N.E.2d 497, 500 (1971), cert. den., 408 U.S. 943 (1972). On a
Hill v. Durkin, 58 Ill. App. 3d 1003, 374 N.E.2d 1147 (3d Dist.
1978). Even if facts are undisputed, a genuine issue exists if
fair-minded persons could draw different conclusions from the
facts. Torrence v. DeFrates, 56 Ill. App. 3d 118, 371 N.E.2d 1281
A.A. Store Fixture Co., Inc. v. Kouzoukas, 87 Ill. App. 3d 631, 410
N.E.2d 23 (2d Dist. 1958), realty, Illinois Power and Light Corp.
v. Talbott, 321 Ill. 538, 152 N.E. 406 (1926), and physician's
- 185 -
fees, Rubenstein v. LeSage, 135 Ill. App. 424 (2d Dist. 1907).
the holdings indicate that questions of value are for the fact-
finder to decide.
that the fees were the usual, regular, and proper charges for the
services. The defendant offered no counter-affidavits. The
defendant apparently did not question the reasonableness of the
charges. 121 Ill. App. 2d at 476, 257 N.E.2d at 126. The court
noted that the defendant had sufficient opportunity to object to
the itemized bill but did not object to the charges.
- 186 -
question of value is merely an expression of opinion and does not
motion. In Duane v. Altenburg, 297 F.2d 515, 518 (7th Cir. 1962),
the Court held that an affidavit does not negate the existence of
the reasons given by the witness as the basis for his opinion, the
character of the injury or disease, and the length of time required
to perform the operation. Id.
The only testimony on value was given by the owner of the hospital
- 187 -
who testified that the fee charged was the "usual, regular, and
The court cited the following justifications for holding that the
professional services is not binding on the jury; and (3) the jury
also Shellnut v. Randolph County Hospital, 469 So.2d 632 (Ala. App.
1985).
- 188 -
exist. First, as stated above, the hospital's affidavit might be
considered a conclusion or opinion, rather than a "fact." The
First District has stated: "It is well established that even
though the party opposing the motion for summary judgment fails to
file counter-affidavits, the moving party is not entitled to
summary judgment unless the affidavits filed in support of the
motion establish, as a matter of law, her right to judgment."
Fryison v. McGee, 106 Ill. App. 3d 537, 539, 436 N.E.2d 12, 14 (1st
Dist. 1982). Second, a simple counter-affidavit from the defendant
could defeat the motion for summary judgment. For example, in Blum
& Sang v. Kurtzon, 351 Ill. App. 107, 113 N.E.2d 475 (1st Dist.
1953) (abstract only; see full opinion), an attorney sought summary
judgment on his claim for fees against his former client. The
client's affidavit that he believed he had already paid the lawyer
an amount exceeding the value of services rendered created a
triable issue of fact.
- 189 -
IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
MUNICIPAL DEPARTMENT, THIRD DISTRICT
COLUMBUS CASH )
MEDICAL CENTER )
)
Plaintiff, )
)
vs. ) No. 99 M1 1335
)
FERNANDO EMEDIN and )
CAROLINA EMEDIN, )
)
Defendants. )
MOTION TO STRIKE
A. Trial Considerations
- 190 -
1. Overview
patient has been dealt a crippling bill. See below: Picking a Jury
for more money. You may be able to argue that the hospital has
- 191 -
summary of charges may be insufficient. Computer-generated
equipment is standard; (2) that the entries are made in the regular
of the event recorded; and (3) that the sources of information and
Liquor Co. v. Dept. of Revenue, 67 Ill 2d 195, 202, 367 N.E.2d 1238
Medical Clinic v. Corral, 227 Ill. App.3d 221, 591 N.E.2d 111 (2d
Dist. 1992), where the medical clinic's witness did not know "how
the computerized bills were generated or checked for accuracy".
But see Victory Memorial Hospital v. Rice, 143 Ill. App. 3d 621,
1031, 424 N.E.2d 1302, 1306 (5th Dist. 1981). The hospital may
need to produce a number of witnesses at trial to meet its burden.
- 192 -
N.E.2d 117 (2d Dist. 1986) an Illinois appeal court reversed a
that its charges were reasonable, but found that the hospital had
testimony of:
1. treating physician;
3. vice-president of finance;
conducted under Supreme Court Rule 286(b), the trial court allowed
Majid, 226 Ill. App. 3d at 641, 589 N.E.2d at 1048. Where the
- 193 -
normal rules of evidence are at play, a hospital should not be able
counsel.
v. Corral, 227 Ill. App.3d 221, 591 N.E.2d 111 (2d Dist. 1992),
where the medical clinic failed to present any evidence of how its
charges compared to other providers in the community.
4. Comparable Hospital Charges.
- 194 -
survey material to cross-examine the hospital witness if they admit
to being familiar with it. To get the IHCCCC survey into evidence
official record.
services were actually needed; and (3) what is the reasonable value
witness has a medical background they will not be able to state why
that they do not know if a test was medically necessary. You may
also get them to concede that they do not know if tests reflected
can probably show that the witness has very little knowledge
regarding rates charged by other hospitals during the relevant time
period. What other hospitals is she aware of? Are they similar
institutions? What rates does she have knowledge of? Only room
rates? Does she know the comparable rates for procedures actually
- 195 -
records supporting the cost comparisons she has observed? Does she
really have any idea whether Hospital X charged more or less than
After the hospital has rested its case you should move for a
directed verdict, arguing that all of the evidence when viewed in
its aspect most favorable to the hospital does not satisfy the
hospital's burden of providing the amount it seeks is the
Eastern Railroad Co., 37 Ill.2d 494, 509-510, 229 N.E.2d 504, 513-
14 (1967). A model motion for directed verdict is found at 213.
8. The Defendant: To Testify or Not?
- 196 -
compelling factual testimony. Where there have been excessive
charges for simple items such as aspirin or paper goods, have your
client purchase such goods at a drug store, save the receipt, and
testify about the cost "on the outside." Perhaps she can testify
that certain goods or treatments for which she was billed were not
provided. Maybe she can relate a hospital snafu that cost her an
634 (Ala. App. 1985). See also Bay Island Drainage v. Nussbaum,
- 197 -
388 Ill. 131, 134, 56 N.E.2d 615, 616 (1944) (if evidence
page .
jury. Pick a "theme" and weave your argument around it. One
Related Documents
- 198 -
IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
MUNICIPAL DEPARTMENT, FIRST DISTRICT
GRANT HOSPITAL )
)
Plaintiff, )
)
vs. ) No. 88 M1 203240
)
MIGUEL HUERTAS, )
)
Defendant. )
NOTICE TO PRODUCE
Rule 237 (b) requests that plaintiff produce the following persons
and documents for trial on whatever date this case shall be brought
to trial:
1. All medical records of defendant's treatment at plaintiff
hospital.
2. All records reflecting charges to defendant, including
pharmacy records.
- 199 -
and/or ability to pay for medical services.
payment is sought.
- 200 -
evaluation of the costs of the particular individual medical
services and procedures received by defendants from plaintiff.
12. All documents describing the manner in which, or the
basis upon which, plaintiff has determined the cost of each
individual medical service it provided to defendant.
13. An itemized list of what the charge (or reimbursement
amount) of each service rendered to defendants would have been if
said services had been charged to:
a. Medicaid;
b. Medicare; or
c. Blue Cross
d. HMO Illinois
- 201 -
B. TRIAL MEMORANDUM
)
THE CHILDREN'S MEMORIAL HOSPITAL, )
)
Plaintiff, )
)
-vs- ) No. 00 M1-103189
)
PONCIANO LOPEZ and )
FRANCISCA LOPEZ, )
)
Defendants. )
)
TRIAL MEMORANDUM
INTRODUCTION
- 202 -
rendered are reasonable. A statement of account,
standing alone, is not proof of the reasonableness of a
supplier's charges. (citations omitted).
424 N.E.2d 1302, 1305-06 (5th Dist. 1981). Since defendants deny
- 203 -
covered by Medicaid may pay $1,500 for an appendectomy while a
self-paying patient may have to pay $2,500 for the same operation.
(IHCCCC):
amount for services which exceeds the amount the hospital accepts
customarily has lower actual charges for other payers. The inquiry
- 205 -
will also show that the hospital's costs are not equitably recouped
Co. v. Dover National Bank, 80 Ill.App.3d 867, 875, 400 N.E.2d 614,
620 (1st Dist. 1980), "[a] contract implied in law is equitable in
revenues.
- 206 -
patient. Emmett v. Eastern Dispensary and Casualty Hospital, 396
F.2d 931, 935 (D.C. Cir. 1967). The situation in the instant
Ill.App.3d 706, 711, 355 N.E.2d 86, 90 (5th Dist. 1976), where the
court reversed an award of attorney fees because more than just the
closely examining the need for and results of the services billed.
Memorial Hospital v. Rice, 143 Ill. App. 3d. 621, 625, 493 N.E.2d
117, 120 (2d Dist. 1986). In addition, the reasonableness of the
charges is measured against "the usual and customary charges for
App. 3d 161, 164, 523 N.E.2d 220, 222 (2d Dist. 1988) (emphasis
510 N.E.2d 99, 100 (1st Dist. 1987) (initial inquiry of the court
- 207 -
The hospital was under a duty to review the hospital treatment
court held that the Standards for Hospital Accreditation, the state
The Darling court noted that the "medical profession and other
responsible authorities regard it as both desirable and feasible
- 208 -
that a hospital ensure certain responsibilities for the care of the
patient. Id. at 332, 211 N.E.2d at 253. The Supreme Court found
that the Charleston "hospital failed to review" the private,
treating physician's work or to require consultation, and thus
upheld the jury finding that this was negligence. Id. at 333, 211
N.E.2d at 254. The failure of the hospital to exercise its review
responsibility in this case to determine the medical necessity of
Elidia Lopez' hospitalization is negligence and a breach of the
hospital's responsibility to defendants' daughter requiring that
the claim for these unnecessary services brought be dismissed.
See also Dreyer Medical Clinic v. Corral, 227 Ill. App.3d 221, 591
N.E.2d 111, 115 (2d Dist. 1992), where the medical clinic failed to
present any evidence that its services were necessary.
- 209 -
C. PICKING THE JURY IN A HOSPITAL COLLECTION CASE
1. LOOK FOR JURORS WHO ARE NOT AFRAID TO COMPLAIN ABOUT THINGS. THE
BEST JUROR IS ONE WHO HAS AT SOME POINT IN HER LIFE COMPLAINED ABOUT
A BILL. MAYBE
IT WAS JUST A $1 MISTAKE ON A RESTAURANT CHECK--YOU WANT THE JUROR WHO
HAS COMPLAINED ABOUT THAT $1 MISTAKE RATHER THAN THE JUROR WHO LET IT
SLIDE.
3. TEACHERS, ARTISTS, AND LOW PAID INDIVIDUALS ARE YOUR BEST JURORS.
IN FACT YOUR IDEAL JUROR WOULD BE A LOW PAID ART TEACHER.
4. PEOPLE WHO HAVE BEEN HOSPITALIZED ARE PREFERABLE TO THOSE WHO HAVE
NEVER BEEN HOSPITALIZED. A JUROR WHO HAS BEEN A HOSPITAL PATIENT IS
ONE WHO
HAS SEEN HOW HIGH HOSPITAL BILLS CAN BE.
5. JURORS WHO DO NOT HAVE HEALTH INSURANCE ARE VERY DESIRABLE. THEY
MAY HAVE A NEGATIVE VIEW OF THE AMERICAN HEALTH CARE SYSTEM AND THIS
WILL AID YOUR PRESENTATION.
6. ELDERLY JURORS WHO HAVE GOOD REASON TO FEAR HIGH MEDICAL BILLS MAY
BE VERY GOOD JURORS. HOWEVER, AVOID SENIOR CITIZENS WHO HAVE VERY
COMFORTABLE EXISTENCES AND AMPLE HEALTH INSURANCE...NO RETIRED BANK
PRESIDENTS PLEASE.
7. WHEN YOUR CLIENT IS BEING SUED BY A HOSPITAL WHICH IS AFFILIATED
WITH A RELIGIOUS DENOMINATION, YOU SHOULD CAREFULLY SCREEN POTENTIAL
JURORS OF THAT RELIGION. FOR EXAMPLE, IF YOUR CLIENT IS BEING S UED
BY MORMAN GENERAL HOSPITAL YOU WANT TO BE SURE THAT A MORMAN JUROR
WILL NOT ALLOW THEIR RELIGIOUS BELIEFS TO HAVE THEM LEAN TOWARD THE
HOSPITAL. THIS CAN BE A DELICATE SITUATION BUT YOU HAVE TO DEAL WITH
IT.
- 210 -
8. YOU ARE LOOKING FOR OPEN MINDED PEOPLE, PEOPLE WILLING TO
QUESTION AND EXAMINE WHAT LARGE INSTITUTIONS LIKE HOSPITALS DO. YOU
WANT TO STAY AWAY FROM AUTHORITARIAN PERSONALITIES--LIKE A LOT OF
ARMED FORCES PERSONNEL, BIG CORPORATION EMPLOYEES OR GOVERNMENTAL
BUREAUCRATS--WHO MAY BE WILLING TO ACCEPT ANYTHING THE HOSPITAL SAYS
WITHOUT QUESTION.
- 211 -
D. SAMPLE VOIR DIRE QUESTIONS
bill to a patient?
- 212 -
high? If yes, what did you do about it?
give each the same weight all other things being equal?
a bill collector?
11. Do you have any feeling against the defendant Tomas Jones
defendant?
14. Do you and all members of your immediate family have
medical insurance? If yes please specify the insurance company,
ALAN A. ALOP
- 213 -
- 214 -
IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
MUNICIPAL DEPARTMENT, THIRD DISTRICT
ELVIS HOSPITAL, )
)
Plaintiff, )
)
vs. ) No. 77 M1 142090
)
HARPO AND CHICO SOSA )
)
Defendants. )
- 215 -
E. JURY INSTRUCTIONS
DEFENDANT'S PROPOSED
JURY INSTRUCTIONS
instruct the jury on the law set forth in these requests. These
- 216 -
Faithful performance by you of your duties is vital to the
administration of justice.
Given Refused
- 218 -
Given Refused
Given Refused
- 219 -
Any verdict you reach must be unanimous. And in your
deliberations you should examine the questions submitted with a
proper regard and consideration for the opinions of each other.
You should listen to each other's arguments with an open mind, and
you should make every reasonable effort to reach a verdict.
Given Refused
- 220 -
When I say that a party has the burden of proof on any
proposition, or use the expression "if you find" or "if you
decide", I mean you must be persuaded, considering all the evidence
in the case, that the propositions on which he has the burden or
proof is more probably true than not true.
Given Refused
- 221 -
- 222 -
The fact that the defendants did not appear or testify at
this trial should not be held against them, or considered in any
fashion.
Given Refused
You must decide what goods and services were in fact delivered
to the defendant by the plaintiff hospital.
Then you must fix the amount of money which is the reasonable
value of the goods and services that were delivered to the
defendant by the plaintiff hospital. Once you have established
that amount you must deduct from it all amounts already paid on
this bill. You may then fix a judgment sum in an amount anywhere
from $0 to $ .
Dreyer Medical Clinic v. Corral, 227 Ill.App.3d 221, 591 N.E.2d 111
(2d Dist. 1992).
Given Refused
- 225 -
In order to meet its burden of proof that its charges were
reasonable, the hospital must show that its charges to the
defendant were comparable to the charges of other similar
hospitals for similar services and that its charges to the
defendant were its usual and customary charges. In making the
determination of whether the hospitals charges were reasonable,
you may also consider the amounts the hospital will accept as
payment in full for similar services where the government or other
entities are paying the bill.
We, the Jury, find against the plaintiff and for the defendant
on plaintiff's complaint.
- 227 -
Chairperson
- 228 -
F. CLOSING ARGUMENT (Sample)
This IS A CASE THAT MUST HAVE RAISED MANY QUESTIONS IN YOUR MIND AS
YOU HEARD THE EVIDENCE UNFOLD, QUESTIONS THAT MAKE YOU WONDER
ABOUT HospitalS LIKE THE ONE IN THIS CASE. IN FACT...QUESTIONS
THAT MAKE REASONABLE PEOPLE LIKE MARGIE JONES GET VERY UPSET AT
INSTITUTIONS LIKE THE Hospital IN THIS CASE.
THE BIGGEST QUESTION IN THIS CASE IS WHY IN THE WORLD WAS she
CHARGED $9000 FOR FOUR DAYS IN THE Hospital?
AND THE OTHER BIG QUESTION HERE IS WHY WAS MS. JONES CHARGED $9000
for arm surgery WHEN OTHER PATIENTS WHO HAD THE SAME ARM SURGERY
AND THE SAME SERVICES WOULD ONLY HAVE BEEN CHARGED $2700?
WHY DID THE Hospital CHARGE MARGIE JONES FOR THINGS and services
- 229 -
SHE NEVER RECEIVED?
DID THE Hospital THINK IT WAS OK TO CHARGE MARGIE JONES $14 FOR
EACH TYLENOL TABLET? DID THEY THINK SHE WOULDN'T NOTICE? Was this
a reasonable charge?
DID THE Hospital THINK IT WAS FAIR TO CHARGE MARGIE JONES FOR AN
EXTRA DAY SHE SPENT IN THE Hospital-- A DAY SHE SPENT THERE BECAUSE
THE Hospital MADE A MISTAKE IN THEIR SCHEDULING OF HER LAB TEST?
AND WHY DID THIS Hospital CHARGE A LOT MORE MONEY TO MARGIE JONES
FOR SOME OF ITS SERVICES--more money THAN OTHER HospitalS CHARGE
FOR THOSE VERY SAME THINGS?
WHAT YOU SAW AND HEARD IN THIS CASE WAS MARGIE JONES STANDING UP
AGAINST THE Hospital. MS JONES STOOD UP AGAINST THIS INSTITUTION
TO SEND THEM A MESSAGE. SHE IS SENDING A CRYSTAL CLEAR MESSAGE TO
THE Hospital AND THAT MESSAGE IS THAT PATIENTS MUST BE TREATED FAIR
AND SQUARE and that this hospital has a lot of work to do to make
that come about.
BUT AS THE EVIDENCE SHOWED IN THIS CASE, SHE DID NOT GET A FAIR
SHAKE FROM THE Hospital. I WANT TO REVIEW WITH YOU NOW SOME OF
THAT EVIDENCE.
- 230 -
AND WHILE I DISCUSS THE EVIDENCE I WANT YOU TO KEEP IN MIND A
MATTER OF LAW THAT THE JUDGE IS GOING TO INSTRUCT YOU ON.
YOU HEARD NURSE WILSON TESTIFY. SHE WORKS AT THE Hospital AND SHE
SAID THAT DUE TO A SCHEDULING ERROR THAT MARGIE JONES' LAB TEST HAD
TO BE PUT OVER FROM MARCH 7 TO MARCH 8. SHE SAID THAT this delay
COST MS JONES A DAY IN THE Hospital THAT SHE DIDNT HAVE TO BE THERE
AS A RESULT OF THE Hospital'S MISTAKE. AND THAT MEANS THAT MARGIE
JONES WAS BILLED $550 FOR THE Hospital room on MARCH 7 JUST BECAUSE
THE Hospital MADE A MISTAKE. I submit to you that because it was
- 231 -
the hospital's error, it is not reasonable to charge Margie Jones
for that extra day she was forced to stay in the hospital.
HE SAID THAT IF MARGIE JONES HAD BEEN ON MEDICAID, THAT HER BILL
WOULD HAVE BEEN $2700 IN TOTAL INSTEAD OF THE $9000 THAT THE
Hospital IS NOW CLAIMING.
THINK ABOUT THAT FOR A SECOND... Another PATIENT GOES INTO THIS
Hospital, HAS Arm surgery AND THE Hospital ACCEPTS $2700 AS FULL
PAYMENT FOR THE FOUR DAY STAY. BUT AT THE SAME TIME--- MARGIE
JONES has arm surgery AT THE SAME Hospital, she has THE SAME
TREATMENT, THE SAME SERVICE, THE SAME EVERYTHING, BUT MARGIE JONES
GETS A BILL FOR $9000. I submit to you that this is not a
reasonable bill.
- 232 -
THAT'S ABOUT SIXTY PERCENT OF WHAT MS JONES IS BEING ASKED TO PAY.
DID MR THOMPKINS THINK IT WAS FAIR TO CHARGE MS JONES THOUSANDS OF
DOLLARS MORE THAN WHAT A BLUE CROSS PATIENT WOULD HAVE TO PAY?
YES HE DID--THE Hospital APPARENTLY BELIEVES THIS-- BUT I AM
CONFIDENT THAT YOU WILL NOT ALLOW THIS TO HAPPEN.
MR THOMPKINS SAID ONE MORE THING THAT I WANT YOU TO GIVE SOME
THOUGHT TO.
THAT MEANS THAT THIS NON-PROFIT Hospital CHARGED ITS PATIENTS 15%
MORE THAN IT HAD TO IN ORDER TO BREAK EVEN THAT YEAR. SO YOU
SHOULD START YOUR FIGURING BY CUTTING 15%--$1350-- OFF MS JONES'
BILL RIGHT FROM THE START.
REMEMBER TOO WHAT NURSE WILSON SAID ABOUT SOME OF THE CHARGES ON
THIS ITEMIZED BILL. [DISPLAY BILL TO JURY].
- 233 -
SHE SAID THAT MS JONES WAS CHARGED $14 FOR A TYLENOL TABLET ON
MARCH 7. AND ANOTHER $14 FOR A TYLENOL TABLET ON MARCH 8 AND THE
SAME TWO TIMES MORE ON MARCH 10. THAT'S $56 FOR FOUR TYLENOL
TABLETS. MARGIE JONES TESTIFIED THAT WHEN SHE GOT OUT OF THE
Hospital SHE PURCHASED 100 TYLENOL TABLETS FOR $2.50. SO THE
Hospital ADMITTED IT WAS CHARGING $14 FOR THE SAME MEDICATION THAT
ANYONE CAN BUY FOR A FEW PENNIES EACH.
NURSE WILSON ALSO SAID THAT MARGIE JONES WAS CHARGED $550 FOR THE
USE OF HER SEMI-PRIVATE ROOM EACH NIGHT AT THE Hospital. WHEN I
ASKED HER HOW MUCH CLARENDON Hospital, LOCATED JUST FOUR BLOCKS
DOWN THE STREET, CHARGED FOR A SEMI-PRIVATE ROOM, SHE SAID $400.
SO WHY DOES THIS Hospital CHARGE AN EXTRA $150 A NIGHT FOR A ROOM?
AND WHY SHOULD IT EVEN COST $400 TO HAVE A ROOM AT ANY Hospital I
ASK YOU? THE HOLIDAY INN CHARGES A LOT LESS AND YOU DON'T EVEN
HAVE TO SHARE YOUR ROOM THERE!
NURSE WILSON ALSO STATED THAT WHILE MARGIE JONES WAS CHARGED FOR
FOUR EKG TESTS AT $90 EACH, THAT THE MEDICAL HISTORY ONLY SHOWED
TWO EKG TESTS ACTUALLY WERE PERFORMED.
NURSE WILSON THOUGHT THAT TWO OF THE EKG TESTS PROBABLY WEREN'T
DONE ON MS JONES AND THAT SHE SHOULDNT HAVE BEEN BILLED FOR THEM.
AND, INCIDENTALLY, WHAT DID CLARENDON Hospital CHARGE FOR THE SAME
EKG TEST? HALF AS MUCH AS THIS Hospital, ONLY $45. AND DO YOU
REMEMBER WHAT MR THOMPKINS SAID IT COST THE Hospital TO DO AN EKG
TEST? HE SAID ABOUT $25. SO THE Hospital IS CHARGING $90 FOR A
TEST THAT COSTS IT ONLY $25.
- 234 -
hospital. Fully 25% of every dollar this hospital gets goes toward
the training of hundreds of young doctors and pays the salaries of
their teachers--other doctors at the hospital and the research
costs associated with a teaching hospital. Now there is nothing
wrong with the fact that this hospital teaches and trains the next
generation of doctors...thats fine. But the problem is that the
patients of this hospital--like Mrs Jones--are required to pay
hospital charges that are 25% higher in order to pay for these
doctors schooling. Imagine that---Mrs Jones is being asked to pay
an extra $2000 here to pay for the medical schooling of some
doctors who are going to go out and earn $200,000 a year soon...Ask
yourself if that makes sense?
AND HE SAID THE Hospital DID NOT HAVE ANYONE on staff WHOSE
SPECIFIC JOB WAS TO FIGURE OUT HOW TO CONTROL THE INCREASING COSTS
AND CHARGES OF THE Hospital. That is--the hospital hasn't taken
cost cutting or saving money seriously enough to assign that
responsibility to anyone. So I am asking you to cut another 5% off
of Mrs Jones' bill because that's the least amount the bill would
have been reduced if the hospital really cared about reducing its
costs and its charges to patients.
- 235 -
THIS Hospital HAS BILLED ITS PATIENT FOR THINGS SHE NEVER RECEIVED.
MS JONES WAS BILLED FOR A CATHETER AND TESTS THAT
WERE NEVER PERFORMED ON HER.
WHAT MATTERS IS NOT WHAT THE Hospital TREATED YOU FOR BUT INSTEAD
WHO IS PAYING THE BILL. IF MEDICAID IS PAYING THE BILL IN THIS
CASE WOULD HAVE BEEN $2700. IF BLUE CROSS HAD BEEN PAYING THE
BILL WOULD HAVE BEEN $5600. BUT THE Hospital HAD TO ADMIT THAT
PEOPLE LIKE MARGIE JONES--PEOPLE WHO DON'T HAVE INSURANCE-- THEY
GET BILLED THE MOST BY THIS Hospital. THEY GET BILLED THE HIGHEST
AMOUNTS, FOR THE SAME SERVICES OTHERS PAY LESS FOR.
THIS Hospital ALSO CHARGES MORE THAN THE OTHER Hospital THAT WAS
DISCUSSED, CLARENDON Hospital. WHILE CLARENDON CHARGES $400 A
NIGHT FOR A SEMI-PRIVATE ROOM, THIS Hospital CHARGES MORE THAN 37%
MORE FOR ITS SEMI-PRIVATE ROOM. AND THIS Hospital CHARGES 100%
MORE THAN CLARENDON FOR A URINE TEST. The hospital makes no
excuses for this either...they really did not even attempt to
- 236 -
justify their higher room rates or even to explain that.
AND THINK OF IT...$14 FOR A TABLET OF TYLENOL THAT YOU CAN BUY FOR
PENNIES. IF THE Hospital MARKUP ON TYLENOL--I MAKE IT ABOUT 720%--
IS THE SAME FOR THE OTHER MEDICATION GIVEN MS JONES OR THE TESTS
DONE ON HER-- THEN THIS Hospital IS BILLING IN AN OUTRAGEOUS
MANNER. BUT REMEMBER, MS JONES DOESNT EVEN HAVE TO SHOW THAT THE
Hospital ACTED OUTRAGEEOUSLY. THE QUESTION IS simply WHETHER THEY
ACTED REASONABLY IN BILLING MS JONES. AND NO ONE WHO LOOKS AT WHAT
THE Hospital DID IN THIS CASE CAN CONCLUDE THAT THE Hospital here
HAS ACTED IN A REASONABLE MANNER.
Soon the judge will give you instructions on the law that you will
apply to this case. And like I mentioned before , the judge will
tell you is that the burden in this case is on the hospital to
establish its case by a preponderance of the evidence. That means
that the hospital has to prove, for example, that its charges were
reasonable. And it has to prove the bill was reasonable by the
greater weight of the evidence. So that means it is not Ms Jones'
responsibility to prove that the hospital charges were
unreasonable...no, not at all. Instead, the burden is squarely on
the hospital to establish the reasonableness of its charges.
One more thing about the instructions. The judge will instruct
you that the hospital can only recover the reasonable value of
services provided. And the key ingredient here--reasonableness--
the instructions will tie what is REASONABLE to two factors---what
- 237 -
other hospital charge and what this hospital customarily and
usually charges.
The evidence here shows that the bill the hospital seeks to collect
is NOT reasonable because it is higher than other hospitals charge
[OR the hospital did not meet its burden by showing what other
hospitals charge] and this bill is NOT the customary bill for these
services....the evidence showed that most patients paid LESS for
the same services.
YOU THE JURY CAN SEND A MESSAGE TO THE Hospital BY YOUR VERDICT IN
THIS CASE. THAT MESSAGE IS THAT big INSTITUTIONS LIKE this
Hospital WILL NOT BE ALLOWED TO CHARGE PEOPLE THOUSANDS OF DOLLARS
FOR SERVICES UNLESS THEY MEET THE REQUIREMENTS OF THE LAW.
THE Hospital CAN RECOVER FOR THEIR SERVICES BUT ONLY WHERE THEY ARE
BILLING PEOPLE THE RIGHT AMOUNT BASED ON WHAT THE Hospital
ACTUALLY DID, AND A FAIR AMOUNT, BASED ON WHAT IS REASONABLE. IT
SHOULD NOT DEPEND ON WHO IS PAYING THE BILL LIKE IN THIS CASE. THE
CHARGES MUST BE REASONABLE AND THE Hospital IS GOING TO HAVE TO
meet its burden under the law by showing IT IS REASONABLE, WHICH
HAS CERTAINLY NOT OCCURRED IN THIS CASE.
- 238 -
WELL, AS PREMIUMS CLIMB EVERY YEAR. MORE AND MORE PEOPLE ARE
FINDING THEMSELVES UNABLE TO PAY higher and higher INSURANCE
PREMIUMS, AND ENDING UP LIKE MS JONES, HAVING TO FACE A Hospital
BILL ON THEIR OWN.
SHE HAS HAD THE COURAGE TO SAY THAT SHE WILL PAY THE Hospital ONLY
WHAT IS DEEMED REASONABLE AND ONLY FOR WHAT SHE RECEIVED.
ENTER A VERDICT FOR MS JONES AND AGAINST THE Hospital IN THIS CASE
AND YOU WILL SEND A MESSAGE TO THE Hospital ADMINISTRATORS, IN FACT
TO Hospital ADMINISTRATORS ALL ACROSS THIS CITY.
YOU CAN SEND THAT MESSAGE TO THE Hospital WITH YOUR VERDICT IN THIS
CASE BECAUSE TODAY--for this day only-- YOU ARE THE BOARD OF
DIRECTORS OF THIS Hospital. Today you are the board of directors
for this hospital-- because today you have the power to make things
right, to make things fair.....
- 239 -
THIS TRIAL AND YOUR VERDICT WILL BE THE ONLY CHANCE MS. JONES HAS
TO GET a measure of JUSTICE FROM THE SYSTEM. AFTER TODAY SHE WILL
NOT GET ANOTHER OPPORTUNITY TO HAVE THIS MATTER RESOLVED IN A FAIR
MANNER.
WHEN I BEGAN I TOLD YOU THAT THIS CASE RAISED A LOT OF QUESTIONS.
LET'S REVIEW THOSE 6 QUESTIONS AND ANSWER THEM RIGHT NOW.
THE FIRST QUESTion WAS WHY DID THE Hospital CHARGE $9000 FOR A FOUR
DAY Hospital STAY THAT OTHER PATIENTS WOULD HAVE ONLY HAD TO PAY
$2700 FOR.
THE ANSWER IS THAT THIS Hospital HAS A POLICY-- A POLICY THAT MOST
PEOPLE DON'T KNOW ABOUT-- THAT ALLOWS THIS TO HAPPEN....it's called
cost shifting or variable pricing.
THE SECOND QUEST WAS WAS IT REASonable FOR THE Hospital TO CHARGE
MORE THAN $9000 FOR THIS 4 DAY STAY? AND THE ANSWER TO THIS
QUESTION IS CLEARLY "NO". THE Hospital DIDNT SHOW IT TO BE
REASonable AS THEY HAD TO AND OF COURSE THERE JUST WASNT ANY WAY
THEY COULD HAVE SHOWN IT TO BE REASonable.
I ALSO ASKED AT THE BEGINNING WHY THE Hospital CHARGED MARGIE JONES
FOR THINGS SHE NEVER RECEIVED AND FOR A DAY IN THE Hospital CAUSED
BY Hospital ERROR.....
- 240 -
AND FINALLY I ASKED WHY THIS Hospital CHARGES MORE THAN OTHER
Hospital.....(elaboration)
FIRST YOUR STARTING POINT SHOULD BE NOT THE $9000 THE Hospital IS
DEMANDING BUT THE $2700 THE Hospital WOULD HAVE ACCEPTED IF MARGIE
JONES WAS A MEDICAID PATIENT. BECAUSE IT JUST WOULDNT BE FAIR TO
MAKE MS JONES PAY MORE THAN OTHER PATIENTS.
THEN YOU SHOULD TAKE 15% OFF THAT $2700--WHICH WOULD BRING IT DOWN
TO ABOUT $2300...THAT'S THE 15% PROFIT THE Hospital MADE EVEN
THOUGH ITS A NON-PROFIT CORPORATION.
THEN YOU SHOULD DEDUCT ANOTHER $450 FOR THOSE THREE TESTS THAT MS
JONES WAS BILLED FOR AND WHICH THE Hospital CANNOT SHOW THEY REALLY
WERE DONE. THAT BRINGS US TO $1850.
THEN I WOULD URGE YOU TO SEND THE Hospital A REAL CLEAR MESSAGE--
THAT THEY ARE NOT DOING THEIR JOB IN KEEPING COSTS DOWN OR CARING
ABOUT SPIRALLING Hospital COSTS. And it is not fair to ask Ms
jones to pay the schooling costs of doctors. YOU CAN SEND the
hospital a NICE MESSAGE by SLASHING THE BILL DOWN TO $500. THAT
WOULD BE FAIR TO MS JONES AND MIGHT CONVINCE THIS Hospital THAT
WHEN IT COMES TO BILLING AND COST Reductions, THEY CAN DO THINGS a
lot BETTER than the way they do them now.
THERE IS ONE final QUESTION THAT I WANT TO LEAVE YOU WITH, AND THIS
IS A QUESTION I WOULD ASK OPPOSING COUNSEL, MR. HUNTINGTON, TO
ANSWER FOR YOU WHEN HE ADDRESSES YOU IN A MOMENT.
- 241 -
AND I BOTH KNOW THE ANSWER TO THIS QUESTION. LET YOUR VERDICT
TELL THE Hospital WHAT YOU BELIEVE.
OUR JURY SYSTEM DEPENDS ON PEOPLE like you TAKING TIME OUT FROM
your busy LIVES TO SERVE--AND WE APPRECIATE YOU DOING SO.
- 242 -